Minutes of the first Meeting of the International Association of Physicians in Audiology held in the Aukamm Hotel, Wiesbaden, Germany on November 1st and 2nd, 1980.
Present:
B. Barr (Sweden)
O. Bentzen (Denmark)
B. Blegvad (Denmark)
V. Coletti (Italy)
B. Davies (UK)
R. Hinchcliffe (UK)
M. Hoke (Germany Fed. Rep. of)
T. Jauhiainen (Finland)
W. Kumpf (Germany Fed. Rep. of)
W. Niemeyer (Germany Fed. Rep. of)
K. Schorn (Germany Fed. Rep. of)
B. Seelenfreund (Germany Fed. Rep. of)
S. Snashall (UK)
M. Tonning (Norway)
The meeting was chaired by Professor W. Niemeyer and Professor R. Hichcliffe acted as secretary.
1. - Apologies for Absence;
L. Fisch, A. Glorig, Linda Luxon, J.A.M. Martin, H. Opitz, P. Pizzaro, S.D.G. Stephens and I.G. Taylor.
2. - Opening;
The meeting was opened by Dr. MED. WOLFGANG BECHTOLDT, President of the General Medical Council of the State of Hesse, President of the European Federation of Salaried Doctors and Member of the Advisory Committee of the E.E.C.
DR. BECHTOLDT welcomed the delegates to Wiesbaden and emphasised the expanding role which physicians in audiology would need to occupy in the future.
3. - Chairman's Report;
PROFESSOR NIEMEYER reviewed the events leading up to the decision to hold a meeting of Physicians in Audiology in Wiesbaden.
Over recent years, an increasing number of medical specialists had been devoting their professional lives to the care and the management (exclusive of surgical aspects) of patients with disorders of hearing. A number of problems were arising out of this development. There was clearly a need for a forum where such medical practitioners could meet and discuss problems problems and topics of mutual interest. An association of such medical persons would also help towards formulating standards for the many procedures involved in the investigation, care and management of patients with disorders of hearing. There was a nned to have a global outlook. It was necessary to consider the impact of the disorder on the patient. The hearing impaired person was not just a normal person with "not-so-good" hearing.
It was agreed to hold an initial meeting of interested persons on the occasion of the XV International Congress of Audiology which was held in Krakow in September of this year. That meeting was held on Thursday, September 4th, 1980. DR. O. BENTZEN had proposed, and DR. J.A.M. MARTIN had seconded, the formation of an international association of such physicians. The proposal was endorsed by all those who were present at that meeting. The meeting also agreed that he (PROFESSOR NIEMEYER) should organise a further meeting in Marburg or Wiesbaden on November 1st and 2nd of this year. (Dr. Stephens has aleady circulated the Minutes of the Krakow meeting to all who had attended it).
4. - Statements of National Representatives;
a) Denmark;
DR. BLEGVAD said that there were fifteen audiological departments in Denmark. All these departments were hospital-based. The heads of these departments were all medical doctors with an E.N.T. training together with two years training in audiology. There was no specialty corresponding to audiological medicine.
A doctor was unable to qulify as an E.N.T. specialist unless he had undertaken three months training in audiolgy.
Paramedical personnal included teachers for the hearing-impaired, who were trained techers with special training in audiology, including hearing aids, engineers, technicians and social workers. Only two departments had their own engineers to take care of the hearing aids. There were no hearing aid dispensers since there was no private sector dealing with the provisionof hearing aids in Denmark. The state buys thirty thousand (30 000) hearing aids per annum from manufacturers to cover its rehabilitation programme.
b) Finland;
DR. JAUHIAINEN said that each of Finland's twenty regional hospitals had a Hearing Centre. This cente was part of the E.N.T. Department. The head of each centre was a medical doctor. These doctors were either E.N.T. specialists or specialists in phoniatrics with a sub-specialisation in audiology. This sub-specialisation covered a period of study over two years, involved taking theoretical and practical courses in audiology and culminated in an examination.
It was recommended that an E.N.T. specialist should have three months training and experience in audiology. In practise, many E.N.T. specialists had had a much shorter training than this.
Paramedical personnel included audiological assistants, engineers, psy chologists, speech therapists and technicians. An audiological assistant had received training first as a nurse and then in audiology, including hearing aids, and in vistibulogy. There was no special training for psychologists working in hearing centres. Speech therapists possessed a university degree follwed by a one year period of study in audiology, speech and language.
c) F.R.G.;
In the whole of the country there are only two clinics for communication disorders (disorders of hearing and of speech). These are those in Berlin and in Mainz. Those audiology departments that have existed have now been degraded to function areas. This means that there are no gaurantee for personnel, space or financial support.
The clinical audiology in German hospitals is don by audiology assistants in the E.N.T. departments. E.N.T. departments with at least thirty to forty beds will have at least one clinical audiology assistant. These assistants undergo a two year in-post training.
Paramedicial personnel include hearing aid dispensers, social workers, speech therapists and teachers of the hearing-impaired. The hearing aid dispensers have termed themselves "Hearing Aid Audiologists". The roles of the various skilled groups do not appear to have been satisfactorily defined.
For at least ten years, phoniatricians have been responsible, except in Munich, for paedo-audiology.
The assessment and control of noise-induced hearing loss, together with the care of afflicted subjects, in firmly in the hands of doctors who have taken only a two week course in the subject.
Training in audiology, including paedo-audiology, and phoniatrics is theoretically part of the training programme for E.N.T. specialists. However, there is considerable variation. In very few clinics is there anywhere near a reasonable, practical training in audiology. A three day training course for E.N.T. specialists is provided each year in Essen.
Medical students in the F.R.G. are introduced to the audiometer in their Physics Course. During the one to two hour period allotted to audiometry, they are shown how to determine the pure tone threshold of hearing. The medical students will also obtain a brief acquaintancship with audiology during their E.N.T. lecture. In Marburg, the medical students have a two hour group training in audiological science in their last year.
d) Italy;
PROFESSOR COLLETTI said that twenty two universities have Schools of Audiology, but only six were active. Medical graduates wishing to specialize in audiology took a three year course. A typical programme would be: First Year - Anatomy, Physiology and Psychology; Second Year - Technical Audiology, Clinical Audiology, Otolaryngology; Third Year - Phoniatrics, Otosurgery, Radiology. As well as the course work a thesis would also be presented at the end of the third year. It would appear that, in Italy, audiology encompasses otosurgery. About five hundred medical people are specialising in audiology in Italy. However, apart from three centres, clinical audiology takes place within departments of E.N.T.
e) Norway;
DR. TONNING said that audiological medicine was neither a specialty nor a sub-specialty in Norway. Hearing centres were part of E.N.T. departments. The Head of the E.N.T. Department was also Head of the Audiology Service. However, audiology was not included in the training programme for E.N.T. specialists. The training programme typically comprised three years in otolaryngology, one to two years in anaesthetics, internal medicine, peadiatrics, general surgery, neuro-surgery, oral surgery and reconstructive sugery, together with six months in microbiology, pathology, radiology and respiratory physiology. Nonetheless several Norwegian doctors interested themselves in audiology but there were effectively only two doctors working full time in this area of medicine. This compares with the one hundred and fifty E.N.T. specialists out of the five thousand doctors who look after Norway's four million inhabitants.
Paramedical personnel include teachers of the hearing-impaired and social workers. It would appear that the role for the latter skill group has not yet been satisfactorily defined.
f) Sweden;
PROFESSOR BARR said that in 1954 an official report outlined the future development of Audiology in Sweden. The audiological service was to be created by the setting up of Hearing Centres in connection with already existing hospitals and universities. Linking the Hearing Centres to the E.N.T. Departments initiated a primary development in Clinical Audiology. In the beginning the work was mainly concentrated on the diagnosing hearing defects and on providing hearing aids. The audiological team - initially doctors and audiometricians - was gradually supplemented by technical, psychological, social and educational experts to widen the scope of the activities.
At present there are 22 Hearing Centres in Sweden with markedly different resources. A more comprehensive responsibility is taken by the Departments of Audiology that have been established in eleven central hospitals and university clinics. As distinguished from a Hearing Centre, the Department of Audiology is organized as a completely independent unit under the direction of a medical graduate with special training in audiology. Some of these departments are fairly large and may include a staff of fifty to sexty members.
Since 1968, Audiology has been accepted as a specialty in its own right by the Swedish Medical Board. The basic training to become a general physician is sex and a half years with another four and a half years to be a specialist in audiology. This time is divided into two years practise in an Audiology Department, two years in an E.N.T. department and six months training in psychiatry, neurology, neorosurgery and neurophysiology. There is no final examination but during the training programme one must attend six one-week courses. Four of these courses are compulsory, viz, clinical audiology, paediatric audiology, technical audiology and diseases of the ear.
Audiological physicans are mainly recruited from the E.N.T. field. Moreover, a doctor may become qualified as a specialist in both audiology and E.N.T. In Sweden today there are twenty two audiological physicians working in eleven Audiology Departments. There is a strong wish to have a trained audiologist in every E.N.T. clinic responsible for a local health region. This means demand for another twenty to twenty five physicians in audiology.
g) U.K.;
PROFESSOR HINCHCLIFFE reported that Audiological Medicine had been firmly established in the U.K. following the actions of the Joint Committe on Higher Medical Training in establishing a formal training programme in 1975. This consisted of three years training in internal medicine followed by four years of specialist training, including one year of E.N.T. and one year of full time study at a university to obtain a Msters Degree in Audiology.
A Brittish Association of Audiological Physicians was established in 1977 and now had about twenty members who were of Consultant level and spent the greater part of their time practising Audiological Medicine.
DR. DAVIS pointed out that a quarter of British audiological physicians, including herself, confined their practice to paedo-audiology. She described her own practice in audiological medicine at two university teaching hospitals. Se examines all children coming to a Child Development Centre and it involved an assessment of multiple-handicapped children.
DR. SNASHALL spoke of her own practice which was based upon a country town of about sixty thousand inhabitants, but probably draining a population of about a quarter of a million. Her practice inevitable covered the whole range of audiological medicine - children and adults, audiology and vestibulogy, diagnostic and rehabilitative.
Both DRS. DAVIES AND SNASHALL emphasised the diverse backgrounds of the present group of British Audiological Physicians. Less than one thrid had been E.N.T. surgeons; other had come from Community Medicine, Educational Medicine, general practice, military medicine, neurology or psycho-acoustics.
In summarising the above reprots, PROFESSOR NIEMEYER pointed out that different countries had evolved to different degrees and along different paths in their audiological health care systems. However, it would appear that five types of audiological medicine practice were distinguishable;
- as part of E.N.T. practise
- as a sub-specialty of E.N.T.
- as a sub-specialty of Phoniatrics
- as a separate specialty in its own right
- as a separate specialty which also encompasses otosurgery
5. - Constitution;
Using the Constitution of the British Association of Audiological Physicians as a basis, the assembly deliberated on their own Constitution. As a result of these discssions a draft Constitution was drawn up. This is shown in Appendix A. The agreed name for the Society would be "The International Association of Physicians in Audiology".
6. - Officers;
It was agreed that PROFESSOR W. NIEMEYER would be the first President of the Association, DR. S.D.G. STEPHENS would be the first Honorary Secretary and PROFESSOR R. HINCHCLIFFE the first Vice-President.
7. - Honorary Members;
It was agreed that Honorary Membership of the Association shold be offered to DR. MED WOLFGANG BECHOLDT and PROFESSOR W. KEIDEL.
8. - Future Meetings;
a) Lisbon;
PROFESSOR NIEMEYER announced that he had received an invitation from DR: PIZZARO to mmet in Lisbon at the end of September, 1981. It was hoped that the meeting would be supported by the Gulbenkian Foundation. It was envisaged that that meeting would take palce on a Friday and a Saturday. At the suggestion of DR. BENTZEN the first day would be occupied by a Round Table conference on "The Provision of Hearing Aids for Developing Countries". It was agreed that DR. GLORIG would be asked to be the moderator for that session. The actual programme would be determined by DR. BENTZEN and DR. GLORIG acting in consultation. The second day could be devoted to visiting audiological facilities in Portugal.
b) Helsinki;
DR. JAUHIAINEN invited the Association to meet in Helsinki at 1400 h on Thursday, 27th May, 1982 on the occasion of the XVI International Congress of Audiology. It was agreed that DR. COLLETTI would convene a panel on that afternoon to report on the various training programmes in different countries.
9. - Approved Courses;
It was agreed that the Association would give consideration to approving courses in audiology.
10. -Membership List;
It was agreed that the Honorary Secretary would compile a list of the names and addresses of members of the Association.
11. -Association Representatives;
It was agreed to appoint an Association Representative in each of a number of countries. The agreed proposed list of names is shown in Appendix B. The role of these representatives would be to:
a) Promote the interests of the Association in their own country
b) To provide links with their own country and the Honorary Secretary
c) To liaise with other related associations in their own country
d) To recruit additional members from their own country
It was agreed that the Honorary Secreatary would write to these proposed representatives asking if they were prepared to accept the task allotted to them.
12. -Date and Place of Next Meeting;
It was agreed that the next business meeting of the Assocation would take place in Lisbon towards the end of September, 1981.
