Volume 12 No. 6 Pg. 8

Clinicians who make vestibular evaluation, diagnosis and treatment their concentration of interest are struck by the incredible complexity of this fascinating and challenging subspecialty. Many clinicians avoid this area as much as possible, for many different reasons. However, the changing demographics of our patient population over the next several years will drive an increasing need for vestibular services. The aging of America along with an increased focus and need for evaluation of mild traumatic brain injury patients will make them much-needed services.

Over the years, I have had the good fortune to have trained a variety of health professionals on how to evaluate and diagnose vestibular patients. These professionals included audiologists, neurotologists, otologists, otolaryngologists, neurologists, nurses, physical therapists, medical and audiology students, as well as vestibular technicians. The knowledge level of these professionals varied from none to extensive regardless of the type of clinician.

A Closer Look
To further evaluate this variation in knowledge base, a survey was created to gather information from audiologists who are interested in vestibular evaluation. The audiologists gave an informed consent to be surveyed prior to attending my lecture at the American Academy of Audiology, AudiologyNow! 2010, Evidence Based Medicine: "Bedside" Exam of the Dizzy Patient. A group of 146 audiologists and audiology students responded, of which 87 completed all the questions. The preliminary results described here are from those who completed the entire survey.

Ten multiple choice questions were asked on a variety of basic diagnostic tenants a clinician should understand in order to diagnose a vestibular patient. If you use the typical professional/medical school adage of "C's = degrees," then only 30 percent passed. The clinicians also were asked what they believed to be their knowledge level in vestibular diagnosis. Seventy-seven percent believed their knowledge to be adequate to excellent. The perceived level of knowledge and percent correct on the quiz were not correlated. So, it seems that we are poor judges of our own knowledge level when it comes to the vestibular arena.

The scores achieved on the quiz also were not correlated with years of experience in vestibular evaluation. Therefore, the more experience subjects had doing vestibular evaluation did not mean they scored better on the quiz. The type of education (student in training, doctorate, master's, distance or residential) also did not predict how well subjects scored. Neither did the number of focused semesters of vestibular education taken while in school.

Closing the Gap
What can we glean from this? Audiologists may need to step back and solidify the basics of vestibular diagnostics. These results also seem to indicate that our profession may need to focus on what constitutes a good vestibular education program, both at the university level and in the realm of continuing education opportunities.

Continuing education gives excellent exposure to new theory, procedures and research. Now, it seems evident that we also must focus on creating dynamic educational opportunities to sharpen diagnostic skills from basic through advanced concepts in the complex area of vestibular and balance disorders.

The evidence of this survey indicates that as a group we are not all where we need to be in our knowledge base. We need to educate ourselves better. We need to evaluate how to impart this knowledge more effectively. We need to better gauge our own knowledge level and recognize when it is not sufficient. We need to recognize when the tests at our disposal are not enough and when to refer to advanced balance centers.

I personally will continually strive to better understand the vast and ever-changing landscape of the vestibular realm. Maybe, this wake-up call will cause others to also carefully examine and continue to expand their diagnostic vestibular knowledge base.

Terri E. Ives, ScD, AuD, is co-owner of Hearing and Balance Institute of the Rockies Inc. in Lone Tree, CO. For more information: 303-993-8832, www.HearingandBalanceInstitute.com, Dr.Ives@HearingandBalanceInstitute.com.