What is otology?

Simply put, otology is the medical specialty that focuses on hearing and balance disorders and diseases of the ear.

I've always gone to an ear, nose and throat doctor when I have a problem in my ears. She seems to have a lot of expertise in hearing problems. Is she an otologist?

No. An ear, nose and throat doctor - technically called an otolaryngologist, or more popularly an ENT - spends only a portion of his or her practice on treating problems involving the ear. In fact, ENTs typically spend less than 20 percent of their practice dealing with ear issues. Most of their patients see them because of tonisilitis, sore throats, problems with swallowing or sleeping, or other conditions that have nothing to do with the ears.

So does an otologist have different training than an ENT?

Actually, otologists have all the training ENTs have: medical school, followed by a year of general surgery, and then a four-year otolaryngology residency.

But to become an otologist, a doctor has to follow up all that training with a two-year otology fellowship. So otologists have much more education devoted especially to the ear than any other kind of doctor.

"An ENT residency is very diversified," said prominent Dallas otologist Dr. Robert Owens. "The people who have come out of that residency may have been exposed to some ear problems, but they've spent a lot of their residency on nose and throat problems too. The otology fellowship is all ears, all day, every day, for two solid years."

Everyone's heard of ENTs. But the term otologist isn't as well known. Why is that?

Traditionally, otology has been classified as a sub-specialty of otolaryngology. These days there's a growing trend to identify otology as a specialty unto itself.

As an example, Dr. Owens notes that a cardiologist studies internal medicine and then serves a cardiology fellowship. But no one considers cardiology a sub-specialty of internal medicine. "Cardiology is considered a specialty, not a sub-specialty," Dr, Owens said. "And in that exact same way, otology is a specialty."

Is education the only difference between and ENT and an otolaryngologist?

When an ENT and an otologist first start their practices, the additional two-year fellowship focusing on otology would be the main difference. But as they gain experience in their medical practice, the differences become magnified.

For example, if you need a mastoidectomy, a common but very serious surgery used to remove tumors and other growths in the ear, an otologist who has been in practice for 10 years would have performed that procedure much more often than an ENT who's been practicing for about the same length of time. Dr. Owens cites the example of an ENT friend of his in Dallas who performs one or two mastoidectomies a week; Dr, Owens performs about 500 every year. For any given ear issue, treatment or surgery, an otologist will have much more experience than an ENT who's been in practice for the same length of time.

And because they're concerned exclusively with ear issues, otologists have time to keep up with the latest technological advancements, medications, research and treatment options in a way that most ENTs might not.

I'm getting older and my hearing isn't what it used to be. I know I just need a hearing aid. It's okay if I just go to one of those hearing aid vendors I see advertised in the paper, isn't it?

Hearing aid vendors aren't doctors. They're trained to test and fit people with hearing aids and that's all. They can't diagnose the cause of the hearing problem, and even if they could diagnose it they wouldn't be able to treat it.

Seeing only a hearing aid vendor can actually be dangerous, Dr. Owens said. There is some cause for your hearing loss, and it's important to find out what it is. It could be something that's fairly benign, and a hearing aid might be all that's called for. But it could be something like a tumor or an infection. By going only to hearing aid vendor and being fitted for a hearing aid, you might be satisfied with your hearing improvement but you'd be ignoring the underlying cause. The tumor could be growing, or the infection could be spreading toward your brain, and because your hearing is better you don't see an otologist.

It's best to see an otologist in the first place. Surgery or medical treatment may be called for, and after that treatment you may not even need the hearing aid. If you do need a hearing aid, the otologist and their staff of highly trained audiologists can fit you with one, under the doctor's supervision.

There are also hearing problems that hearing aids can't treat, such as an inability to understand what people are saying. Merely amplifying sounds, which is all a hearing aid vendor and a hearing aid can do, won't help. Unscrupulous vendors might fit you with a hearing aid anyway, just to make money, and because you are hearing louder sounds you might think your problem is better. Going to an otologist first will save you time and money and get appropriate treatment initiated sooner.

Can I just make an appointment with an otologist or do I need a referral?

That depends on your insurance. Check your policy or call your insurance company or HMO.