gms | German Medical Science

77. 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.

24.05. - 28.05.2006, Mannheim

Ergebnisse einer follow-up Untersuchung bei chronischen Tinnituspatienten im Rahmen der integrierten Versorgung

Integrated healthcare for chronic Tinnitus patients - results of a follow up study

Meeting Abstract

Suche in Medline nach

German Society of Otorhinolaryngology, Head and Neck Surgery. 77th Annual Meeting of the German Society of Otorhinolaryngology, Head and Neck Surgery. Mannheim, 24.-28.05.2006. Düsseldorf, Köln: German Medical Science; 2006. Doc06hno112

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Veröffentlicht: 7. September 2006

© 2006 Pilgramm et al.
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Gliederung

Text

The experiences gained during the realisation of the Tinnitus compact cure since 2000 reveal the success of the practised Tinnitus accomplishment (4-pillar strategy) for the medium and long term [1], [2].It became obvious that balneologic cure measures were beneficial for only a very small number of patients and therefore a sustainable and insurance-borne diagnostic- and therapy model was necessary.

The opportunity of paragraph §140 B of the German social insurance code for Tinnitus patients was brought into the discussion by an alliance of health insurance funds.

The application of the developed concept (intensive weekend seminars for Tinnitus accomplishment) for one year, has now unfolded the first results and follow-up history data.

The concept: The suffering Tinnitus patient will be transferred from the family doctor to a Tinnitus specialist centre, where the patient will be subjected to an interdisciplinary diagnostic (ENT, audiological, psychological) as well as an interdisciplinary education. If necessary, an introduction to hearing aid and instructions to relaxation exercises are offered.

In a team meeting the further therapeutic proceedings (audio- & hyperacusistraining, psychotherapy, physical therapy, hospitalisation) are determined and presented to the patient in an elaborated closing meeting. Subsequently the patient can use the telephone hotline.

Results:

a) pre-/post- development, catamnesis

The development of the results of the ABI questionnaire [3] and the Tinnitus questionnaire according to Göbel and Hiller [4] for 62 patients as well as 32 post therapeutic interviewed patients (6 month after the therapy) shows the following results:

  • hearing loss: -16,7%
  • hyperacusis: -23,9%
  • Tinnitus: -31,4%
  • ear pressure: -26,0%
  • TF: -41,8%

b) comparison: weekend seminar vs. Tinnitus compact cure

The patients of Tinnitus compact cures (3 weeks) have (in average) been 10 years older and had a 22% higher entry score than those patients of weekend seminars.

The follow-up study shows a 42% reduction for the weekend patients and a 39% reduction for the compact cure patients.

c) follow-up special survey

The analysis of the follow-up questionnaire revealed the following data:

  • 3 of 32 patients were subjected to clinical aftercare
  • the leftover 29 patients did not consult a doctor concerning Tinnitus for 6 month
  • there was no sick leave from work
  • oral medication was discontinued
  • all suggested therapy measures were conducted
  • all suggested hearing aid provision were carried out

Discussion and conclusion:

After substantial experience with the integrated Tinnitus healthcare, the summary is:

  • a consistently good and persistent reduction of psychological strain is achieved
  • the discontinuation of the Tinnitus pill is persistent
  • a consequent supply of hearing aid is feasible
  • there was no post therapeutic sick leave within 6 month (except clinical aftercare)
  • a high reduction of medical tourism
  • there is a good cooperation of all contractual partners
  • a commendable payment behaviour of insurance institutions exists

These advantages prevail the following disadvantages:

  • the involved therapists do also have to spend their weekends
  • individual contracts have to be signed with the different health insurance companies

The practiced concept of the Tinnitus diagnostic and Tinnitus therapy can be seen as successful, effective and well priced. The adoption of this concept (ISO 9001 certified) is possible after the successful training and arrangements with insurance funds.


References

1.
Pilgramm M, Lebisch H, Pehle W. Ätiologie. Pathomechanissmen und Therapieansätze bei Tinnitus. Fortschritt und Fortbildung in der Medizin Band 25 Seite 143-195 (2001/2002) Bundesärztekammer, Deutscher Ärzteverlag Köln 2001
2.
Pilgramm M. in Bundesgemeinschaft für Rehabilitation (Hrsg). Rehabilitation und Teilhabe, Wegweiser für Ärzte und andere Fachkräfte der Rehabilitation, 3. Auflage, Deutscher Ärzteverlag Köln 2005
3.
Lebisch H, Pilgramm M. Hyperakusis – Diagnostik und Therapie CD 6. DGA-Tagung Würzburg 2003
4.
Goebel G, Hiller W. Verhaltensmedizinische Diagnostik bei chronischem Tinnitus mit Hilfe des Tinnitusfragebogens (TF). Diagnostika 2, 1994, 155-167