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Tinnitus Retraining Therapy (TRT) is a well-defined method for treatment of individuals who suffer from tinnitus [1-4]. Habituation is a concept that has been a part of the learning and conditioning literature for many years and refers to a decrease in responsiveness because of repeated stimulation with an inconsequential stimulus [7]. Treatment with TRT has two components, and each component addresses a different aspect of habituation.
Prospective controlled studies have not been reported to document outcomes of treatment with TRT [10,11].
TRT was first offered to patients at the University of Maryland Tinnitus and Hyperacusis Center in 1990. Clinical implementation of TRT requires patients to receive a thorough audiological and medical evaluation before entering treatment [6]. The examiner recommends treatment for TRT based primarily upon patients' audiological test results and their verbal responses from the TRT initial interview [14]. The TRT initial interview is designed to delineate a patient's relative problems with tinnitus, hearing loss, and loudness intolerance. The original version of the TRT Initial and Follow-up Interview forms appears in a condensed format that is intended to simplify administration of the interviews as well as record keeping [14].
Because TRT is often used for treating tinnitus, practitioners must have access to standardized TRT assessment tools. Category 1 patients require extended treatment for their tinnitus condition but do not require the use of hearing aids. Proper patient categorization requires the clinician to clearly understand the patient's subjective difficulties with each of the conditions of tinnitus, reduced sound tolerance, and hearing loss. Tinnitus of recent onset (up to about 6 months duration) may be more labile than longer-duration tinnitus and thus may resolve spontaneously [27]. From a population of over 1,800 tinnitus patients, 43 percent were reported to have described their tinnitus as consisting of multiple sounds [28].
Most patients responding to the TRT initial interview will have negative emotions associated with their tinnitus, with consequent effects on certain life activities. This item comprises a series of questions related to the patient's use of hearing protection. Question 10 is straightforward in asking if the patient is receiving any other tinnitus treatment. Question 12 identifies bothersome aspects of tinnitus from a closed set of different activities that can be adversely affected by tinnitus. These two questions will obtain an estimate of the percentage of waking hours that patients are consciously aware of, and annoyed by, their tinnitus. Patients are given an opportunity to provide any additional information concerning their tinnitus. Decreased sound tolerance can involve different components, including hyperacusis, misophonia, and phonophobia [4]. These questions are the same as questions 7 through 18 for tinnitus, but focus on effects of reduced sound tolerance. The TRT Follow-up Interview form (Figure 2) duplicates those questions from the TRT initial interview that would be considered necessary to monitor treatment progress and to determine treatment outcomes [14].
In the scripted instructions to the follow-up interview, patients are told to consider their tinnitus and its effects over the previous month when answering the questions. Question 1 contains a series of questions about whether patients experience some days that are more affected by their tinnitus than others.
Question 5 determines the impact of tinnitus on various activities, as does Question 12 from the initial interview. Questions 6 and 7 are the key questions that assist in determining if patients are habituating to, respectively, tinnitus perception and tinnitus reaction.
Questions 8, 9, and 10 ask patients to estimate, respectively, their tinnitus loudness, annoyance, and life impact.
Questions 23, 24, and 25 are particularly important for a clinician to determine the relative effects of tinnitus, reduced sound tolerance, and hearing loss on the patient's life. Question 26 determines if patients feel that their auditory condition has benefited overall, considering tinnitus, sound tolerance, and hearing loss. This article provides tools to evaluate patients for treatment with TRT and to monitor the efficacy of treatment with TRT. The TRT Initial and Follow-up Interview forms were revised primarily to help determine outcomes of treatment in a standardized manner for a randomized clinical study currently being conducted at the Portland Department of Veterans Affairs (VA) Medical Center (VAMC) in which subjects receive treatment with either Tinnitus Masking or TRT. There are accepted methods for developing and testing scales that measure health or functional status.
Substantial literature exists concerning tinnitus outcomes instruments-some of which have undergone the more traditional method of development and testing.
With regard to the preceding comments, a need exists to provide further development and testing for the TRT interview forms to be documented as valid and reliable.
Finally, it should be noted that the developers of the original TRT interview forms administer the Tinnitus Handicap Inventory to all of their patients in addition to performing the interviews [41,42]. We wish to acknowledge the significant contributions from Tara Zaugg, MS; and Barbara Tombleson, BS. Obwohl sich die Tinnitus-Retraining-Therapie (TRT) zunehmend als Therapiekonzept durchsetzt, ubernehmen die gesetzlichen Krankenkassen (GKV) die komplette Finanzierung der ambulanten Variante der TRT nicht. Fur Grund- und Aufbaumodul (Hortherapie und therapeutische Gesprache) in Einzel- oder Gruppentherapie und administrative Leistungen des Tinnitus-Zentrums sind die Kosten selbst zu tragen! Bitte rufen Sie an und scheuen Sie nicht, dem Anrufbeantworter Ihren Namen, das Anliegen und Ihre Tel.-Nr. Bei der zweitagigen Zertifizierung wurde die Einhaltung der strengen Kriterien fur die drei Qualitatsbereiche Lebensmittelauswahl, Speisenplanung und -herstellung sowie Lebenswelt von der Deutschen Gesellschaft fur Ernahrung gepruft.
Im Zuge der Zertifizierung haben das Team der Diatassistentinnen und Koche den Speiseplan vollig neu uberarbeitet und designt. Oberammergau – Mit gro?em Erfolg hat der Bereich der stationaren Rehabilitation des Rheumazentrums Oberammergau Mitte Oktober die Zertifizierung nach Q-Reha bestanden.
Das Ziel der Waldburg-Zeil Kliniken ist die umfassende medizinische Versorgung von Patienten. Zwei Tage lang fand eine umfassende Uberprufung in der Klinik durch eine unabhangige Auditorin statt.
Die DRV Bund wird im Jahr 2015 Medizinisch-Beruflich orientierte Rehabilitation (MBOR) in der Psychosomatik einfuhren. Die Fachtagung richtet sich Arzte und Therapeuten sowie an alle Mitarbeiter in Reha-Einrichtungen, die mit MBOR befasst sind.
In einem ersten Schritt wird jetzt eine gemeinsame Geschaftsfuhrung beider Gesellschaften gebildet. In einem zweiten Schritt soll dann im Laufe des Jahres 2015 auch rechtlich die Zusammenfuhrung der beiden Gesellschaften im Wege einer Verschmelzung erfolgen. Durch den Zusammenschluss entsteht ein neuer, noch leistungsstarkerer Versorgungsanbieter mit zusammen 72 Reha-Einrichtungen, Akutkliniken und Pflegeheimen.
Fur die Beschaftigten, die bereits vorab in einem Brief der Geschaftsleitung informiert wurden, andert sich zunachst nichts. Waterland ist eine unabhangige Private-Equity-Investment-Gesellschaft mit Hauptsitz in den Niederlanden, die Unternehmer bei der Realisierung ihrer Wachstumsplane unterstutzt.
Die RHM Klinik- und Pflegeheimgruppe mit Hauptsitz in Deidesheim gehort seit 2011 zu Waterland Private Equity. Die DEGEMED setzt sich mit ihrer im Fruhjahr gestarteten Kampagne „Meine Reha – Mein Leben.“ fur eine bedarfsgerechte Finanzierung der medizinischen Reha ein. Zum Jahreswechsel wird es wieder laut: Punkt Mitternacht werden zahllose Raketen und Knaller angezundet.
Vor einigen Jahren wurde im Zuge der Harmonisierung europaischer Gesetze die deutsche Sprengstoffverordnung gelockert, was zur Folge hat, dass mitunter mehr als doppelt so viel Sprengmasse verwendet werden darf als zuvor – und zum Teil sogar Sprengstoffmengen auf dem Markt sind, die vorher nur Pyrotechnikern zur Verfugung standen. Wenn Raketen oder Boller weniger als zwei Meter entfernt von den Ohren explodieren, wirken laut DGHNO KHC etwa 25 Millisekunden lange Schallimpulse auf das Gehor. Deutschland, Pravention, Selbsthilfe Kommentare deaktiviert fur Deutsche Tinnitus-Liga e. Der Einsatz von Robotern ist langst medizinischer Alltag und auch in der Rehabilitation spielen robotische Systeme eine immer gro?ere Rolle.
Das Forschungsprojekt Recupera Reha wird vom Bundesministerium fur Bildung und Forschung (BMBF) im Projekttrager Softwaresysteme und Wissenstechnologien (PT-SW) des Deutschen Zentrums fur Luft- und Raumfahrt e.V. Zum Aufbau der Systeme erarbeiten die RIC-Wissenschaftlerinnen und -Wissenschaftler neue Methoden zum Leichtbau sowie auf dem Gebiet der Antriebstechnologie und der Regelungstechnik. Ziel der Bremer Forscherinnen und Forscher ist es, das Recupera-Teilsystem bei der Rehabilitation von Patienten mit motorischen Einschrankungen im Bereich des Oberkorpers einzusetzen. Unter der Uberschrift „So viel wie ich brauche“ widmet sich die heute erschienene Jubilaumsausgabe der DEGEMED News ihre Titelstory dem Reha-Budget. Ein Wasserglas steht als Symbol fur die bedarfsgerechte Finanzierung der Rehabilitation und im Mittelpunkt der dritten Etappe der Kampagne der Deutschen Gesellschaft fur Medizinische Rehabilitation e.V. Die Kampagne der DEGEMED, die seit dem Fruhjahr lauft, ist inzwischen in vielen Reha-Einrichtungen in ganz Deutschland angekommen. Aktionen, Verbande Kommentare deaktiviert fur Bedarfsgerechte Finanzierung ist Titelthema der 50. Die DEGEMED setzt sich mit ihrer im Fruhjahr gestarteten Kampagne „Meine Reha – Mein Leben.“ fur einen leichteren Zugang in die Rehabilitation ein. Der Aufsichtsrat der AHG Allgemeine Hospitalgesellschaft AG hat in seiner gestrigen Sitzung zum 1. AHG-Aufsichtsratsvorsitzender Dieter Hebel dankte ausdrucklich dem scheidenden Vorstandsmitglied: „Wir haben es in den vergangenen Jahren geschafft, die AHG in allen Bereichen mit einer Exzellenzoffensive im personellen Bereich deutlich zu verstarken. Die langjahrigen Geschaftsbereichsleiter Ilona Michels und Peter Schauerte ubernehmen als neue Vorstande die bisher von Norbert Glahn als COO geleistete operative Leitung der AHG mit ihren 45 Kliniken, Therapiezentren und Ambulanzen. Durch diese interne Besetzung setzt die AHG AG im nunmehr vierkopfigen Vorstand auf langjahrige Erfahrung und bewahrte Zusammenarbeit. Die AHG Allgemeine Hospitalgesellschaft als Familienunternehmen mit Sitz in Dusseldorf gehort zu den gro?en deutschen Therapieanbietern in der Behandlung psychosomatischer Erkrankungen, Abhangigkeitserkrankter und der Soziotherapie.
Die Kosten einer Behandlung werden von allen gesetzlichen Krankenkassen, den RentenversicherungstrA¤gern sowie den Berufsgenossenschaften A?bernommen. The TRT Initial Interview form was developed to guide clinicians in obtaining essential information from patients that would specify treatment needs.
It is estimated that about 80 percent of individuals who experience constant tinnitus naturally habituate to their tinnitus to such a degree that their tinnitus does not constitute a problem requiring clinical intervention [1,8]. The individual with problematic tinnitus first must habituate to any emotional responses to the tinnitus. Outcomes data have been reported from a number of clinics, however, indicating that treatment with TRT significantly benefited 70 to 85 percent of their patients (reviewed by Henry et al. In addition, patients must demonstrate that their tinnitus condition is sufficiently problematic to warrant implementation of long-term treatment with TRT. The TRT initial interview is a structured set of questions that are designed specifically to determine proper placement of patients into TRT treatment categories (described in TRT Patient Categories section).
Using the TRT Initial Interview form, each of these three potential problems is discussed individually, enabling the clinician to differentially assess the subjective impact of each. These categories have been fully described elsewhere [4-6,21] and thus are only briefly described here (see the Table). They are fitted with wearable ear-level sound generators and counseled repeatedly, usually over a period of 1 to 2 years. Understanding the patient's natural tinnitus history is considered important for counseling [8]. The potential for spontaneous improvement is important to consider in the assessment of patients for treatment. This question seeks to determine if there are days when these tinnitus effects are noticeably worse than on other days. Patients commonly report that their tinnitus becomes louder as a result of exposure to certain sounds. The questions will stimulate discussion about the need to provide hearing protection in dangerously noisy situations, but the main purpose is to determine if the patient is overprotecting his or her hearing. Often, patients have not analyzed specifically why tinnitus is a problem for them and this list prompts them with the most likely concerns. Patients are asked to rank their tinnitus with respect to loudness, annoyance, and life impact. In most cases, the TRT initial interview will have covered all the issues and patients will have nothing further to add. Patients must clearly understand the intent of Question 19 because their response to it will determine whether or not they are identified as having a problem with sound tolerance.
Patients will often confuse functional effects of reduced sound tolerance with tinnitus effects. There can also be Category 4 placement specific to hyperacusis as shown in the Table, page 159. No clear relationship exists between patients' audiograms and how they feel about their hearing [39]. During the preceding questioning, patients will have learned to distinguish between the conditions of tinnitus, reduced sound tolerance, and hearing loss.
Some of these questions have been modified relative to the initial interview as appropriate for follow-up evaluation. Thus, they are not asked to respond in relation to any particular day or circumstance, but to think of how the tinnitus has affected them generally during the previous 30 days.
The clinician should have the patient's responses to the initial interview in hand during administration of the follow-up interview. Similar to Question 1, patients are asked to report if they feel that the amount of time they have been aware of their tinnitus, or annoyed by their tinnitus, has changed during the previous month. For these questions, as well as Questions 23, 24, and 25, clinicians are again advised to have the patient's previous answers available to indicate to the patient whether improvement has been noted.
If improvement is not noted after 1 to 2 years of treatment, the clinician must assess honestly as to whether continued treatment with TRT is in the patient's best interest. If reduced sound tolerance was not noted as a problem during the initial interview, these questions are bypassed during the follow-up interview. The question requires only a yes or no response, but its intent is to raise the issue as a discussion point to evaluate whether the patient considers hearing loss a problem [39].


In some cases, only one of these is a problem at the beginning of treatment and treatment will be specific to that condition throughout the program.
Question 27 is somewhat unusual because it asks patients how they would feel about giving back their ear-level devices. The original one-page interview forms, both initial and follow-up [14], can work effectively for the experienced TRT clinician.
Since all subjects in both groups were to receive the TRT initial and follow-up interviews, administering the interviews in a consistent fashion was essential. None of these instruments, however, has achieved discipline-wide consensus as a standardized method of evaluating the negative effects of tinnitus. Jastreboff and Jastreboff state that the choice of supplemental questionnaires is a matter of personal preference of the provider [14]. Es hat sich bisher fur jede Finanzsituation eine therapeutisch vertretbare Losung gefunden!
Als Bestandteil unseres Therapiekonzeptes tragt das Essen dazu bei, Gesundheit und Leistungsfahigkeit wieder herzustellen bzw. Daruber hinaus erhalten die Patienten zukunftig ein umfangreiches Informationsangebot rund um die Auswahl der Lebensmittel, verwendete Rezepturen und Zubereitungsmethoden. Wichtig ist dabei auch der Blick unabhangiger Gutachter auf die Ablaufe in der Einrichtung. Neben konzeptionellen Fragen stehen fur ambulante und stationare Reha-Zentren dann die Integration in den Therapiealltag, Probleme in der praktischen Durchfuhrung, das Fallmanagement und die Dokumentation der Leistungen im Vordergrund. Carsten Rahlfs, Principal von Waterland und Leiter des Dusseldorfer Buros, begrundet den Zusammenschluss: „Die Gesundheitsbranche unterliegt gerade mit Blick auf die demografische Entwicklung einer erheblichen Wandlung. Der Hauptsitz des Gesamtunternehmens wird in Berlin sein, Deidesheim bleibt als weiterer Standort erhalten. Die finanziellen Mittel und das Branchen-Know-how von Waterland ermoglichen den Portfolio-Unternehmen organisches Wachstum und Akquisitionen. Das Unternehmen mit Hauptsitz in Berlin ist in der Postakut- und Rehabilitationsmedizin mit rund 7.500 Mitarbeiterinnen und Mitarbeitern Marktfuhrer unter den privaten Betreibern in Deutschland. Sie ist ein kompetenter Anbieter von stationaren Rehabilitations-, Pflege- und spezialisierten Akutleistungen sowie erganzenden teilstationaren und ambulanten Angeboten. Dezember 2014 – Die wirtschaftliche Situation vieler Reha-Kliniken in Deutschland ist prekar.
Inzwischen unterstutzen zahlreiche Reha-Einrichtungen, Klinik-Mitarbeiter und Rehabilitanden die Kampagne und die Forderungen der DEGEMED.
Der Brauch, mit dem viele Menschen das alte Jahr verabschieden und das neue willkommen hei?en, ist jedoch gefahrlich: Boller und Raketen konnen schwere Gehorschaden verursachen. Dies stellt eine noch gro?ere Gefahr fur die Ohren dar, denn: Je mehr Sprengstoff, desto lauter sind die Knallkorper.
Das Robotics Innovation Center (RIC) des Deutschen Forschungszentrums fur Kunstliche Intelligenz GmbH (DFKI) arbeitet zusammen mit der rehaworks GmbH an Methoden zum Aufbau eines Ganzkorper-Exoskeletts und eines mittelfristig fur die Rehabilitation einsetzbaren robotischen Teilsystems.
Dafur entwickeln sie mogliche Therapieverfahren, die exemplarisch umgesetzt und in einer Evaluationsstudie zur Anwendernahe uberpruft werden sollen.
Hintergrund ist die Kampagne „Meine Reha – Mein Leben.“ der DEGEMED, die im Oktober in ihre dritte Etappe gegangen ist. Rehabilitanden und Mitarbeiter von Reha-Kliniken unterstutzen „Meine Reha – Mein Leben.“ mit Aktionen, Unterschriften und Statements. Sie konnen ihn direkt hier als PDF herunterladen oder sich hier die E-Paper-Ausgabe ansehen. Dezember 2014 – Immer mehr Menschen scheitern, wenn sie eine medizinische Reha bei ihrer Krankenkasse beantragen wollen. Petra Kempel hat als Arbeitsdirektorin und Personalvorstand mit gro?em Engagement seit 2013 wichtige Weichenstellungen fur die Zukunftsfahigkeit des Unternehmens vorgenommen.
Die personellen Entscheidungen des Aufsichtsrates der AHG sind gleichzeitig ein klares Zeichen der Kontinuitat und Stabilitat. An 45 Standorten in 11 Bundeslandern mit uber 3.000 Beschaftigten schaffen vernetzte Behandlungsformen aus Kliniken, Therapiezentren und Ambulanzen flexible Angebote. The TRT Follow-up Interview form is similar to the initial interview form and is designed to evaluate outcomes of treatment. The model identifies different areas of the brain that can be involved in tinnitus and theorizes as to how those areas interact to create a clinical condition of tinnitus [5,6]. Such natural habituation apparently does not occur for about 20 percent of these individuals. In 1999, Jastreboff created another center to treat tinnitus and hyperacusis patients at the Emory University School of Medicine in Atlanta, Georgia. In addition to questions about tinnitus, the TRT interview includes questions about decreased sound tolerance (hyperacusis) and about subjective hearing difficulties [6,15]. In addition, use of the interview educates the patient to understand these problems and how they differ. The abbreviated nature of the questionnaire items requires the clinician to fully understand the intent of each item in order to phrase the questions appropriately and is a reminder to assure that all questions are asked. This paper provides the expanded forms of the initial and follow-up interviews to clinicians who are practicing, or who intend to practice, TRT with their tinnitus patients.
Category 0 identifies patients whose tinnitus condition requires only basic counseling and sound therapy without the need for wearable sound generators or hearing aids. Category 2 patients also require extended treatment for their tinnitus condition, but in addition, they report significant hearing difficulties.
The treatment approach will vary according to category; thus, accurate placement of patients into these categories is critical to provide proper treatment. The tinnitus description defines the symptom for both patient and clinician, providing a common reference for the remainder of the tinnitus-related questions.
With an increase in tinnitus duration, the likelihood of tinnitus being a permanent condition also increases. Based on these data, tinnitus is likely to consist of multiple sounds for about half of all patients attending tinnitus clinics. Many patients with tinnitus use earplugs or earmuffs to prevent their tinnitus from becoming worse. This information is important for the clinician to help the patient determine the best overall course of treatment. Since habituation is the primary goal of TRT, these questions are particularly helpful in assessing this outcome of treatment. Only the end points of each scale have labels; thus, patients must select a number on the continuum in relation to the two extremes. Hyperacusis is a physiological response to certain sounds; thus, some level of physical discomfort is involved. It is thus important to guide the patient to respond appropriately, keeping in mind the different components of reduced sound tolerance as described for Question 20. In the latter case, certain sounds will exacerbate the hyperacusis for an extended period of time (at least until the next day).
Some patients will reveal a significant reduction in hearing sensitivity and yet will not be bothered particularly by their hearing loss.
These three questions now allow them to consider how much each condition is a problem in relation to the other.
It is thus important to know if patients feel that they are having fewer bad days than before.
Indicating the previous responses on the follow-up interview form is helpful when asking about these activities. An awareness that improvement has occurred can be very encouraging to the patient and is an important incentive to maximize compliance with the treatment protocol. If reduced sound tolerance was initially reported, completing these questions will enable an evaluation of treatment efficacy. This perception often changes from appointment to appointment, which can potentially result in making changes in ear-level devices. In other cases, more than one of these conditions will be a problem at the outset of treatment and their relative effects can change during treatment.
Many clinicians, however, especially those who are relatively new to TRT, have expressed the need for scripting of questions and for explaining the various questions in the forms.
The interview forms therefore were revised so that exact wording of each question would be provided on each form. Such an approach has not yet been taken with the TRT interview forms, which were originally developed by the second and third authors of this paper because of their perception that take-home questionnaires were inadequate for assessing tinnitus patients [14]. Meikle and Griest have reviewed the various outcome measures that have been developed and have noted the many discrepancies between them [40]. A working group has been formed that is presently evaluating four tinnitus outcomes instruments, including the TRT interview forms, the Tinnitus Handicap Inventory [41,42], the Tinnitus Handicap Questionnaire [19], and the Tinnitus Severity Index [43].
Tinnitus Retraining Therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients. Celebrating a decade of evaluation and treatment: The University of Maryland Tinnitus and Hyperacusis Center. An experimental study to test the concept of adaptive recalibration of chronic auditory gain: interim findings. Modification of loudness discomfort level: evidence for adaptive chronic auditory gain and its clinical relevance.
Shifts in dynamic range for hyperacusis patients receiving Tinnitus Retraining Therapy (TRT). Changes in loudness discomfort level and sensitivity to environmental sound with habituation based therapy.
Psychometric adequacy of the Tinnitus Handicap Inventory (THI) for evaluating treatment outcome.
Horgeraten, Psychotherapie sowie stationare REHA, Kompaktkur oder Krankenhausbehandlung ist die Kostenbeteiligung bzw. Damit erfullt die Fachklinik die hohen Qualitatsrichtlinien der Bundesarbeitsgemeinschaft fur Rehabilitation (BAR). Die Auditorin betrachtete unter anderem die Patientensicherheit, Prozessorientierung sowie das Qualitats- und Risikomanagement der einzelnen Bereiche.
Die eintagige Fachtagung zeigt die Anforderungen und das Verfahren der DRV bei der Auswahl der beteiligten Einrichtungen, Praxisbeispiele aus stationarer und ambulanter Rehabilitation und die Anderungen in der Dokumentation in der neuen KTL 2015 der DRV. Das hat heute der Mehrheitseigentumer beider Unternehmen, der Finanzinvestor Waterland Private Equity, bekannt gegeben.
Waterland agiert als Investor, der Portfoliounternehmen finanziell, strategisch und operativ begleitet. Insgesamt 26 Kliniken und Pflegeheime mit 2.900 Behandlungs- und Betreuungsplatzen in sieben Bundeslandern gehoren zur Gruppe.
Stattdessen verlagern Krankenkassen immer mehr sachfremde Kosten auf die Reha-Kliniken, etwa fur Fahrdienste und Krankentransporte. Ein solches Knalltrauma kann eine lebenslange Schwerhorigkeit sowie Tinnitus auslosen, warnt die Deutsche Tinnitus-Liga e. Da sich Lautstarke aus einer Kombination von Schalldruck und Dauer ergibt, nimmt das Ohr diese kurzen Spitzenpegel weniger als Larm wahr und ist fur Horschaden besonders anfallig, weshalb Innenohrverletzungen gerade an Silvester besonders haufig entstehen.
Ziel des Projekts ist es, ein innovatives und mobiles Ganzkorper-Exoskelett fur die Bewegungsassistenz des menschlichen Bewegungsapparates zu entwickeln und aus dieser Entwicklung ein mittelfristig zu rehabilitativen Zwecken einsetzbares robotisches Teilsystem zu definieren und als Demonstrator aufzubauen. Der Verbundpartner rehaworks GmbH wird dabei von Anfang an die Anforderungen an medizinische Gerate betrachten und das entstehende System dahingehend kontinuierlich evaluieren. The treatment approach is aimed to induce and facilitate habituation by the patient to his or her tinnitus. Habituation to tinnitus perception can only occur if there has been habituation to the associated emotional responses. In the past 7 years, he has conducted 13 three-day instructional courses in the United States that have been offered to physicians and audiologists to learn the TRT protocol. It is thus critical to accurately assess the patient's condition, need for treatment, and motivation to comply with all treatment requirements. Hyperacusis is a condition that is observed to occur to some degree for approximately 30 to 40 percent of patients who are evaluated for TRT [4,16,17]. The process helps the examiner and patient to mutually determine the optimal course of treatment. To help conduct the interview in a standard manner, the main questions are presented verbatim at the bottom of the forms. Further, to ensure that the TRT practitioner fully understands the intent of each question, detailed explanations are provided. Typically, these patients achieve enrichment of their sound background using tabletop sound generators and other sound-generating devices [22]. They receive the same treatment as for Category 1 patients except that they are fitted with either hearing aids or ear-level combination devices that incorporate both hearing aids and sound generators. This baseline description might also be useful for the clinician to compare during and following treatment to determine if the patient's tinnitus characteristics have changed as a result of treatment.
For the TRT evaluation, it is important for patients to identify which of the tinnitus sounds is most bothersome. Such action in fact will result in the tinnitus sounding louder, because of the occlusion effect, and is reported to cause reduced loudness tolerance [29-35]. Many of these other types of treatment have no scientific basis and the patient should be educated regarding realistic expectations. Question 13 determines the amount of time patients spend thinking about their tinnitus; thus, it is specific to habituation of tinnitus perception.
The main consideration is to determine whether patients have trouble tolerating everyday sounds that are otherwise tolerated comfortably by most other persons.
It is an educational process for some patients who will gradually begin to understand how these different factors have affected their lives differentially. Other patients complain about considerable hearing difficulties that would seem incongruous with their mild hearing loss. The clinician should be aware if the patient is concurrently receiving treatment with anxiolytics or other psychotropic medications and should consider potential effects of such treatment. Patients can be told if they have shown improvement or not, but it is not advised to inform them of their previous responses. Such changes will usually involve the addition of amplification as the patient recognizes the degree to which hearing loss is a problem.


For example, if hyperacusis is the primary problem at the beginning of treatment, the treatment protocol will be specific to the hyperacusis. In most instances, patients will indicate adamantly that they would not be comfortable giving up their devices.
These revised forms now are being used in the TRT training seminars, and their clinical application will minimize variability in administration of the questionnaires. These authors therefore designed structured interviews to be a guide for acquiring information from patients and to evaluate potential changes during treatment.
Meikle and Griest emphasized the need for a single standardized instrument to assess tinnitus-related distress and resulting functional impairment. Fur die drei akutmedizinisch arbeitenden Kliniken erfolgt die Zertifizierung nach einem anderen Verfahren. Der Schritt war moglich geworden, nachdem der Erwerb der MEDIAN Kliniken durch Waterland am 15. Nachdem wir mit MEDIAN Kliniken einen zweiten Krankenhausbetreiber in Deutschland erworben haben, ist die Zusammenfuhrung unserer beiden Beteiligungen der nachste logische Schritt. Schmidt als Vorsitzender der Geschaftsfuhrung (CEO) und Herrn Roland Seebauer als kaufmannischer Geschaftsfuhrer (CFO). Schmidt, „dazu werden wir in den nachsten Wochen und Monaten mit der neuen Geschaftsfuhrung alle Standorte personlich besuchen und vor Ort das Gesprach suchen.
Die dynamische Entwicklung des wirtschaftlichen Umfelds fuhrt zu einer steigenden Anzahl von (grenzuberschreitenden) Akquisitionen und Zusammenschlussen.
Medizinische Schwerpunkte sind die neurologische, orthopadische, psychosomatische und kardiologische Rehabilitation.
Trotz Anhebung des Reha-Budgets der Deutschen Rentenversicherung (DRV) wird sich die Lage nach Einschatzung zahlreicher Experten kaum andern.
Wenn das so bleibt, steht spatestens dann unsere Infrastruktur auf dem Spiel“, warnt Achim Schafer, Vorsitzender der Fachgruppe Reha des Verbandes der Krankenhausdirektoren.
Nach Angaben der Deutschen Gesellschaft fur Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO KHC) erleiden jedes Jahr rund 8.000 Menschen hierzulande eine Verletzung des Innenohres durch explodierende Feuerwerkskorper. Durch Knalltraumen werden die Horsinneszellen, Stutzzellen und andere Teile der sogenannten Horschnecke im Innenohr bleibend geschadigt, die Spatfolgen sind oft nur noch durch ein Horgerat auszugleichen. Rund 13.000 Mitglieder machen die DTL zum gro?ten Tinnitus-Zusammenschluss in Europa und zum anerkannten Partner des Gesundheitswesens in Deutschland. Das projektierte Gesamtsystem soll kinematisch annahernd den gesamten menschlichen Korper erfassen, sich selber tragen und energieautark agieren konnen. Auf diese Weise eroffnen sich neue Perspektiven in der Entwicklung und Anwendung von robotischen Rehabilitationsgeraten. Nur noch 16% betragt der Anteil der Rehabilitanden, die regular nach einem Antrag in die Reha gelangen. Der Vorstandsvorsitzende Norbert Glahn ubernimmt ihre Arbeitsbereiche und wurde zusatzlich zu seinen bisherigen Aufgaben zum CHRO und Arbeitsdirektor der AHG bestellt. The forms have been used in a highly abbreviated format with the potential for inconsistent interview administration between examiners. The inherent variability in administering the TRT interviews can be reduced further by scripting each question. Further details regarding administration of the Initial Interview form have been provided elsewhere [6].
These patients require fewer follow-up visits than do patients in the other TRT categories.
Category 3 patients have the primary problem of hyperacusis and are treated for this condition with a specific TRT protocol that involves use of wearable sound generators or combination instruments.
The first is that the patient who has recent-onset tinnitus should be started on full treatment as soon as possible.
Constraining the psychoacoustic evaluation to the most bothersome tinnitus sound can save a substantial amount of time and, therefore, is subsequently used as a reference during the tinnitus matching procedures.
It is important for the clinician to be sensitive to the patient's potential need for psychological or psychiatric evaluation and treatment and to refer the patient as necessary [6]. Patients in Category 4 are the most difficult to treat effectively, and a specific variation of TRT is implemented for these patients [21,23]. It is thus an important issue, but the examiner must use caution during the questioning so as not to give patients the new concern that sound might make their tinnitus worse. Question 14 evaluates how much of their time they are annoyed by their tinnitus, which helps to determine if they are habituating to their tinnitus reaction.
If this occurs, patients can generally recall the types of everyday sounds that cause loudness discomfort.
The objective of these questions is to determine the patients' subjective feelings about their hearing, regardless of their hearing thresholds.
Thus, for some patients, it is simply a matter of continuing to encourage them in spite of their lack of progress. At a follow-up visit, the hyperacusis may become less of a problem and the tinnitus might become the primary concern. Question 28 is quite general in asking if patients are glad or not that they started the program.
Our hope is that this information will be useful for promoting a higher level of standardization in conducting TRT. The interview forms are a clinical tool to conduct TRT and, while not claimed as a universal tinnitus assessment technique, can potentially be used with other types of tinnitus treatment methods. Most importantly, the four questionnaires are being evaluated with respect to how the patients themselves respond to the questionnaire items. Thus, for the clinician or researcher who is actively involved in conducting TRT, we suggest that the interview forms be used along with one of the self-administered questionnaires that has undergone documentation for validity and reliability. Peter Keysser sichert durch die strukturierten Ablaufe mit seinem Team eine qualitativ hochwertige Versorgung der ihm anvertrauten Patienten. Da Stillstand im Qualitatsmanagement Ruckschritt bedeutet, ist als nachster Schritt nach dem erfolgreichen Umbau des Rheumazentrums die erneute Zertifizierung der Akutkliniken geplant, so Qualitatsmanagementbeauftragter Dr. Wir werden das Beste aus dem Erfahrungsschatz der beiden hervorragend aufgestellten Klinikgruppen – ganz im Sinne unserer Patienten und Mitarbeiter – in den kommenden Monaten vereinen.“ Auch fur die Patientinnen und Patienten andert sich nichts an der gewohnt hohen Qualitat der Versorgung. Unternehmer konnen mit Hilfe von Waterland ihre Wettbewerbsfahigkeit in einem zunehmend internationalen Umfeld steigern. Neben hoch spezialisierten Fachkliniken fur Rehabilitation sind auch Fachkrankenhauser und Betreuungs- und Pflegeeinrichtungen Bestandteil des Unternehmensverbunds.
Das wurde heute bei der Konferenz „Wirtschaftliche Erfolgsfaktoren fur Rehabiltationskliniken“ des Deutschen Krankenhausinstituts (DKI) in Berlin deutlich. Die Folgen konnen lebenslang bestehen bleiben: Tinnitus und Schwerhorigkeit, insbesondere bei hohen Tonen. Uber 800 Fachleute gehoren der DTL als Partner und fordernde Mitglieder an, darunter renommierte Wissenschaftler, HNO-Arzte, Arzte weiterer Disziplinen, Horgerateakustiker, Psychologen und Therapeuten. Im Teilsystem sollen die Neuerungen aus dem Gesamtsystem aufgegriffen werden und hinsichtlich verschiedener Ansatze der Therapie und Rehabilitation evaluiert werden. Die gute Resonanz ist auch ein Grund, warum sich die DEGEMED entschieden hat, die Kampagne bis ins Fruhjahr 2015 hinein fortzusetzen.
Die ubrigen schaffen es nur noch direkt aus dem Krankenhaus in eine Anschlussheilbehandlung (AHB).
Sound therapy is thought to be effective only when the emotional responses have been neutralized. Misophonia reflects dislike of sound [6,18] and is present in the majority of patients [17]. Furthermore, for outcomes research, standardization of wording is vital to ensure consistent administration of the interviews within and across patients and within and across examiners. The TRT Follow-up Interview form is a shortened version of the Initial Interview form because some items in the initial interview would not be relevant to evaluate treatment outcomes at follow-up visits. Category 4 patients are relatively uncommon and suffer from a condition in which their tinnitus or their hyperacusis is significantly worsened because of exposure to certain types of sounds. From a group of 784 nonveteran tinnitus patients, however, 47 percent was reported as not being able to identify any precipitating event that could be associated with their tinnitus onset [26]. When treatment is provided with TRT, the psychoacoustic characterization of tinnitus is irrelevant and is mentioned only briefly during counseling. Patients need to know that the use of hearing protection for any reason other than protection from damaging levels of sound constitutes overprotection. Many patients will report that the main problem with tinnitus is that it interferes with their hearing ability.
Habituation to both the perception of and the reaction to tinnitus would indicate that the program has been successful [1,36,37]. The responses will determine whether placement in Category 2 is appropriate, which would indicate the use of amplification.
At some point, however, the clinician and patient should mutually decide if another form of treatment is the best option.
Otherwise, there is the potential that the patient would be constantly frustrated by hearing difficulties. In such a case, the treatment effort would shift to address primarily the tinnitus condition. Such an analysis is possible because each of the questionnaires has been used in the tinnitus treatment study that is presently being conducted at the Portland VAMC. Durch gezielte Investitionen werden wir gerade die akutnahen Rehabilitationsbereiche weiter ausbauen, aber auch ma?geblich Konzepte anbieten, um Arbeitnehmer langer gesund im Arbeitsleben halten zu konnen.
Philipp Cremer wird weiterhin die Rolle des operativen Geschaftsfuhrers (COO) der MEDIAN Kliniken ausuben. Besonders oft sind Kinder, Jugendliche sowie junge Erwachsene zwischen sechs und 25 Jahren von Knalltraumen betroffen.
The expanded forms are presented in this article, and the intent of each question is explained.
Subjective hearing difficulty is a problem that patients often assume to be the result of their tinnitus [6,19].
The Follow-up Interview form also contains specific instructions for obtaining outcomes information.
This study was an analysis of clinical data from 149 patients, of which 28 of the patients reported a total absence of their tinnitus even when attempting to focus their attention on it. The sooner treatment is started, the sooner this vicious cycle can be broken and the patient's normal life can be restored. These examples represent very different kinds of problems that would indicate different strategies of treatment. If treatment is fully successful, these percentages of time will drop to zero or close to zero. For patients who were initially fitted with hearing aids, it will be important, of course, to provide appropriate follow-up care to ensure that the amplification is performing adequately. It is thus important at each of the follow-up visits to redefine the extent of each of these auditory problems. An important outcome of this effort will be an assessment of the performance of the expanded TRT interview forms in relation to the three self-administered tinnitus instruments that have been documented for validity and reliability.
Zur Sicherstellung des stabilen Ubergangs wird Herr Daniel Koch der Gesellschaft fur eine Ubergangszeit als CFO zur Verfugung stehen. Standardized administration of these interview forms will facilitate greater uniformity in the initial evaluation and outcomes analyses of patients treated with TRT.
Proper training to perform TRT requires attendance at one of these courses, which have been completed by over 300 health professionals in the United States and over 600 in other countries. In most of these cases, the hearing assessment reveals reduced hearing sensitivity of the sensorineural type. With these forms and the instructions provided herein, TRT clinicians have the tools necessary to administer the TRT interviews in a standardized fashion. If generalizable, these data would indicate that approximately half of the nonveteran tinnitus patient population do not know the cause of their tinnitus, and this may be a major reason why they seek professional help. The second school of thought is that patients should be informed of the potentially labile nature of tinnitus during its first few months.
Patients using amplification therefore should be asked any questions that would be important for assessing any problems.
Following this effort, a further revised TRT interview form may be proposed that will require testing for validity and reliability. Waterland hat Buros in Bussum (Niederlande), Antwerpen (Belgien), Dusseldorf und Munchen sowie Warschau (Polen).
Thus, most likely, the tinnitus is not causing their hearing difficulties but rather the decline in sensory cell population in the cochlea is causing their hearing loss [6,20].
This finding leads to the question, Does tinnitus of unknown onset result in greater tinnitus distress than when the cause is clearly identified? Whether or not the tinnitus resolves completely, the patient's fears may be sufficiently allayed by the hopeful information. Most likely, a generalized version of a self-administered tinnitus outcomes instrument will be developed and promoted for standardized clinical and research application.
Herr Hartmut Hain verlasst das Unternehmen als Vorsitzender der Geschaftsfuhrung der MEDIAN Kliniken zum Ende des Jahres 2014 auf eigenen Wunsch und im Einvernehmen mit den neuen Gesellschaftern. For TRT, however, the interview format will be retained for the purposes just mentioned [14].
Rahlfs dankte sowohl Herrn Hain als auch Herrn Koch ausdrucklich fur ihren personlichen Einsatz und Beitrag zur erfolgreichen Entwicklung des Unternehmens. Each patient should be treated individually, and treatment decisions should be made solely according to what will provide the greatest benefit to the patient. The common approach with TRT is that a patient with recent-onset tinnitus mainly needs a full evaluation and counseling.




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