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Intraoperative Monitoring

Mukunda Kantamneni mrkantamneni at uiowa.edu
Mon Feb 17 11:51:39 EST 1997

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?).

smoore at otolaryngology-po.oto.uiowa.edu

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