Maintaining quality

Setting standards

Audiovestibular physicians are actively involved in setting standards for the medical and audiological care of patients with hearing and balance problems in the UK. An example is acting as a champion for audiological services in the Department of Health to develop good practice guides for the provision of services for adults with tinnitus (opens PDF, 372KB), adults with balance problems (opens PDF, 270KB) and children with hearing difficulties (opens PDF, 455KB). AV physicians have also had an essential role in the NHSP (Newborn Hearing Screening Programme) Quality Assurance process.

The British Association of Audiovestibular Physicians (BAAP) has developed clinical standards for the medical care of patients with hearing and balance problems. BAAP has also produced a range of guidelines on aetiological investigations into hearing impairment in children and adults. These include aetiological investigations into:

  • unilateral permanent childhood hearing impairment
  • mild to moderate bilateral permanent childhood hearing impairment
  • severe to profound bilateral permanent childhood hearing impairment
  • sensorineural hearing loss in adults.

The BAAP guideline process has been granted NICE accreditation. The clinical guideline for the investigation of children with hearing loss was adopted by the NHSP programme and is the standard guideline across the UK. BAAP audits practice against the guidelines and has an active audit committee promoting national audit. Audiovestibular physicians are actively involved in research and in the dissemination of knowledge from that research eg balance in adults and children, migraine-associated vertigo, the role of cytomegalovirus in the causation of hearing loss in children, and the diagnosis and management of auditory processing disorders.

Patient group engagement

Audiological services work alongside a number of voluntary organisations and patient support groups, providing excellent information and education for patients and carers. The demand for services for hearing and balance problems is championed by several charities including:


Audiovestibular physicians are well placed to advise on planning and commissioning specialist services because of their training and multidisciplinary work. Their professional standards and national collaborations ensure that significant national variation of hearing and balance service provision is minimised, while maintaining focus on local needs.

Commissioning of audiovestibular medicine services on a regional basis ensures that the specialist skills of the limited number of audiovestibular physicians are used more effectively. This enables development of robust regional networks for hearing and balance services located within tertiary centres. Services should be delivered by well-trained multidisciplinary teams with a consultant audiovestibular physician providing advice on a consultancy basis possibly in outreach clinics as well as supra-specialist centres. Well-developed nationwide clinical networks integrating audiovestibular services can also ensure national equality of hearing and balance service provision.

Accessing data for quality improvement

As audiovestibular medicine is a small specialty with many single-handed consultants, regional networking, national networks and meetings are a necessity. The British Association for Audiovestibular Physicians (BAAP) has an established system of mentoring available for all members that is particularly targeted to final year registrars and newly qualified consultants (within 5 years of appointment).BAAP arranges an annual national audit meeting that supports and promotes audit to inform and improve practice. This forum also provides specialty-specific national audit.

Audiovestibular consultants provide standards and guidelines for the field of audiovestibular medicine. BAAP has a  clinical standards group  that works on developing, and regularly reviewing, standards and guidelines. The BAAP guideline process has been granted NICE accreditation. Adherence to published clinical standards and the development of national and local guidelines are reviewed by audit.

Where possible, practice should be evidence based with identifiable patient care pathways. Audiovestibular physicians have a pivotal role in producing and providing specialty-specific patient care pathways. The development of patient care pathways is not only fundamental to improve care but also to ascertain cost-effective streamlined services. Effective dissemination of information on pathways (associated to direct access) to GPs and other relevant primary and secondary care services is essential. This ensures that patients are put on the right pathway and reduces unnecessary referrals and investigations.

Audiovestibular physicians participate in partnership with other professional and voluntary bodies to provide information, education and improve practice. These include:

  • Department of Health
  • Royal College of Physicians
  • Joint Neuroscience Council
  • British Association of Paediatricians in Audiology
  • British Society of Audiology
  • British Academy of Audiology
  • British Tinnitus Association
  • Action on Hearing Loss.