As specialists in hearing disorders, we would like to provide you with comprehensive information and advice on the various options for hearing rehabilitation.
On the following pages, we will give you an insight into the various treatment options for different hearing disorders.
We would also be happy to advise you personally and individually during our consultation hours.
We look forward to seeing you!
Your interdisciplinary hearing centre Ulm (HZU)
| Management: | Dr E. Goldberg-Bockhorn, Prof Dr T. Hoffmann |
| Medical staff: | Mr B. Emmanuel, Ms J. Hempe, Dr J. Lingl, Prof. Dr P. Schuler, Dr H. Schuster, Ms C. Schwamborn |
| CI fitting: | Mr Dipl.-Ing. R. Leiacker, Ms M. Münch, Ms Dipl.-Ing. E. Munk (CI audiologist) |
| Diagnostics: | Mrs M. Barth, Mrs S. Mayer, Mrs M. Münch, Mrs K. Salmen, Mrs C. Seil |
Section Phoniatrics & Paediatric Audiology: | Prof. Dr A.-K. Rohlfs (head), Prof. Dr R. Reiter (senior physician), A. Häge (qualified psychologist), R. Schlüter (speech therapist) |
Appointments at the Ulm Hearing Centre
Monday and Wednesday from 08:00 - 12:00 and 13:00 - 16:00
Tuesday from 08:00 - 12:15
General information on hearing disorders
Hearing disorders are among the most common diseases that impair quality of life ("Global Burden of Disease" study, WHO). It is estimated that around13 to 14 million people suffer from hearing loss that requires treatment. Due to demographic trends, the number of people suffering from age-related hearing loss in particular is increasing. Noise-induced hearing loss and hearing disorders due to chronic middle ear infections are among the most common causes. Temporary hearing loss, such as ventilation disorders of the middle ear in children, can usually be remedied by simple measures.
Hearing disorders that cannot be adequately treated with middle ear surgery or hearing aids often require specific, individualised clarification and therapy. Affected patients can take advantage of detailed diagnostics and counselling at our hearing centre. In the case of congenital or severe sensorineural hearing loss in particular, we work on an interdisciplinary basis with the ophthalmology, nephrology and neurology clinics as well as the social paediatric centre and the paediatric clinic. In the case of a family history of hearing loss, we offer human genetic counselling via the Human Genetics Department. Under certain conditions, we carry out all necessary examinations on an outpatient basis or as part of a two to three-day inpatient stay. Ward doctors and nursing staff will guide you through the various disciplines together with the hearing centre team.
Children are cared for in close cooperation with the phoniatrics and paediatric audiology department. This is where the initial indication and organisation of post-operative rehabilitation takes place.
Range of services
If fitting a hearing aid is not successful, there are various surgical options for improving hearing, depending on the type of hearing impairment.
Middle ear surgery
Hearing loss is often caused by a deficit in sound transmission in the middle ear. The most common diseases include chronic middle ear inflammation mesotympanalis and cholesteatoma (bone erosion) as well as otosclerosis (ossification of the stapes). Rare diagnoses include aseptic incus necrosis and middle ear tumours (glomus tumour, adenomas, carcinomas, etc.).
Inflammation and damage in the area of the auditory ossicles, such as can occur in the case of a cholesteatoma (chronic bone suppuration), are treated by a rehabilitative middle ear operation (tympanoplasty). Microscopic and endoscopic techniques are used here. Various prostheses, usually titanium or gold prostheses(SMART prostheses), can be used to replace defective ossicles.
Surgical treatment of so-called otosclerosis (ossification of the stapes) is carried out by means of a stapedotomy or stapedectomy (partial or complete replacement of the stapes). The CO2 laser is often used for this procedure.
Partially and fully implantable hearing aids
The spectrum of surgical therapy for severe hearing loss that cannot be treated with hearing aids or other "minor" surgical measures ranges from partially implantable bone anchored hearing aids (BAHA, Bone-Bridge) to active middle ear implants and cochlear implants.
Vibrant Soundbridge
The Vibrant Soundbridge (VSB) is an active middle ear implant and is an alternative to conventional hearing aids. It consists of two components: the implant (VORP), which is placed under the skin in an operation, and a speech processor worn behind the ear, which is connected to the implant via a magnet. The VSB is therefore a partially implantable hearing system.
A microphone integrated into the speech processor picks up the sound, which is converted into electrical signals. These signals are transmitted to the implant. From there, the signals reach the so-called FMT (Floating Mass Transducer), a tiny magnet that is placed on the ossicular chain, a middle ear prosthesis, the round or oval window in the middle ear. The FMT converts the electrical signal into mechanical vibrations and thus sets the ossicular chain, the round or oval window in motion. This can then excite the inner ear.
The Vibrant Soundbridge significantly improves sound quality and speech intelligibility, especially in noisy environments. The sound comes very close to "natural hearing". As the auditory canal remains clear, feedback, which can occur with conventional hearing aids, is avoided.
Indications
The VSB can be used for mild to severe sensorineural hearing loss, conductivehearing loss and combined hearing loss .
As it is an alternative to conventional hearing aids, but is significantly more expensive, certain conditions must be met before a VSB can be prescribed.
- Medical indication for fitting with conventional hearing aids given
and - Treatment with conventional hearing aids is not possible for medical or audiological reasons,
e.g. in the case of ear malformations, chronic recurring middle ear inflammation with ear discharge, ear canal eczema, psoriasis or allergic skin diseases of the ear canal
Treatment with the Vibrant Soundbridge
- Prerequisite: willingness and ability to handle the device
- Implantation of the VSB in the bone behind the ear and fixation of the FMT to a movable middle ear structure under general anaesthetic (approx. 1-2 hours)
- Healing time until activation 6-8 weeks
- Fitting of the VSB via the hearing aid acoustician
- Check-ups in our cochlear implant consultation and/or with your treating ENT specialist
People who suffer from conductive or combined hearing loss and cannot be fitted with conventional hearing aids can benefit from a bone conduction implant under certain conditions. In the case of unilateral deafness, these implants can be used to redirect sound from the deaf side to the side with normal hearing
Bonebridge MED-EL
The Bonebridge is an active bone conduction implant that conducts sound directly to the inner ear via the bone. Unlike the BAHA, the implant lies completely under the skin (partially implantable hearing system). It receives its signals from a magnetically coupled audio processor that is worn on the head behind the ear.
Indications
Like other bone conduction hearing aids, the Bonebridge is used when the transmission of sound via the auditory canal and/or the middle ear to the inner ear does not work.
Conductive hearing loss (sound transmission to the middle ear is impaired) or
Combined hearing loss (sound transmission to the middle ear is impaired AND damage to the inner ear)
Single-sided deafness (e.g. due to sudden deafness)
- Cause cannot be sufficiently remedied by middle ear surgery and fitting with conventional hearing aids is not possible
- last ear to hear: an operation that could correct the cause of the hearing impairment would mean a high risk of deafness
- Ear canal/middle ear malformation, chronically recurring middle ear inflammation with ear discharge, ear canal eczema, psoriasis or allergic skin diseases of the ear canal
The audiological results to date are comparable to those of the BAHA, although the attenuation through the skin is eliminated with the Bonebridge. The advantages of the Bonebridge are the extremely rare occurrence of skin irritation, as the implant is completely covered by skin, and the ease of handling. The cost of batteries is usually covered by health insurance companies.
Treatment with the Bonebridge
- Prerequisite: willingness and ability to handle the device
- Testing of a bone conduction hearing aid for at least 3 weeks before an operation
- Implantation of the Bonebridge in the bone behind the ear under general anaesthetic (approx. 0.5-1 hour)
- Healing time until activation 2-4 weeks
- Fitting of the Bonebridge via the hearing aid acoustician
- Check-ups in our cochlear implant consultation and/or with your ENT specialist
The bone-anchored hearing aid (BAHA) consists of a small titanium implant that is inserted into the skull bone behind the ear in a minor surgical procedure. A titanium anchor (abutment) is fixed to the titanium implant, onto which a special hearing aid can then be attached (BAHA connect, Cochlear; Ponto, Oticon). Alternatively, a magnetic plate can be attached to the implant so that the speech processor can be magnetically coupled (BAHA attract, Cochlear).
Indications
Conductive hearing loss (sound transport to the middle ear impaired) or
Combined hearing loss (sound transport to the middle ear impaired AND damage to the inner ear)
One-sided deafness (e.g. due to sudden deafness)
- Cause cannot be sufficiently remedied by middle ear surgery and fitting with conventional hearing aids is not possible
- Last hearing ear: an operation would mean a high risk of deafness
- Not fit for anaesthesia
- Bone conduction component greater than 30 dB
- Hearing threshold for bone conduction not worse than 65 dB
- Ear canal/middle ear malformation, chronically recurring middle ear inflammation with ear discharge, ear canal eczema, psoriasis or allergic skin diseases of the ear canal
Treatment with the BAHA system
- Prerequisite: willingness and ability to wear the device and care for the implant
- Special hearing test before the operation with a so-called test rod, which is clamped between the teeth, or via a test bracket
- Testing of a BAHA on the soft band for at least 3 weeks before an operation
- Implantation of the titanium screw into the bone, usually under general anaesthetic on an outpatient basis (in special cases, a further surgical procedure is necessary after 4 weeks)
- Healing time approx. 2-3 months
- Fitting of the BAHA via the hearing aid acoustician
- Check-ups in our university outpatient clinic or with your treating ENT specialist
People with profound hearing loss or deafness who no longer have sufficient hearing gain with hearing aids and are therefore severely restricted in their ability to communicate can in many cases be rehabilitated with cochlear implants.
Cochlear implants are inner ear prostheses that consist of an implantable component(implant) and an externally worn component(speech processor). The implant is placed behind the ear in the skull bone during an operation under general anaesthetic. The electrode cable is inserted directly into the cochlea via a small hole in the inner ear or the round window (physiological opening in the inner ear covered by a membrane). The skin behind the ear is then closed again and a pressure bandage is applied for a few days. After around 5-6 weeks of healing, the speech processor can be activated for the first time and gradually adjusted.
The costs for the operation and the cochlear implant are generally covered by statutory and private health insurance companies.
In the speech processor, the sound waves received by a microphone are converted into digital signals and transmitted through the skin to the implant via the transmitter coil. In the implant, these signals are converted into electrical impulses and transmitted to an electrode array located in the cochlea. The impulses from the individual activated electrodes directly excite the auditory nerve fibres. From here, signals are transmitted to the brain, where an auditory impression is created.
In some cases, the hearing loss is mainly in the high frequency range, while the low frequencies can still be heard very well. Such people can only understand speech very poorly despite good low-frequency hearing. The high frequencies in particular can only be equalised with difficulty and often insufficiently with conventional hearing aids. Such people can also benefit from a special cochlear implant. In this case, the speech processor is combined with a conventional hearing aid(electrical acoustic stimulation = EAS or hybrid CI). The low-pitched sounds are amplified by the hearing aid function and transmitted to the inner ear via the normal route (auditory canal, middle ear). The high frequencies are encoded in the speech processor and transmitted to the auditory nerves and the brain via the cochlear implant. The acoustic and electrical information is combined in the brain to create an auditory impression.
Cochlear implants are suitable for people with profound sensorineural hearing loss, bilateral but also unilateral deafness.
Adults
For adults, the prerequisite is that the hearing impairment occurred after language acquisition (around the age of 4-6) (postlingual deafness). People without language acquisition only benefit from implantation in individual cases.
Children
Children born deaf or with early onset deafness should, if possible before the age of 2 be fitted with a cochlear implant. It is known that normal speech development in such children is only possible if they are implanted as early as possible. The later the implantation takes place, the worse the chances of normal hearing and speech development.
Deafness due to an accident or meningitis
Children or adults with deafness caused by an accident or meningitis should undergo cochlear implantation as soon as possible, as in these cases there is a risk of ossification of the cochlea (cochleasclerosis), so that an electrode can no longer be inserted into the cochlea.
Single-sided deafness
For some years now, people with unilateral deafness and normal hearing on the opposite side can also be fitted with a cochlear implant.
EAS, HYBRID-CI
People with good residual hearing in the low frequency range who do not achieve sufficient speech intelligibility with conventional hearing aids benefit from a combined fitting.
Costs
The fitting of a cochlear implant is covered by both statutory and private health insurance companies if the implantation is clearly medically indicated following extensive diagnostics. If the patient is at the indication limit, authorisation from the health insurance company is required before the operation. In this case, we will be happy to support you.
In order to determine whether cochlear implantation is an option, various outpatient examinations must be carried out. The examinations include an MRI and computer tomography of the skull, special tests of the hearing and balance system as well as an interdisciplinary assessment of any accompanying organ diseases that may play a role in the implantation (neurology, ophthalmology, nephrology).
Prerequisites:
- Existing inner ear structures and normal auditory nerve
- Motivation and realistic expectations of the cochlear implant
- New hearing aid fitting without sufficient speech comprehension in the speech test
- Children: Sufficient test phase with conventional hearing aids (6 months) and intensive early support
Contraindications
Cochlear implantation is not possible under the following circumstances:
- Missing inner ear structures or missing auditory nerve or tumours in these areas
- Severe psychotic disorders, advanced dementia
- Severe intelligence defects
- Severe psychomotor developmental disorders
- Postoperative rehabilitation not ensured
- Lack of rehabilitation ability during CI fitting
- Terminal tumour diseases
Cochlear implantation takes place as part of a 3 to 5-day inpatient stay. One day before the operation, you will be admitted to our ENT ward, where you will undergo final examinations and have the opportunity to speak to your surgeon again in detail. Cochlear implantation is a routine operation, similar to those performed for middle ear diseases. It is performed under general anaesthetic and the operation takes about 2 hours. Access to the middle ear is created under microscopic vision via an incision in the skin, which is cosmetically favourably positioned behind the pinna. The electrode array is then placed in the cochlea via a small opening. The functionality of the cochlea is tested in detail during the operation. The signal transmission via each individual electrode is measured and checked using a computer system.
The implant is fully healed after approx. 4 to 6 weeks. This is followed by regular adjustments to the cochlear implant by our specially trained staff and medical check-ups in our CI consultation hours.
Regular adjustment of the cochlear implant by our specially trained engineer in the ENT clinic
- Regular check-ups in our cochlear implant hearing clinic
- Supplementary speech therapy hearing training
- If necessary, inpatient rehabilitation in a specialised rehabilitation clinic after fitting of the speech processor and unsatisfactory hearing ability
The fitting of cochlear implants (CI) enables severely hearing impaired and deaf people to regain their ability to communicate and return to social life. Children born deaf or with profound hearing loss in early childhood, who would not be able to learn language without a CI, develop under optimal conditions comparable to their normal hearing peers after early CI treatment.
As the auditory nerve is no longer stimulated acoustically but electrically after CI implantation, the "new hearing" must first be learnt. In order to get this process going, an intensive rehabilitation phase is required, which - unlike the usual follow-up treatment after cardiological or orthopaedic illnesses, for example - usually lasts 2-3 years. This is followed by lifelong aftercare.
Our rehabilitation centre is part of the Ulm Hearing Centre at the University Clinic for Ear, Nose and Throat Medicine, Head and Neck Surgery on Michelsberg. Rehabilitation doctors, therapists, CI technicians and surgeons work closely together here to ensure holistic care for optimum results. The rehabilitation rooms are integrated into the premises of the ENT clinic, which houses professionally equipped diagnostic rooms as well as optimally equipped examination rooms and fitting rooms. This means that the technical and surgical expertise of the ENT Clinic can be used quickly for special issues and interdisciplinary medical care can be provided for problems that go beyond hearing impairment in a university environment.
Rehabilitation of adults
The rehabilitation of adults after cochlear implantation is carried out in our CI rehabilitation centre on an outpatient basis. Inpatient rehabilitation is only necessary in exceptional cases.
Rehabilitation begins after the healing phase of the CI approximately 4-5 weeks after the operation and is divided into post-operative basic and follow-up therapy.
The main contents of basic therapy is the commissioning and initial adaptation of the speech processor. The aim is the perception of initial auditory impressions at the noise and sound level and, if possible, an initial understanding of individual words. The initial fitting lasts 2-3 hours.
In the subsequent follow-up therapy further adaptations of the speech processor are carried out at specific, customised intervals in addition to clinical checks and hearing tests. At the same time, hearing and speech training is carried out by practising speech therapists, supervised by our in-house speech therapist from the Department of Phoniatrics and Paediatric Audiology. The aim is to guide the CI user from noise and sound perception through simple word and sentence comprehension to open speech comprehension.
The time frame for appointments as part of follow-up therapy extends over the following periods:
- In the first month after the initial setting: 3 - 8 rehabilitation days
- In the second to sixth month after the initial setting: 1-2 rehabilitation days per month
- Six months to two years after initial treatment: 2-6 rehabilitation days per year
- From the 3rd year: annual follow-up care for life, provided there is no need for intensive fitting and good hearing results are achieved
The outpatient rehabilitation days are accompanied by the integration of relatives and self-help groups as well as the possibility of contacting the social medical service for counselling and assistance with specific occupational and social medical issues.
Rehabilitation of children
The initial fitting of the speech processor in children is carried out with even greater sensitivity than in adults and under constant observation of the child in several sessions. The first phase of CI fitting in children is particularly critical and determines the acceptance of the CI. Overstimulation by the CI and excessive demands on the child must be avoided at all costs in order not to jeopardise the success of the CI fitting.
It is essential to involve the parents, who are not only trained in the operation of the processor and the CI accessories, but are also informed about the necessary measures in the home environment (hearing training, necessary wearing time of the processor per day). The Phoniatrics and Paediatric Audiology Section prescribes accompanying speech therapy hearing training close to home and liaises with the early intervention centres.
After the initial fitting, up to 20 rehabilitation days are required for the rehabilitation of children in the first year. If intensive rehabilitation is required, this can also take place in blocks of 3-5 days at the CIC Süd in Würzburg, with which a co-operation agreement has been reached.
The other rehabilitation days are distributed as follows:
- 10-15 treatment days in the 2nd year
- In the 3rd year 2-5 treatment days
- From the 4th year: six-monthly follow-up care until the age of 18, then annually for the rest of the patient's life, provided there is no need for intensive fitting and good hearing results are achieved
There is close cooperation in particular with the early intervention centres and schools for the hearing impaired in Schwäbisch Gmünd, Ravensburg-Wilhelmsdorf and Augsburg.
In addition, there are co-operations with various qualified hearing aid acousticians in the catchment area, who can provide services such as processor updates or spare parts procurement on site. All interested and qualified hearing aid acousticians have the opportunity to enter into such a financially independent co-operation. If you are interested, please contact the management.
- Anaesthesia
- Eye Clinic
- Human Genetics
- Paediatric Clinic
- Paediatric and adolescent psychiatry
- Neurology
- Psychiatry
- Psychosomatics
- Radiology
- Social Paediatric Centre
- DCIG German Cochlear Implant Society e.V.
- Ulmer Ohr e.V.
- German Association for the Hard of Hearing Baden-Württemberg e.V.
- Bavarian Association of the Hard of Hearing and Deaf e.V.
- SHG Ulm
- SHG Allgäu; Download flyer
- SHG Lake Constance/Upper Swabia
- CIV-BaWü Cochlear Implant Association Baden-Württemberg e.V.
The Ulm Hearing Centre (HZU) at Ulm University Hospital is certified by the German Society for ENT (DGHNO) as a CI care facility. In this context, an annual quality report is published in which the structures of the hearing centre are presented in accordance with the contents of the CI White Paper and the AWMF guidelines in the respective valid versions.