Doctors in audiovestibular medicine (AVM) investigate, diagnose and manage hearing, balance and communication disorders in adults and children from birth onwards.
This page provides useful information on the nature of the work, the common procedures/interventions, sub-specialties and other roles that may interest you.
Nature of the work
The aim in audiovestibular medicine is to improve patients’ wellbeing and quality of life by investigating and interpreting audiovestibular clinical findings. Doctors in this specialty seek to identify other pathologies which may have an impact on the patient’s health or wellbeing and institute treatment and advice about their prevention or further progression.
Disorders include tinnitus (noises in the ear such as ringing and hissing) and neuro-otological manifestations of other primary disease, ie caused by neurological diseases of the ear.
Audiovestibular (hearing and balance) symptoms can be both peripheral otological (ear) and central nervous system in origin. They include disorders which are:
- inherited (genetic)
- vascular (relating to the blood vessels)
- traumatic (following a wound or injury)
- metabolic (relating to the range of biochemical processes that occur in the body)
- neurodegenerative (nervous system dysfunction)
The broad scope of illness means that staff work in multidisciplinary teams (MDT). Staff specialise in different aspects of audiovestibular medicine whilst also focusing on integrated patient care. They also combine clinical information and counselling with the rehabilitation approaches of other professionals.
Common procedures and interventions
- clinical and neuro-otological examination, which might include tests to evaluate the patient’s balance
- measurement of audiovestibular function ie relating to the auditory functions of the ear (with healthcare scientists
- investigations, including radiological imaging, and a variety of blood and urine tests
- assessment for suitability for hearing aids and cochlear implants (an electronic device inserted in the ear that stimulates the auditory system to enable the perception of sounds and speech), alongside healthcare scientists and other staff
- treatment of infection, autoimmune disorders (diseases where the body’s immune system attacks its own tissues), and peripheral vestibular dysfunction (ie dysfunction of the balance organs of the inner ear). This could be through pharmaceutical products, repositioning manoeuvres and physiotherapy involving relevant professionals
Sub-specialty areas include:
- paediatric auditory rehabilitation
- paediatric neuro-otology
- paediatric communication disorders including auditory processing disorders
- adult auditory rehabilitation
- adult neuro-otology
Want to learn more?
Find out more about:
- the working life of a doctor in this area of medicine
- the entry requirements and also about training and development
- a first-hand account of life in audiovestibular medicine
- Pay and conditions Expand / Collapse
This section provides useful information about the pay for junior doctors (doctors in training), SAS doctors (specialty doctors and associate specialists) and consultants.
NHS employers provides useful advice and guidance on all NHS pay, contracts terms and conditions.
Medical staff working in private sector hospitals, the armed services or abroad will be paid on different scales.
- Where the role can lead Expand / Collapse
Read about consultant and non-consultant roles in audiovestibular medicine, flexible working and about wider opportunities.
Managerial opportunities for consultants include:
- clinical lead - lead NHS consultant for the team
- clinical director - lead NHS consultant for the department
- medical director - lead NHS consultant for the trust
Most NHS consultants will be involved with clinical and educational supervision of junior doctors.
Here are some examples of education and training opportunities:
- director of medical education - the NHS consultant appointed to the hospital board who is responsible for the postgraduate medical training in a hospital. They work with the postgraduate dean to make sure training meets GMC standards
- training programme director - the NHS consultant overseeing the education of the local cohort of trainee doctors. This could be the role of foundation training programme director within the LETB
- associate dean - the NHS consultant responsible for management of the entirety of a training programme, working within the LETB
SAS doctor roles
SAS doctors (staff, associate specialists and specialty doctors) work as career grade specialty doctors who are not in training or in consultant posts. You will need at least four postgraduate years training (two of those being in a relevant specialty) before you can apply for SAS roles.
See further information about the role of SAS doctor.
Other non-training grade roles
These roles include:
- trust grade
- clinical fellows
If you have trained on an academic audiovestibular medicine pathway or are interested in research there are opportunities in academic medicine.
For those with a particular interest in research, you may wish to consider an academic career in audiovestibular medicine. Whilst not essential, some doctors start their career with an Academic Foundation post. This enables them to develop skills in research and teaching alongside the basic competences in the foundation curriculum.
Entry into an academic career would usually start with an Academic Clinical Fellowship (ACF) and may progress to a Clinical Lectureship (CL). Alternatively some trainees that begin with an ACF post then continue as an ST trainee on the clinical programme post-ST4.
Applications for entry into Academic Clinical Fellow posts are coordinated by the National Institute for Health Research Trainees Coordinating Centre (NIHRTCC).
There are also numerous opportunities for trainees to undertake research outside of the ACF/CL route, as part of planned time out of their training programme. Find out more about academic medicine.
The Clinical Research Network (CRN) actively encourages all doctors to take part in clinical research.
There are opportunities to be employed by the NHS, academic institutions, private sector, universities, the armed forces, organisations and national governing bodies.
- Job market and vacancies Expand / Collapse
This section provides useful information about the availability of jobs, how to find vacancies and sources of further information.
Job market information
Audiovestibular medicine is one of the smaller specialties. In 2016, audiovestibular medicine had 37 consultants and 15 medical registrars in England (NHS Digital 2016). Women make up 55% of the consultant workforce, 58% of higher specialty trainees in the UK (2014/15 RCP census, 2016).
The recruitment situation has fluctuated in the last few years probably linked to competing demands and financial pressures on the NHS; but where new posts have been created these have been mainly consultant posts for paediatric consultants as well as replacement substantive consultant posts in both adults and paediatrics. The RCP has recognised the patchy provision of hearing and balance services around the country, and the need to gain more specialists to develop these services in areas that are currently under-resourced.
For England you can read the information on audiovestibular medicine provided by the Centre for Workforce intelligence.
The ratio of applicants to ST3 posts in 2015 was 5.0 (10 applicants for 2 NTN) (JRCPTB, 2015).
The Royal College of Physicians have produced a census of physicians and higher specialty trainees in the UK (2015-16).
On this section we have information for England only. For information regarding Scotland, Wales and Northern Ireland please click on the links below.
Where to look for vacancies
All candidates apply through the online application system Oriel.
Local education and training boards (LETBs)/deaneries will have details of training vacancies. Not all local LETBs will offer new training posts in all specialties in all years.
All jobs will be advertised on NHS Jobs.
- Further information Expand / Collapse