Comparison Of Health Insurance Coverage For Hearing Aids And Other Services In Alberta.

OBJECTIVES: Of the several barriers associated with uptake and adherence to hearing services, cost is the most commonly identified barrier in Canada. This study evaluated health insurance plans for hearing care coverage within Alberta, Canada, and subsequent out-of-pocket expenses that would result if an individual chose to pursue treatment. METHODS: An investigation of eight companies that provide supplementary health coverage in Alberta was conducted. Categories of health service coverage included hearing, vision, speech-language pathology (S-LP), physical therapy related (PT-R; including massage therapy and chiropractic therapy) and alternative medicine related (AM-R; including osteopathy, acupuncture and naturopathy). All coverage amounts were corrected to a four-year term for comparison purposes. RESULTS: For a four-year term, the coverage amounts for hearing services were CAD 300-750; for vision services were CAD 0-900; for S-LP services were CAD 0-2,400; for PT-R services were CAD 1,400-10,200; and for AM-R services were CAD 0-10,200 per four-year term. The expected out-of-pocket expense for vision ranged from CAD 0 to CAD 2,766, whereas for hearing, it ranged from CAD 250 to CAD 11,700. CONCLUSION: A considerable range and discrepancy were reported between hearing care and most paramedical services. In addition, the coverage amounts for hearing care were inconsistent with treatment costs, resulting in considerable out-of-pocket expenses for most consumers. The potential implications of such cost-related barriers on public health are an important consideration as our understanding of the impact of untreated hearing impairment continues to increase.

[The Königsteiner Empfehlung of 2012 - essential alterations and modifications]. / Die Königsteiner Empfehlung von 2012 - Wesentliche Neuerungen und Änderungen.

BACKGROUND: Since 1974, the recommendation for assessment of hearing impairment caused by noise - formerly known as "Königsteiner Merkblatt" (now: "Königsteiner Empfehlung") - has been representing the state of the art for the assessment of the occupational disease BK-No. 2301. It was updated several times, the last time in 2012. It provides a summary of the current medical knowledge. A new measurement for the entire working life - the Effective Noise Dose by Liedtke - was introduced. Otoacoustic emissions (OAE) are now the crucial tests in order to detect a hair cell dysfunction. As from now the tinnitus has to be put under a more comprehensive examination. On the strength of post experience the previous speech audiometry (Freiburger Test) is reliable, it was retrained. In future the indication for hearing aids will be oriented towards the aid guidelines of the legal health insurance. The questionnaire for the expert opinion was revised and the fee was adapted.

[Assessment inventories for hearing aid outcome]. / Fragebogenassessments für die Hörgerätekontrolle.

BACKGROUND: At the beginning of 2012 new fee schedule positions have been introduced to the ambulatory physician fee schedule ("Einheitlicher Bewertungsmaßstab", EBM) regarding the hearing aid fittings of youngsters and adults. With regards to quality assurance the use of a hearing aid outcome self-assessment inventory is made compulsive. This article aims to review available hearing aid (self-) assessment inventories as well as the evaluations regarding criteria for test quality implemented. METHOD: For this systematic review a selective literature research in PubMed has been carried out. RESULTS: There are various self assessment inventories measuring hearing aid benefit. Many of the studies evaluating these inventories were implemented during the 1980ies and early 90ies when analogue hearing aids were commonly used. These results cannot automatically be transferred to the nowadays common digital devices. Only a small amount of studies investigated German translations of the mostly originally English inventories. DISCUSSION: In order to be able to identify the actual meaning of resulting values from these inventories, it is important for ENT doctors and audiologists to be well informed of the tests' quality criteria.

Patient preferences and willingness to pay for tinnitus treatments.

PURPOSE: There will likely be several different tinnitus treatments necessary, and it is important to understand patient preferences and factors that might contribute to treatment acceptability. This study explores the acceptability of a wide range of different tinnitus treatments, from noninvasive wearable devices to surgically implanted devices in the brain. Understanding how tinnitus sufferers consider and rank such options and how they might be influenced by their own perception of the severity of their tinnitus could help clinicians, researchers, and companies plan future efforts for approaching new treatments. DATA COLLECTION AND ANALYSIS: 197 tinnitus self-help group attendees rated their acceptance of treatments on a scale from 0 (not acceptable) to 100 (fully acceptable). The treatments included external devices, medications, cochlear implants, an implant on the brain surface, and an implant in the brain. They were also asked how much they would pay for successful treatments. RESULTS: There was a significant correlation between loudness and annoyance (r = .78). To reduce tinnitus by half, an "acceptable" response between 91 and 100 was reported by 30% of the respondents for devices, by 52% for pills, by 25% for cochlear implants, by 13% for implants on the brain surface, and by 13% for implants in the brain. To reduce tinnitus completely, a 91-100 acceptable response was reported by 42% for devices, by 62% for pills, by 38% for cochlear implants, by 21% for implants on the brain surface, and by 19% for implants in the brain. To reduce tinnitus completely, participants most commonly selected to pay at least $5000, and 20.3% were willing to pay as much as $25,000. The ratings of tinnitus loudness and annoyance were positively correlated with the likelihood of using any treatment. Surprisingly, there was a weak relationship between annoyance and the amount they were willing to pay. CONCLUSIONS: Tinnitus patients are prepared to accept a wide variety of treatments. Medications are the most acceptable. Invasive procedures can also be acceptable to many, particularly if they provide complete relief.

A comparison of benefit and economic value between two sound therapy tinnitus management options.

BACKGROUND: Sound therapy coupled with appropriate counseling has gained widespread acceptance in the audiological management of tinnitus. For many years, ear level sound generators (SGs) have been used to provide masking relief and to promote tinnitus habituation. More recently, an alternative treatment device was introduced, the Neuromonics Tinnitus Treatment (NTT), which employs spectrally-modified music in an acoustic desensitization approach in order to help patients overcome the disturbing consequences of tinnitus. It is unknown, however, if one treatment plan is more efficacious and cost-effective in comparison to the other. In today's economic climate, it has become critical that clinicians justify the value of tinnitus treatment devices in relation to observed benefit. PURPOSE: To determine perceived benefit from, and economic value associated with, two forms of sound therapy, namely, SGs and NTT. RESEARCH DESIGN: Retrospective between-subject clinical study. STUDY SAMPLE: A sample of convenience comprised of 56 patients drawn from the Tinnitus Management Clinic at the Cleveland Clinic participated. Twenty-three patients selected SGs, and 33 patients selected NTT as their preferred sound therapy treatment option. DATA COLLECTION AND ANALYSIS: Sound therapy benefit was quantified using the Tinnitus Handicap Inventory (THI). The questionnaire was administered before and 6 mo after initiation of tinnitus treatment. Prior to device fitting, all patients participated in a 1.5 hr group education session about tinnitus and its management. Economic value comparisons between sound therapy options were made using a cost-effectiveness analysis (CEA) and cost-utility analysis (CUA). RESULTS: THI scores indicated a significant improvement (p < 0.001) in tinnitus reduction for both treatment types between a pre- and 6 mo postfitting interval, yet there were no differences (p > 0.05) between the treatment alternatives at baseline or 6 mo postfitting. The magnitude of improvement for both SGs and NTT was dependent on initial perceived tinnitus handicap. Based on the CEA and CUA economic analyses alone, it appears that the SGs may be the more cost-effective alternative; however, the magnitude of economic value is a function of preexisting perceived tinnitus activity limitation/participation restriction. CONCLUSIONS: Both SGs and NTT provide significant reduction in perceived tinnitus handicap, with benefit being more pronounced for those patients having greater tinnitus problems at the beginning of therapy. Although the economic models favored the SGs over the NTT, there are several other critical factors that clinicians must take into account when recommending a specific sound therapy option. These include initial tinnitus severity complaints and a number of patient preference variables such as sound preference, listening acceptability, and lifestyle.

Overview of newborn hearing screening activities in Latin America.

OBJECTIVE: Ascertain the status of early hearing detection and intervention services in Latin America. METHODS: Between June and November 2007, Gallaudet University, in collaboration with the U.S. Centers for Disease Control and Prevention Early Hearing Detection and Intervention Diversity Committee, disseminated a survey to 11 Latin American countries. It included questions about newborn hearing screening (NHS) procedures, the availability of intervention services for infants with hearing loss, and challenges in identifying infants with hearing loss. In addition, a literature review was conducted to help identify the status of NHS efforts in Latin America. RESULTS: Six countries (Chile, Costa Rica, Guatemala, Mexico, Panama, and Uruguay) and one U.S. territory (Puerto Rico) responded to the survey. Responses indicated that efforts to identify infants with hearing loss vary within and across countries in Latin America. In some countries, activities have been implemented at a national level; in others, activities have been implemented at a single hospital or region within a country. Common barriers to implementation of NHS programs include a lack of funding, screening and diagnostic equipment, public awareness, and personnel qualified to work with infants and young children. CONCLUSIONS: In spite of several barriers, NHS programs have been implemented in at least some facilities and regions in Latin America. Additional efforts are needed to expand NHS activities in Latin America.

Overview of newborn hearing screening activities in Latin America / Panorama de las actividades de examen sistemático de la capacidad auditiva en recién nacidos en América Latina

OBJECTIVE: Ascertain the status of early hearing detection and intervention services in Latin America. METHODS: Between June and November 2007, Gallaudet University, in collaboration with the U.S. Centers for Disease Control and Prevention Early Hearing Detection and Intervention Diversity Committee, disseminated a survey to 11 Latin American countries. It included questions about newborn hearing screening (NHS) procedures, the availability of intervention services for infants with hearing loss, and challenges in identifying infants with hearing loss. In addition, a literature review was conducted to help identify the status of NHS efforts in Latin America. RESULTS: Six countries (Chile, Costa Rica, Guatemala, Mexico, Panama, and Uruguay) and one U.S. territory (Puerto Rico) responded to the survey. Responses indicated that efforts to identify infants with hearing loss vary within and across countries in Latin America. In some countries, activities have been implemented at a national level; in others, activities have been implemented at a single hospital or region within a country. Common barriers to implementation of NHS programs include a lack of funding, screening and diagnostic equipment, public awareness, and personnel qualified to work with infants and young children. CONCLUSIONS: In spite of several barriers, NHS programs have been implemented in at least some facilities and regions in Latin America. Additional efforts are needed to expand NHS activities in Latin America.

OBJETIVO: Evaluar la situación de los servicios de detección e intervención tempranas de problemas auditivos en América Latina. MÉTODOS: Entre junio y noviembre del 2007, la universidad Gallaudet, en colaboración con el Comité de Diversidad del Programa de Detección Auditiva e Intervención Tempranas de los Centros para el Control y la Prevención de Enfermedades de los Estados Unidos, distribuyó un cuestionario en 11 países latinoamericanos. El cuestionario incluía preguntas acerca de los procedimientos de examen sistemático de la capacidad auditiva en recién nacidos, la disponibilidad de servicios de intervención para menores de un año hipoacúsicos y los retos para detectarlos. Además, se efectuó una revisión bibliográfica para ayudar a determinar el estado de las iniciativas de examen sistemático de la audición en recién nacidos en América Latina. RESULTADOS: Respondieron a la encuesta seis países (Chile, Costa Rica, Guatemala, México, Panamá y Uruguay) y un territorio de los Estados Unidos (Puerto Rico). Las respuestas indicaron que los esfuerzos para detectar a los menores de un año hipoacúsicos varían dentro de cada país y de un país a otro en América Latina. En algunos países se han realizado actividades a nivel nacional; en otros, en un único hospital o zona del país. Los factores que con frecuencia obstaculizan la puesta en práctica de los programas de examen sistemático de la audición en recién nacidos incluyen la falta de financiamiento, de equipos de tamizaje y diagnóstico, de concientización del público y de personal capacitado para atender a menores de un año y niños pequeños. CONCLUSIONES: A pesar de que existen varios obstáculos, se han ejecutado programas de examen sistemático de la audición en recién nacidos en al menos algunos establecimientos de salud y zonas de América Latina. Se necesitan esfuerzos mayores para ampliar estas actividades en América Latina.

Adult aural rehabilitation: what is it and does it work?

Adult aural rehabilitation is here defined holistically as the reduction of hearing-loss-induced deficits of function, activity, participation, and quality of life through a combination of sensory management, instruction, perceptual training, and counseling. There is a tendency for audiologists to focus on sensory management, aural rehabilitation being seen as something done by someone else after the provision of hearing aids or cochlear implants. Effective sensory management may, by itself, lead to improved activity, participation, and quality of life, but there is no guarantee that these outcomes will be automatic or optimal. In fact, there is often a disconnect between clinical measures of assisted auditory function and self-assessed benefit. Costs associated with a holistic approach can be minimized by bundling as many as possible into the cost of hearing devices, by taking advantage of computer-based perceptual training, and by capitalizing on the benefits of group counseling.

Office versus operating room insertion of the bone-anchored hearing aid: a comparative analysis.

BACKGROUND: The Bone-anchored Hearing Aid is indicated for patients with unilateral deafness and/or an irreversible conductive hearing loss. The insertion of this device is usually performed in the operating room under intravenous sedation or general anesthesia. We suggest that the placement of the abutment can occur easily and safely in the clinic setting, reducing time and costs for both the patient and the physician. STUDY DESIGN: Retrospective study. METHODS: Ten patients requiring 11 devices (1 bilateral) were implanted with the Bone-anchored Hearing Aid device in the outpatient clinic and another 8 patients were implanted in the operating room. All office procedures were done under local anesthesia; operating room procedures used either general anesthesia or intravenous sedation. Follow-up occurred over 12 months. Time required, cost of the procedure, and other logistical concerns between operating room and office-based insertion were evaluated and compared. RESULTS: When performed in the office, patient fees were reduced by 31%, and patient time investment was reduced 73%. Physician time was reduced by 50%. After office-based insertion, patients were able to return to their normal routine immediately after the procedure, and no chaperone or designated driver was required. No infection or complications occurred in either group. CONCLUSION: Bone-anchored Hearing Aid insertion in the clinic setting is safe and cost-effective, saving the patient and physician significant time and resources.

Systematic review of the clinical and cost effectiveness of digital hearing aids.

The aim of the present study was to systematically review the clinical and cost effectiveness of hearing aids which use digital signal processing relative to other forms of hearing aid technology, in particular analogue-based aids. A comprehensive search for randomized controlled trials, randomized crossover trials and economic studies was undertaken. Trial quality assessment and data extraction were undertaken by two independent reviewers. Eight trials comparing digital to non-digital devices were identified--one randomized controlled trial and seven randomized crossover trials. The majority of these studies were of small sample size and of poor methodological quality. In the majority of cases (nine out of 13), there was no evidence of a significant difference in either laboratory scores (nine out of 13 outcomes assessed) or user function/quality of life scores (six out of nine outcomes assessed) between digital and non-digital devices. In addition, there was no significant difference in patient preference for digital compared to control aids (relative risk 1.93; 95% CI 0.70-5.35) when pooled across studies. No cost-effectiveness studies directly comparing digital to non-digital devices were identified. In conclusion, the evidence identified by this review provides no significant evidence of the clinical benefit of digital devices compared to analogue-based aids. However, these results are difficult to generalize to current UK practice as the analogue aids and types of fitting in the trials are not those typically used in the NHS.