Presidential address delivered by Dr Anirban Biswas at the 2nd annual conference of Innternational Society of Audiological Medicine held at Bhubaneshwar on 3rd October 2009

^{^{Dear friends}}

^{^{It is my proud privilege to welcome you to this second conference of the}}^{^{International Society of Audiological Medicine.}}

^{^{To the best of my knowled}}^{^{ge this is the only platform in this part of the world where}}^{^{paramedics like}}^{^{audiologists, speech/voice therapists, teachers of the deaf and medical personnel like otologists, laryngologists, neurotologists,}}^{^{paediatricians and}}^{^{general ENT practitioners come under the same roof.}}^{^I}^{^{ndividually all of us}}^{^strive}^{^{to serve the hearing impaired community and patients with speech-language defects}}^{^{to the best of our abilities}}^{^{which no doubt}}^{^are}^{^{a Herculean task.}}^{^{Auditory disorders and speech-language defects are such unique and complex problems that we}}^{^{cannot do justice if we try to do it single handedly and a team effort}}^{^{where professionals from different disciplines can function together}}^{^{from one platform is essential if we need to effectively fight the curse of deaf}}^{^-}^{^{mutism and other disorders that come under the purview of Audiological}}^{^medicine.}^{^{Successful cochlear implant programs are the best examples of this.}}^{^{At the current state of affairs a}}^{^hearing}^{^{impaired person / speech-voice disorder patient walks into a doctor’s clinic}}^{^{where he is either prescribed some tests or some therapy / rehabilitative measures. The audiologist does not know much about the pathophysiology of the suspected medical}}^{^{condition and the logic on which the doctor has suspected the pathology and the}}^{^{doctor does not know much about the diagnostic tests or rehabilitative measures undertaken by the}}^{^audiologist.}^{^A}^{^{very huge communication gap}}^{^exists}^{^{between these two professionals. There has to be a much bigger scope of cooperation between these two groups}}^{^{for the best results}}^{^.}^{^{A common platform like the International Society of Audiological Medicine where these disciplines can function together was long overdue. What is Audiological medicine?? Audiological medicine as defined in the site www.audiologicalmedicineuk.com is a medical speciality that is entrusted with the investigation, care and management of patients with hearing and balance disorders. The term was coined in UK by Sir Ronald Hinchcliffe in 1975. Specialists in Audiological medicine are called Audiological physicians. The relationship of an Audiological physician to the ENT specialist is the same as that between a neurologist and a neurosurgeon. In the site the role of the Audiological physician has been distinguished from an audiologist also. Audiologists are basically scientists and technical experts whereas Audiological physicians are primarily physicians concerned with the care of patients suffering from disorders of auditory communication, equilibrium and spatial disorientation i.e., the deaf and/or dizzy patient. 35 years down the line the term Audiological medicine is used in a much wider perspective and the discipline now encompasses the services rendered by audiologists and Audiological physicians. What was originally defined as Audiological medicine is now referred to as neurotology.}}

^{^{There are a lot of areas where we need to work together}}^{^{and for this}}^{^,}^{^{organisations like AOI, ISHA, ISAM etc will have to sit together and formulate certain norms}}^{^{of testing and also identify the dark areas in our profession. If the ENT doctor thinks that my job ends at severing a part of the anatomy and if the audiologist thinks that my job is}}^{^limited}^{^{to pressing a few switches}}^{^{and shoving a hearing aid into a}}^ⁿ^{^{unsuspecting ear then the discipline of Audiological medicine will only be going backwards. Both disciplines will have to deal with the patients from a broader perspective. The specific areas that need urgent attention are for e.g,-}}

^¹⁾^{^{The issue of CENTRAL DEAFNESS :- We need to work much more on CENTRAL DEAFNESS. Most audiologists and doctors are not competent to carry out the behavioural tests of Central deafness and are also incapable to identify LEARNING DISABILITIES. About 2-3% of all children suffer from central deafness and some more from learning disabilities. We are missing out these children and not diagnosing them and so these are remaining untreated or are treated wrongly. The awareness levels are pathetic not only among the general population but also among audiologists, ENT doctors and paediatricians. A huge lot of work needs to be done in this front. Though most of the modern ABRs come with facilities of MLR and LLR tests these tests are rarely done in clinical practise because doctors very seldom advice these tests.}}

^²⁾^{^{STANDARDISATION OF AUDIOLOGICAL TESTS AND AUDIOLOGICAL EQUIPMENT. There has to be one set of rules for the test processes and some standardisation of equipment that will be followed throughout the country. An accreditation of Audiological clinics to be recognised by a common body like ISAM is the need of the hour. The condition of many Audiological clinics is pathetic, uncalibrated Audiological equipment; untrained technicians and unethical hearing aid dispensers rule roost. Very commonly audiometry tests are done without any contralateral masking the consequencies of which are known to all of you. The profession is getting a bad name and we are doing injustice to the patients and to the discipline. One good clinic or one good institute here or there is inconsequential in a vast country like ours. Professional bodies like the AOI or ISHA or ISAM has to have an ethics committee to introduce professional ethics in clinical practise.}}

^³⁾^{^{STANDARDISE HEARING AID DISPENSING:- Unethical dispensing of hearing aids is very rampant in our country . The question is not who is responsible. We are all responsible for this evil being perpetuated. We will have to work from a common platform to stem the rot. Fitting hearing aids in children without real ear insertion gain measurement and without measuring the real ear coupler difference is not fair and is unethical to say the least. When the technology is there the benefits of it must reach the consumer. I know there will be a hundred people here who will jump up to say that they fit children hearing aids excellently without the REIG or the RECD but then why do audiograms also, the tuning fork is good enough. I can vouch that very few doctors have even heard the name of REIG or RECD.}}

^⁴⁾^{^{Work together to implement UNIVERSAL NEONATAL HEARING SCREENING in our country. This is of paramount importance and needs very urgent attention. We all become irrelevant in society if we cannot bring in this change. All advanced countries have adopted this and India cannot be lagging behind.}}

^{^{Having said all this there is no denying of the fact that a huge lot of change has taken place in extending Audiological services to the masses in our country. We now have qualified audiologists in most of the district towns and a lot of}}^{^{Audiology colleges}}^{^{have come up and in quite a few centres high quality Audiological services are being rendered}}^{^{but we need much more}}^{^.}^{^U}^{^{nfortunately a very big chunk of the best audiologists produced in our country are going}}^{^{abroad and}}^{^{our country is being deprived of their services. We need to have the suitable infrastructure and the right environment}}^{^{and work culture and of course the right remuneration for audiologists in our country such that we can attract the best audiologists and provide them the requisite job satisfaction. Doctors are not trained to distinguish between a good Audiological work and a poor or substandard work because they are not taught about it and can pass examinations without a firm hold on the subject of audiology. Nobody suffers except the hapless patient. The charges of a pure tone audiometry test in the private sector still stands at a average of Rs 200/- irrespective of whether one has used an Interacoustics AC440 audiometer or a Siemens Unity audiometer costing several lakhs of rupees in a sound treated room done properly with requisite contralateral masking or in a low end very cheap uncalibrated audiometer costing a few thousand rupees performed without any masking in the noisy waiting room of a doctor’s chamber. If good work is not recognised and rewarded adequately and if substandard work is nor rejected and despised why should one try for rendering the best services or stay back in our country. A lot of ethical issues may be raised contradicting this but accept it or not this is the reality. There is a lot of scope of improvement and we expect organisations like ISAM to address these problems in addition to the excellent work they are doing by furthering Audiological medicine and bringing together professionals from allied disciplines in such forums.}}

^{^{Thank you very much for giving me a patient hearing.}}^{^{Once again I welcome all of you and especially my teacher and godfather Dr M V Kirtane to this meeting. Let me tell you Sir your kind acceptance of our invitation and your esteemed presence in addition to performing the first ever cochlear implantation in Orissa adds a lot of credibility to our ISAM and we are indebted to you for it.}}

^{^{Dr Anirban Biswas}}