Ross J. Roeser, PhD, Co-editor of
Audiology: Diagnosis, Treatment, and Practice Management, talks with Douglas L. Beck, AuD, Web Content Editor, about the details of his most recent book.
Academy: Good morning, Ross. Thanks for your time today.
Roeser: Hi, Doug. Always a pleasure to work with you.
Academy: Ross, I’d like to discuss the relatively new edition (2007) of the books you, Michael Valente, and Holly Hosford-Dunn co-edited and created. To be clear, this is the second edition from 2007. The series taken as a whole is comprised of one book titled
Diagnosis and then another titled
Practice Management, and the third book is titled
Treatment. So this was the second massive undertaking by the same three co-editors?
Roeser: Yes. The three of us worked on the first edition back in 1997. At that time, our original charge was to create “the ultimate textbooks” for use in audiology education and practice. The three of us met together with the Thieme medical editors and we spent two days brainstorming on the concept.
Finally, after all was said and done, we came up with three book titles and then started to refer to it as the “Trilogy Project.” Once we made those foundation decisions, we had to think through the chapter titles and topics and then the best authors to write those chapters.
Academy: That’s quite an undertaking. And then as if once wasn’t enough, you again contacted all the authors and had revisions and updates written for the 2007 edition?
Roeser: Yes. The publisher was very pleased with the first edition and requested that we undertake the second edition. The 2007 edition represents totally revised chapter. Each author was contacted and asked to revise their chapter with regard to the latest information on their topics. Surprisingly, with very few exceptions, each of the original authors agreed readily to upgrade and enhance their chapters.
Academy: Very good. Let’s look at a few topics addressed in the second edition. For example, with specific regard to the Diagnosis book, can you tell me your thoughts on evidence-based practice (EBP)?
Roeser: Absolutely. Of course, EBP has become a more prominent topic, and so we gave it more attention in the second edition. You know, Doug, in today’s environment, clinicians and researchers are challenged to make sure they can justify and explain the value of the particular procedure. This has really changed our mind-set as to what we do and why, and leads us to a whole system of EBP strategies. Clinicians, in particular, now have to think past doing things just because that’s the way they’ve always been done, or because that’s the way they were taught. Clinicians are now charged with the task of doing things that work, based on efficient and efficacious models which have undergone rigorous scrutiny, hopefully based on scientific methods and principles.
Academy: And that leads to the whole concept of “best practices.”
Roeser: Yes, and we could spend hours talking about EBP rationale and practice. But suffice it to say the trilogy addresses best practices on a pragmatic level, as it does EBP.
Academy: Ross, what about the legal questions as to who can render a “diagnosis,” I know you cover that in the book and I’d like to get your thoughts on that?
Roeser: Well, that’s one of my favorite topics. Doug, I know you’ve done “expert witness” legal work previously, as have many of our colleagues. Well, as you know, what may come up in court is that a physician on the opposing team may try to disqualify you or me or an audiology colleague because we’re audiologists, we are doctors of audiology, but not medical doctors.
The argument is that if we’re not medical doctors we cannot make a medical diagnosis, and of course they are correct. However, as audiologists we can make an audiological diagnosis, which addresses not only the degree, configuration and type of hearing loss, but also causation, as well as audiological treatment.
Academy: Sure. I think we’ve all faced this before. I usually point out optometrists, dentists, chiropractors, psychologists, and even osteopathic physicians are not MDs, but they are each experts in their professions and licensed by the state to practice within their areas of expertise. I like to remind the court that it’s the audiologist on the medical school faculty that teaches the MDs about hearing loss, hearing aids, assistive listening devices, FM systems, pediatric audiology, ABR, and on and on. But I digress… back to your thoughts!
Roeser: Well, I totally agree. Further, if you look at the scope of practice statements by the Academy and by ASHA, of course we’re permitted to render a diagnosis. So the fact is the term “diagnosis” actually doesn’t necessarily imply a medical diagnosis. As you pointed out, it could be a dental diagnosis, or even an optometric or psychological diagnosis. That is, the term “diagnosis” doesn’t necessarily define the profession making the diagnosis. Rather, it explains the type, extent, and etiology of injury or condition. Of course, with respect to hearing, the audiologist is clearly the most qualified professional to render a diagnosis.
We have the knowledge, background, research, clinical and professional background and skill to determine the diagnosis based on history and test results. Further, the dentist is the best authority to make a dental diagnosis, as is the optometrist and the psychologist in their respective professions and areas of expertise. Nonetheless, clearly, the title of the first book in the trilogy is Diagnosis.
Academy: As an aside, one thing I’ve always thought was interesting was the definition of the term “medical certainty” as it relates to the term “medical diagnosis.” As best I can determine, a medical certainty appears to mean “more likely than not.” Sometimes, it may mean a “reasonable, although undefined probability” based on someone’s opinion, and sometimes it may just mean a probability of more than 51 percent.
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Ross, although I love to talk about the legal aspects of practice, we’d better move on to a few other topics featured in the
Diagnosis book. What about fMRI? I love that chapter and thought it was very well written.
Roeser: Yes, that’s a wonderful chapter, written by Lynn Alvord and colleagues. It goes into detail about these technologies that significantly impact the theoretical, philosophical, and scientific basis of our understanding of how the brain reacts to and manages sound. They cover fMRI, magnetoencephalography, PET scans, and more.
Academy: I enjoyed their discussion about how fMRI indirectly assesses blood flow in a region, whereas magnetoencephalography directly measures neural activity. These are things we didn’t learn much about when I was earning my master’s!
Roeser: Yes, some of it is very high tech and cutting edge, and as we learn about these things, we have to adjust and update our thoughts, too. For example, Alvord et al point out when there’s no linguistic content, the response to clicks, pure tones etc., is nearly symmetric in both hemispheres, but when language is involved there’s more activity in the language dominant hemisphere. And also, stimuli presented more quickly produce more neural activity.
Academy: Ross, you’ve heard me present before. I have always thought that despite the slow and intentional pacing of many speakers, the audience pays far more attention when they’re challenged—up to a point. Of course when people use crowded slides and they don’t speak clearly—they do lose the audience, too, but I have always believed that it’s better to go a little too fast, rather than a little too slow.
Roeser: Right. Tasks that are boring produce little activation of language areas, despite activity in auditory areas. Another interesting thing they brought out is cerebellar involvement in response to speech stimuli, which may indicate a sensory role within the cerebellum.
Academy: Yes, that’s very interesting, and I know Dan Levitin talks about that in his book
This is Your Brain on Music. And of course, as we better understand the physiology, that gets us to auditory processing and the chapter in your book by Brad Stach, PhD. One thing I really liked early in the chapter was where he said the real value of APD measures is not in screening for medical disorders, but rather, in quantifying the impact of a neurologic disorder on one’s ability to communicate.
Roeser: Yes, that chapter has a lot of substance. He also addressed one of your recent themes about the impact of cognition on hearing and vice versa. Stach said cognitive ability and APD can indeed be independent, yet each can influence interpretation of measures of the other.
Academy: I totally agree. Ross, the three of you have created a series of books that are not only topical, but also fascinating. I wish we had time to discuss auditory neuropathy and auditory dys-synchrony and so many more of the issues you covered, but I know our time has run out. Thanks so much for your time, Ross.
Roeser: You are more than welcome, Doug. Thanks for your interest in the trilogy.
Douglas L. Beck, AuD, Board Certified Audiologist, is the Web Content Editor of the American Academy of Audiology.
For More Information, References and Recommendations:
Audiology: Diagnosis, Treatment and Practice Management
Second Edition, Thieme
Audiology: Diagnosis
ISBN 978-1-58890-542
Roeser, Valente & Hosford-Dunn
Audiology: Practice Management
ISBN 978-1-58890-511-6
Hossford-Dunn, Roeser & Valente
Audiology: Treatment
ISBN 978-1-58890-520-8
Valente, Hosford-Dunn & Roeser