In Portugal, the doctors who specialise most in the study of vertigo and balance disorders are ENT specialists. But they are not the only ones. Worldwide, the specialities most commonly involved are ENT and Neurology, with varying degrees of prevalence across different countries. Other specialities are also involved, such as Ophthalmology. This is because these conditions involve areas that fall within the remit of different specialities – they are ‘borderline’ conditions.
Inevitably, all professionals dealing with these issues must be familiar with the anatomy, physiology, pathology and diagnostic methods of neighbouring specialities, which is either demanding or unrealistic. This is the reason for the existence of Otoneurology or Neurotology – terms which have their advocates, but whose distinction seems to me to be of mainly semantic importance. The aim is to establish a common theoretical and practical foundation that enables all doctors, regardless of their basic training, to manage patients with such complaints competently.
The key question is whether all ENT specialists (or neurologists) are qualified to diagnose and treat these patients. And the answer is, of course, no. That being the case, it is essential to recognise or certify qualified professionals.
Ever since I took on the role of scientific director of the APO website, I have been receiving enquiries from internet users about doctors they could consult in different parts of the country. I have consistently declined to do so, as I believe I have no mandate to express a personal opinion. There must be an official body responsible for certifying professional competence – and, in my view, only the Portuguese Medical Association should do so, following consultation with (or upon a proposal from) the Portuguese Association of Otoneurology, which is statutorily responsible (Article 3) for the "development of otoneurology in both theory and practice". I therefore advocate that otoneurology should be recognised as a field of specialisation or subspecialisation by the Portuguese Medical Association.
Another issue is how to recognise the competence of members who claim the right to be regarded as otoneurologists. Through their CVs or by means of theoretical assessments? I have nothing against professional assessments, but as this is a controversial issue, I believe the decision should be debated and taken at a General Assembly of the APO. Now, as a matter of urgency, we must confront the Medical Council with the need to recognise the necessity of this specialism (Otoneurology) and our demand that anyone who claims to be qualified to call themselves an "otoneurologist" should be recognised as such by our Association. Not all ENT specialists who are members of SPORL are otoneurologists. And the same can be said of neurologists.
We cannot continue to condone so-called "vertigo consultations" carried out by those who do not attend training sessions, have no known scientific publications to their name, nor even possess basic diagnostic facilities. We have a duty to ensure competence. Who assesses the candidates, and how? The APO must play a decisive role, using criteria to be defined by its competent bodies.
Otoneurology in Portugal is currently enjoying a period of growth that should fill us with pride. Several members of the APO have seen their work recognised internationally. Although this is due almost exclusively to individual merit, it represents an asset for our Association. It is important to capitalise on the benefits of the contacts we have established, such as their participation in our meetings or the dissemination of their work.
Let us work together in a spirit of openness, tolerance and mutual support – and, whilst we’re at it, with the nobility of purpose to preserve what matters most: the joy of teaching and fostering knowledge among the younger generation. Let us be proactive, supportive and discerning.
