gms | German Medical Science

76. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

04.05. - 08.05.2005, Erfurt

Integral care of “chronic tinnitus” - the diagnostic and therapy model of the future!?

Meeting Abstract

Suche in Medline nach

  • corresponding author Manfred Pilgramm - Tinnituszentrum Detmold
  • Helmut Lebisch - Tinnituszentrum Detmold
  • Stefan Doeding - BKK Verband OWL, Gütersloh

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie. 76. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V.. Erfurt, 04.-08.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05hno077

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/hno2005/05hno070.shtml

Veröffentlicht: 22. September 2005

© 2005 Pilgramm et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

In 2000, the four pillars of successful tinnitus management (education and information, conflict-centred problem resolution, attention deflection, aftercare) were taken up in the concept of “Compact Treatment at a Health Spa” (§23 of the German Code of Social Law, Part V).

Over the past 5 years, just under 2500 patients received therapy (52,650 enquiries)

Follow-up examinations show clearly: a lasting reduction in the psychological strain due to tinnitus and an improvement in the quality of life, as well as a reduction in the amount of medical tourism.

At the same time, however, significant drawbacks of this therapeutic procedure have emerged:

1. The German word “Kur”, used to describe treatment at a health spa, generally has negative connotations

2. Since the treatment is a statutorily specified preventive measure, patients who work are required to take vacation

3. The spa town of Bad Meinberg is not all that familiar as a therapy location

4. Many opportunities for inpatient tinnitus treatment exist in the Federal Republic of Germany

The possibility of integral care put forward by the legislator (§140 a/b of the German Code of Social Law, Part V) would seem to be ideal for uniting all the advantages of outpatient tinnitus management training while, at the same time, almost eliminating the drawbacks of “Compact Treatment at a Health Spa”.

Integral care makes provision for close cooperation between doctors with their own practices (e.g. networks of doctors), specialist centres, clinics and health insurance companies. The aim is to form and promote centres with a specific focus while, at the same time, improving performance and ensuring consistent cost savings.

On the basis of the contract concluded with a health insurance company association, the patient is referred to a specialist centre (tinnitus centre) by their general practitioner or specialist doctor. At the specialist centre, an interdisciplinary diagnostic examination is performed (ENT doctor, audiologist, psychologist), together with a differentiation of the psychological strain due to tinnitus.

Alongside interdisciplinary education, selective individual treatment is provided on the basis of the focal points established (e.g. supply of a hearing aid, hyperacusis training, problem resolution, etc.).

If outpatient treatment is not sufficient, the patient will be referred to a specialist tinnitus clinic for inpatient treatment.

Once the therapy has been administered, the patient will receive aftercare for two years from the specialist centre, the specialist doctor or the clinic.

After the contract came into force, a large number of new specialist centres sprang up virtually overnight, all of which demanded that the same conditions be applied to them. This meant that, from the viewpoint of the health insurance company, the contract (with networks of doctors and private practices as the other parties to the contract) was unable to survive.

The new concept that has now been developed makes provision for the insurance companies to work solely with qualified specialist centres and clinics which can demonstrate that they have sufficient experience in dealing with tinnitus patients.

At present, the specialist centre (Tinnitus Centre Detmold) offers a 15-20 hour weekend seminar which covers the contents set out above. In the framework of this seminar, the further diagnostic and therapeutic measures that are required are established, and aftercare is organised.

Initial results show clearly that the reduction in the psychological strain due to tinnitus is readily comparable with that achieved with the “Compact Treatment at a Health Spa” albeit with somewhat different patients. Although no follow-up data is available, it would seem that a 15-20 hour interdisciplinary seminar can influence the focus of the psychological strain due to tinnitus in a highly positive manner. Seven or 21-day outpatient measures and inpatient measures lasting several weeks ought to be reserved for selected cases.