Verordnung von Hörgeräten auf Kosten der Berufsgenossenschaften

Ohne Zusammenfassung     

Einflussfaktoren auf die Rehabilitation der Innenohrschwerhörigkeit mit Hörgeräten

BACKGROUND: A large proportion of older as well as younger patients do not use their hearing aids. Of the younger hearing impaired population, this occurs in the majority of those who do not benefit sufficiently from their hearing aids and, consequently, they face difficulties in their working and social life. SCIENTIFIC QUESTION: Our aim was to evaluate whether a classical hearing aid adjustment is of sufficient predictive value to determine whether adequate rehabilitation in everyday and professional life will occur. METHODS AND RESULTS: A questionnaire was returned by 197 adult hearing impaired patients. Only 108 were using their hearing aids all the time; 57 rarely and 32 never. The main reason for this low rehabilitation rate proved to be inadequate amplification. At the workplace, insufficient speech discrimination came into play. Another important factor was dysacusis induced by specific noise signals. There was an intolerable acoustic feedback in 40% which could not be sufficiently alleviated. Taking these results into account, only about a third of patients were sufficiently rehabilitated. CONCLUSIONS: Proof of effectiveness in a typical audiological testing situation is an important but not a fully reliable predictor for effectiveness in everyday life. Even when hearing aids are shown to be effective with such testing, their application in particular everyday or work situations may be insufficient of even impossible.     

Komplikationen bei der Hörgeräteversorgung ohne HNO-Arzt

Background

Hearing loss is a symptom. The underlying disease must be investigated by an otolaryngologist, in order to ensure timely identification of alterations in disease course, complications and newly occurring secondary disease.

Methods

During the course of 1 year, 484 case studies in which treatment errors had arisen due to lack of otolaryngologist involvement during hearing aid fitting were collected from 115 practices and 7 ENT clinics, as well as from the patient representatives of the Federal Joint Committee. Depending on the type and cause of the individual complications, these were classified into five groups and described cumulatively.

Results

A total of 484 cases in which results had been incorrectly interpreted or charged to the wrong payer organization were presented in the form of a systematic overview. Furthermore, serious technical deficits, as well as unnecessary temporary and inappropriate fittings were observed.

Conclusion

The aforementioned cases are interpreted on the basis of regulations governing hearing aid fitting and current legal practices. These case reports clearly demonstrate that otolaryngologist expertise are required not only at the first hearing aid fitting, but also for subsequent fittings, in order to appropriately treat the underlying disease. Only so can the patient be protected from damage to their health and financial complications, and health insurance providers avoid wasting resources.     

Sprachverstehen mit Hörgeräten in Abhängigkeit vom Tongehör

Background and aim

Speech perception is the most important social task of the auditory system. Consequently, speech audiometry is essential to evaluate hearing aid benefit. The aim of the study was to describe the correlation between pure-tone hearing loss and speech perception. In particular, pure-tone audiogram, speech audiogram, and speech perception with hearing aids were compared.

Materials and methods

In a retrospective study, 102 hearing aid users with bilateral sensorineural hearing loss were included. Pure-tone loss (PTA) was correlated to monosyllabic perception at 65 dB with hearing aid and with maximum monosyllabic perception with headphones.

Results

Speech perception as a function of hearing loss can be represented by a sigmoid function. However, for higher degrees of hearing loss, substantial deviations are observed. Maximum monosyllabic perception with headphones is usually not achieved with hearing aids at standard speech levels of 65 dB.

Conclusion

For larger groups, average pure-tone hearing loss and speech perception correlate significantly. However, prognosis for individuals is not possible. In particular for higher degrees of hearing loss substantial deviations could be observed. Speech performance with hearing aids cannot be predicted sufficiently from speech audiograms. Above the age of 80, speech perception is significantly worse.     

Hilfsmethode bei der Untersuchung der Hörfähigkeit von Personen,die aggravieren

Ohne Zusammenfassung     

Zur Hörgeräte-Trageakzeptanz bei Kindern

BACKGROUND: Having one or 2 hearing aids is not a guarantee that a child will wear the instruments constantly. The purpose of this study was to evaluate the hearing aid acceptance by children (assessed using the daily wearing time). PATIENTS AND METHODS: A total of 116 parents of a patient population of persistent hearing-impaired children with a need for a hearing aid (average age 51.1 +/- 30.1 months) rated the wearing acceptance of their children on a 5-point-Likert-scale. This assessment was made after the child had received its individual hearing aid for its specific disorder (on average after 5 months). Hearing levels ranged from mild to profound. RESULTS: 58.6% of the children accepted their electroacoustic aids amplier "excellent" or "good", 18.1% did it "average", 23.3% "bad" to "miserable" or even "not at all". There was no significant difference between girls and boys. The wearing acceptance from children with unilateral hearing impairments was reduced, especially from those with chronic conductive disorders by malformations of the ears. Very young children (prelingual hearing impairments), mainly those with additional handicaps and/or not German speaking homes demonstrated a "bad" to missing wearing behaviour. Hearing acceptance did not correlate with the severity of the disorder. CONCLUSION: The wearing acceptance as one aspect of compliance should be rated before each regular hearing aid control. Finally it is an efficient and sensitive mean to detect faulty amplification and changed diagnosis.     

Hörgeräte-Verordnung bei Lärmschwerhörigkeit

Ohne Zusammenfassung     

Hörgeräteerfolgskontrolle mit dem Freiburger Einsilbertest

The benefit of hearing aids is not always directly subjectively perceivable. Therefore, objective and quantifiable speech audiometric measurements are required. Beside acoustic gain measurements and structured interviews, speech audiometry in quiet and in noise is one of the three pillars of hearing aid evaluation.     

Wirkung von Frequenzkompression in Hörgeräten auf das Sprachverstehen und das subjektive Klangempfinden der Nutzer

Background

The acceptance of hearing aids by users with high frequency hearing loss still represents a problem. Processing algorithms that shift high frequency signal components into an audible frequency range are proposed as a solution. We looked into the issue of whether frequency compression becomes more beneficial with increasing high frequency hearing loss or/and for users with cochlear dead regions (DR).

Subjects and methods

A total of 20 hearing aid candidates were assessed audiometrically and classified into two test groups in terms of their hearing loss and the presence of DR. The subjects then evaluated four hearing aid settings that differed solely in the degree of frequency compression. Speech recognition threshold measurements and subjective sound quality ratings were carried out for all four settings.

Results

Data showed that 15 of the 20 test subjects understood fricatives with a high frequency spectrum component better, since they were able to distinguish between the two logatomes“Afa” and“Asa”. No correlation was found between the beneficial effect of frequency compression and the degree of high frequency hearing loss or the presence of DR. Subjective sound quality ratings indicated no clear preference, but excessive frequency compression was generally deemed counterproductive.

Conclusion

Frequency compression may be appropriate for hearing aid users with high frequency hearing loss and can improve speech recognition. The degree of frequency compression required to achieve maximal benefit varies from case to case and has to be optimized on an individual basis.     

Untersuchungen zur Hörflächenskalierung im Rahmen der Hörgeräteversorgung

The loudness perception of patients with hearing aids was measured with a one-stage category loudness scaling procedure. Data were obtained from 102 ears and were studied primarily in older patients who represented the majority of patients with hearing disorders evaluated in our department. In all, 75% of the patients were older than 45 years and had a mean age of 58 years. The reduction of dynamics at high frequencies was considered to be typical for age-related hearing disorders and was easily quantified with loudness scaling. Findings demonstrated that prediction of recruitment was not possible from pure-tone thresholds or even together with uncomfortable loudness levels, since the slopes of the level-loudness functions revealed a high interindividual variability. In contrast, the desired compression ratio can be easily calculated with data from the loudness scaling. In this study the loudness perception of patients with mainly non-linear hearing aids fitted with customary procedures was evaluated. The benefit from the hearing aids was proven with the outcome from the loudness scaling, with testing also allowing for a better fitting of the aids.     

Hörgeräte, implantierbare Hörgeräte und Cochlear implants in der Therapie des chronischen Tinnitus

Chronic tinnitus can be influenced positively by plastic cortical changes of tinnitus assignment and auditory perception. Acoustic stimulation plays an important role, either through active hearing therapy or through a hearing device. The positive effect of hearing aids regarding tinnitus loudness and severity has been shown in many studies with large numbers of patients and amounts to up to 70%. Implantable hearing systems and their effect on tinnitus have not been examined sufficiently yet; there are reports about positive as well as negative effects on tinnitus perception. There is a strong indication, however, when pathological processes in the middle ear need direct coupling of the implantable hearing aid with the stapes or the round window and there is no possibility of providing a conventional hearing aid due to high-grade combined hearing loss. Cochlear implants (CI) for profoundly deaf patients influence tinnitus loudness and severity in 34–93% of the patients; the large deviation is due to inhomogeneous parameters in the studies that are not always based on validated questionnaires. Existing tinnitus, however, influences the outcome of CI patients. There are studies and discussions about the effect of CI for unilateral deafness with tinnitus.     

Hörgeräte-Trageakzeptanz bei Kindern: eine längsschnittliche Analyse

There exist no systematic longitudinal studies concerning the acceptance of hearing aids in Germany. This study examines the acceptance of a hearing aid (defined by its daily/weekly use) in the management of children with persistent sensorineural hearing loss over a period of years. 35 children with monaural or binaural hearing loss were treated with a hearing aid. All children had at least a 25-dB averaged mid-frequency pure-tone hearing loss (500, 1000, 2000, 4000 Hz). The data consist of standardized parent ratings at 4 points in time over a period of nearly 30 months. Unilateral-impaired children wore their hearing aids less often than bilateral-impaired children. This effect was not significant at the beginning (P = 0.85) but increased over time. By the end the difference was significant (P = 0.004). Mild to moderate monaural hearing-impaired children accepted their hearing aids, whereas children with severe to profound hearing loss refused to wear them. Bilateral hearing-impaired children demonstrated, a priori, a better wearing acceptance that even improved with time. There was never a significant difference between boys and girls in their average wearing time. A significant correlation of age and wearing acceptance was also not observed at any time. Hearing aids are an effective treatment with high acceptance and compliance, especially by children with bilateral sensorineural hearing loss. The quality of acceptance of monaural hearing-impaired children needs to be studied further.