DISCUSSION
Although the diagnostic importance of audiological tests is well known,
the extent to which they guide ENT physicians correctly has not been
studied much. In our study, the effect of audiological findings was
investigated in isolation from all other tools commonly used by ENT
physicians (otoscopic examination, patient history, radiological tests,
etc.). Therefore, “incorrect” or “undefined” answers by physicians
should not mean that audiological tests that are not interpreted
correctly will lead to the misdiagnosis of patients. When evaluated
together with other diagnostic tests, audiological findings are more
likely to guide physicians more accurately.
One of the difficulties in making a diagnostic evaluation with
audiological findings is that the same pathology can yield distinct
findings in patients. In addition, similar audiological findings may
suggest different pathologies. Therefore, the expectation in our study
was that the physicians examining the audiogram would state the
“correct” pathology among the possible pathologies. Hence, if there is
a ”correct” pathology among all the pathologies that come to mind, the
answers were accepted as ”correct”. However, the average of the
”incorrect” answers was higher than the ”correct” answers. Especially in
rare pathologies (ANSD, SSCD, and LVA), “incorrect” response rates
were approximately five times higher than “correct” responses. This
result shows that in rare pathologies, most of the participants did not
associate the features of the pathology with the audiological findings
well enough. In pathologies such as COM, SOM and MD, since the otoscopic
examination and patient history play an important role in the
physician’s determination of the pathology, the relationship between
these pathologies and audiological findings may be easier to establish.
The fact that “incorrect” answers were more than “correct” answers
was valid for all participant groups (faculty members, ENT specialists
and residents). Interestingly, the faculty members gave the highest
ratio of both ”correct” and ”incorrect” answers. Whereas, it was
expected that faculty members gave the highest ”correct” answer. The
high rate of “incorrect” answers can be interpreted as the
audiological test battery not being evaluated holistically.
One of the difficulties in interpreting audiological tests is that
different pathologies may yield similar audiological configurations. For
example, hearing loss, which is more occurs at low frequencies, may
resemble MD, SSCD and otosclerosis at first glance. In such a case, the
relationship of air/bone conduction thresholds, acoustic reflex test and
speech comprehension score gain importance in determining the diagnosis
from an audiological point of view. Therefore, it is important to
evaluate audiological tests holistically. The lack of holistic
assessment was evident in the COM/SOM distinction. Of the 26
participants, 18 (69%) who responded ”incorrect” on the COM audiogram
evaluated the pathology as OME. Interpretation of COM findings as SOM is
most likely related to missing the ear canal volume indicated in the
tympanometric test.
Another common mistake is defining LVA and SSCD audiograms as conductive
or mixed hearing loss. The audiogram configuration and the air/bone gap
seen at low frequencies may suggest a conduction component in these
patients. However, obtaining acoustic reflexes should have brought the
inner ear anomaly to the physician’s mind.
The audiogram configuration of third window syndromes such as SSCD and
LVA appears to be conductive or mixed hearing loss. However, in these
pathologies, hearing loss occurs due to inner ear anomalies.
Classification of these pathologies according to the type of hearing
loss is another matter of debate. It is generally accepted that the
terms ”conductive” or ”mixed type” indicate that outer or middle ear
diseases are effective in hearing loss. Because the middle ear does not
show a pathological effect in the third window syndrome, the definition
of ”third window syndrome” as ”conductive” or ”mixed hearing loss”
according to the audiological configuration was accepted as an
”incorrect” answer in our study.
Responses that correctly stated the type of hearing loss, but not the
pathology causing the hearing loss, were classified as “undefined”.
About one-third of the subjects preferred to specify the type of hearing
loss, even though the questionnaire was asking “name of possible
pathology.” These responses were not unexpected, as the classification
most frequently encountered by ENT physicians in audiological reports is
for the type of hearing loss. However, it did not help us much to answer
our research question about the importance of audiological findings in
diagnosis.
When the results were evaluated according to the institutions where the
physicians worked, it was seen that there were more ”incorrect” answers
in private and state universities. The results are instrumental in that
they show the decision-making augmentation of ENT tests for clinical
practice