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For professionals

Clinical summaries, decision frameworks and the professional-insight layers on every page are written for colleagues. This page collects what is specific to referral and collaboration.

  1. Sound
  2. Eardrum
  3. Ossicles
  4. Cochlea
  5. Auditory nerve
  6. Auditory pathways
  7. Brain
  8. Communication

The reasoning on this site

Every treatment page is built around the same structure: a stated diagnosis, a specific objective, a numeric expected benefit, explicit alternatives, a preservation statement, risks with frequencies, and the person’s priorities. The functional outcome model separates audiometric, functional and real-world results. Professional insight expandables on each page carry the technical detail — differential diagnoses, technique notes, outcome figures with their uncertainty — so that the patient-facing text can stay plain without being simplistic.

Where figures are quoted they are order-of-magnitude summaries of the published literature and of general otological experience, not claims about any individual surgeon’s results. Nothing here is a substitute for local guidelines or for the judgement of the treating clinician.

Referral and case discussion

Cases that are particularly suited to review or referral:

  • Conductive or mixed hearing loss with a normal tympanic membrane where the diagnosis is uncertain — especially with present stapedial reflexes, a low-frequency gap, or supranormal bone conduction.
  • Otosclerosis: primary surgical candidacy, bilateral disease sequencing, mixed loss, far-advanced disease and the stapes-versus-cochlear-implant decision.
  • Poor or deteriorating results after stapes surgery, ossiculoplasty or tympanoplasty, where the question is diagnostic before it is surgical.
  • Hearing preservation questions in an only-hearing ear or where residual hearing has strategic value.
  • Vestibular symptoms coexisting with conductive loss (third-window lesions, fistula).

What to include

A recent audiogram with masked bone conduction and word recognition; tympanometry and reflexes; imaging in DICOM where obtained (temporal-bone CT with reformats in the plane of the superior canal when a third window is in question; DWI-MRI for cholesteatoma surveillance); previous operative reports with prosthesis type and length; a summary of the contralateral ear; and the clinical question.

Use the contact form with “Professional / referral”. Correspondence is by reply; records are handled as described in the privacy notice.

Education and live surgery

Educational broadcasts, courses and live-surgery teaching in otology are part of the work behind this site. Enquiries about teaching, fellowship visits or contributing cases to educational material are welcome under “Research / education”.

Research collaboration

Themes of interest include outcome measurement in middle-ear surgery (bone-conduction reporting, functional and patient-reported outcomes), otosclerosis surgery, evidence synthesis in otology, and clinical decision support. Publication history and the eight research programmes are on orl.nl; see also the research page. The French practice’s own page for colleagues is at grolman-orl.fr/for-professionals.

Reporting standard requested for referred cases

Air and bone conduction at 0.5, 1, 2, 3, 4 and 8 kHz with masking noted; word recognition score with level and material; tympanogram type with peak pressure and compliance; ipsilateral and contralateral reflexes at 0.5–2 kHz; cVEMP thresholds where a third window is possible. For post-operative cases: pre- and post-operative audiograms at matched intervals, the operative note, and any imaging. This allows an Amsterdam Hearing Evaluation Plot to be constructed for the individual ear and a preservation assessment to be made.

How should success be measured?

A closed air-bone gap is a good result on paper. Whether it is a good result for the person depends on what happens outside the test booth.

Audiometric

What the test booth measures

  • Air conduction
  • Bone conduction
  • Air-bone gap
  • Speech audiometry

Functional

What the auditory system can do

  • Speech understanding
  • Hearing in noise
  • Localisation
  • Binaural hearing
  • Listening effort

Real world

What changes in daily life

  • Communication
  • Work
  • Social participation
  • Hearing-device dependence
  • Quality of life
  • Patient priorities

This page provides general educational information. It cannot replace an individual assessment, which depends on a full history, examination, audiometry and, where relevant, imaging. If you have sudden hearing loss, severe pain, facial weakness, severe dizziness or discharge with fever, seek medical care promptly.