Surangi Mendis – ST3. Edited by Reeya Motha – ST6
Brief ‘definition’ of specialty

Medical management of the hearing and balance systems

Overview of training programme 

A five-year programme (ST3-ST7). Trainees entry at ST3 from one of four training pathways; core medical training, ENT core surgical training, paediatrics or general practice. Within AVM, there are distinct sub-speciality areas; tinnitus, neuro-otology (dizziness) and general hearing. In each of these areas, trainees must achieve competency in dealing with both adult and paediatric populations. Attachments in allied specialities are required such as psychiatry, community paediatrics, ENT, neurology, care of the elderly, ophthalmology, genetics and immunology are required. It is expected that trainees should have a good understanding of the available audiological and vestibular testing methods and time is allocated during your training to observe and / or learn how to perform these tests.

A more detailed breakdown of the curriculum can be found at:  the gmc uk website 

Exam requirements

Trainees need to complete the Diploma in Otology and Audiology prior to their CCT. This is comprised of eight modules; 4 core modules (Anatomy and Physiology, Signals and Systems, Research Methods and Statistics and Clinical Diagnostics for Audiovestibular Medicine) and 4 modules of your own choosing. There is talk of this being reduced to a Postgraduate Certificate in Otology and Audiology instead, i.e. the 4 core modules alone, but this is yet to be approved.

Other requirements

We do not have a ‘logbook’ specifically, like the surgical specialities for example. However, evidence should be gathered during training and attached to eportfolio regarding competencies for certain skills and procedures as per the curriculum. The eportfolio is also used to show knowledge and skill competences in the required core areas – tinnitus, audiology and dizziness as well as the allied specialities (ENT, community paediatrics, psychiatry, etc.).

Specialty Skills: AVM is very procedure based but often these tests are untaken by, or in combination with, audiologists or clinical scientist colleagues. Nevertheless, AVM physicians must have a good understanding of these tests in order to interpret them and advise on treatment plans or further investigations, etc.

Microsuction is also a required skill – taught on the job if needed.

Mandatory Training: generic only – e.g. life support, governance, child protection, etc.

Opportunities/expectations for out of programme/research

PHDs, Out Of Programme Experiences, etc. can be undertaken but are certainly not an essential requirement. In addition to the Diploma in Otology and Audiology, a trainee may choose to pursue their own research interests. This is a speciality with plenty of research opportunities. Undertaking of research of any sort is looked upon favourably.

A day in the life of a... Registrar

08:30–09:15: departmental business meeting or AVM / audiologist journal club

09:00–12:30: tinnitus clinic

12:30 – 13:30: AVM-radiology meeting

13:30 – 17:00 : dizzy clinic

Ward referrals are often taken by the SpR. These patients are often brought down to outpatients to be seen at the end of clinic.

Pros and Cons of working in this specialty


  • MDT working – AVM is a multidisciplinary speciality and you will work closely on a daily basis with audiologists, physiotherapists, hearing therapists and many more!  
  • Opportunity to provide continuity of care
  • Opportunity to facilitate potentially life-changing procedures, e.g. cochlear implants.
  • A small, relatively new, evolving speciality – new ideas are welcome and there is plenty of scope for research
  • No on-call commitment! A ‘family-friendly’ speciality


  • Often no ‘quick fix’ treatment option available for patients – treatment is primarily rehabilitation based. The exception is Benign Paroxysmal Positional Vertigo!
  • Geographical restriction – training posts are only available in London and Manchester / Cardiff / Nottingham (2 deaneries)
  • No on-call commitment = no banding supplement = basic pay only...
How this specialty differs from others and why I chose it

AVM is a unique, niche speciality. It is growing and evolving and as a trainee, you are encouraged to help shape this growth. It is one of the smallest medical specialties – this gives you the opportunity to get to know everyone in your field well. I myself came to AVM from a background in general practice; I personally wanted to contrast being a generalist with working in a highly specialised environment. I have not been disappointed so far!

Tips for success in applying for this specialty
  • Use the ‘taster week’ during your FY2 year to observe a few audiovestibular clinics. Use the opportunity to talk with the registrars as well as the consultants about their experiences so far.
  • Formal taster day – used to be offered annually at The Royal National Throat Nose and Ear Hospital. This may start up again in the future.
  • Consider attending a Deaf Awareness Course – e.g. offered by Action on Hearing Loss
  • Look at the person specification and tailor your CV accordingly;  heres; a useful link 
  • Teaching experience, publications, presentations, relevant postgraduate qualifications – whilst not an absolute requirement, these are looked upon favourably.
Further information