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