Intraoperative Monitoring

[Lois J. Barin]

>I have mixed ideas about this intraoperative monitoring thing....

>At the Univ. of Iowa where I work, there is a research scientist who 
>specializes in electrophysilogical measurements who does monitoring
>for mid-cranial fossa approaches to acoustic neuromas.  She also 
>does monitoring of a different sort in the OR for cochlear implants.
>Since I work for her as a research assistant, I have accompanied
>her on many occasions to the OR and have done monitoring myself.

>Personally, I don't think monitoring of the 8th nerve is out of the
>range of potential job responsibilities for an audiologist.  I don't 
>think it to be an appropriate or beneficial use of an audiologist
>/research scientists time and skills to have them monitoring full
>time for neurology--we only do cases of tumor excision by our ENT
>staff.  On cases where neurology is consulted and or part of the 
>surgury, many times the tumor is too big to preserve hearing or
>the hearing has gotten so bad there's not much point to monitoring
>because you won't measure anything in the first place.

>We use the Biologic ABR system, and I could tell the group more I 
>guess if people want more specifics about what and how we do
>what we do.  

>        I wasn't aware there was a separate organization to certify
>the various types of monitoring that can go on in the OR as was
>pointed out in a previous post.  But, there's nothing to stop an
>audiologist with half a brain from monitoring.  You aren't doing
>anything in the surgery other than telling the surgeon when there's
>been a change in the waveforms you are collecting.  You aren't doing
>the surgery.  You aren't in the way.  I think if you haven't had the
>benefit of watching/being supervised by a person doing intraoperative 
>monitoring, or if you know little and have little experience with
>electrophysiological measures you are the last person who should be
>thinking about going to the OR.

>        Of course, whatever organization does do certify techs to
>monitor is going to scream and cry if anyone outside of their group
>tries to move into their territory.  The question is whether they have
>reason to be concerned.  I think you have to take this sort of thing
>on a case by case basis.  It is a new area for audiologists and to
>have successful monitoring, you have to have a good working relationship
>with the ENT--one of mutual respect so that when you say "you're 
>losing it" he/she will trust that you are correct and whatever they
>are doing to the nerve is making it unhappy and will stop.

>        These are my meager opinions, while based on *some* experience,
>they are still only my opinions and do not reflect my employer's policies
>or opinions necessarily (Spelling?).

>Susan
>smoore at otolaryngology-po.oto.uiowa.edu


Do I recall a couple of years ago reading in ASHA that the largest judgment 
ever against an audiologist was "failure to inform" during interoperative 
monitoring?  I believe that's why the typical amount for liability coverage is 
a million......


Lois