Audiology in Czech Republic

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DEMOGRAPHIC INFORMATION

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The Czech Republic is a medium-sized, independent republic, situated in Central Europe. It was formed on January 1, 1993, by splitting Czechoslovakia into two independent republics: the Czech and Slovak Republics.  The earlier country – Czechoslovakia – came into being on October 28th, 1918, after the fall of the Austro-Hungarian Empire at the end of World War I.

The Czech Republic is a landlocked country with no direct access to the world's seas. It shares borders with the Federal Republic of Germany, Austria, Slovakia, and Poland. There are no areas within the country’s territory that are exposed to extreme temperatures, heavy rainfall, droughts or other extreme climates. Central-European weather patterns are stable throughout the country. The highest mountain peak is 1,602 meters.

In accordance with its constitution, the Czech Republic is a unitary parliamentary republic, with 10.6 million inhabitants. It is a highly developed country with an advanced, high income export-oriented social market economy. The country has a "continental" European social model, a universal health care system, and tuition-free university education. According to the Global Index of Religion and Atheism Press Release from the 21 October 2013, the Czech Republic is the 6th safest and most peaceful country in the world. It is based on the rule-of-law state with a liberal and political system based on the free competition of political parties and organizations. The head of the country is the President of the Republic, yet the highest and only legislative body is the bicameral Parliament of the Czech Republic. The government of the Czech Republic holds the highest executive power.

Based on data provided by the World Bank, the Czech Republic is ranked within a group of 31 richest countries. The Human Development Index (HDI) ranks the Czech Republic as the 28th in the world.

The Czech Republic is a strong member of the UNO, NATO, OECD, WTO, WHO, the International Monetary Fund, the World Bank, the Council of Europe, the Organization for Security and Cooperation in Europe, the European Customs Union, The European Economic Area, the Visegrad Group and many other international organizations.

The population has minimal diversity, i.e. the majority of its citizens are homogeneous both in a race (Caucasian) and religion (Christian). The capital of the Czech Republic is Prague with a population of 1.5 million. Prague is located at the center of the entire country.

Country information (source Wikipedia)

Country name Czech Republic
Population 10,436,560 (2011 Census)
Area 78,866 km2/ 30,450 mi2
GDP (PPP) 368.659 billion (2018 estimate)
Languages Czech

 

History of Audiology

In the Czech Republic, audiology is associated exclusively with otorhinolaryngology and phoniatry fields of medicine.  Audiology is studied at medical university schools where both of these fields are included within postgraduate studies.  Proficiency of knowledge is assessed by an oral examination, administered during licensing within the selected fields of specialization. In the Czech Republic, audiologists are then narrowly specialized doctors of otorhilaryngology or phoniatry.

In the Czech Republic, all audiological examinations are performed by registered nurse specialists whose first university degree in nursing (Bachelor’s degree) is enhanced by a one-year-long clinical audiology course organized by the Czech government (the Ministry of Health).  During this additional year of study, future nurse specialists acquire the theoretical and practical knowledge of basic audiological examinations.  Further specialized audiological examinations are always performed by licensed physicians. The experts in charge with the hearing aid fitting and audiological rehabilitation are phoniatrists.

It is widely recognized that the founder of the Czech audiology is prof. Karel Sedláček, the author of the textbook Basics of Audiology in 1951.  Other important persons in the field of audiology include the authors of practical audiology textbooks: Bargár, Brom, Kollár, Novák, Lejska, Dršata, Havlík and others.

Hearing loss incidence and prevalence

 

The frequency of hearing loss in the population increases with age. Precise statistical data is not available. It is thus important to assess prevalence in relationship to the severity of hearing impairment. The data depends on the definition and criteria determining hearing loss. The WHO applies its estimates for the adult population based on so-called "disabling" hearing impairment (hearing loss greater than 41 dB at 0.5 – 4.0 kHz on the better ear), which represents relatively a significant hearing loss. The estimates for the Czech Republic are about 0.5 million hearing impaired (5%), most of which are elderly individuals. About 15,000 hearing impaired people either were born with hearing loss, or acquired hearing loss during childhood (0.15%), less than 8,000 children of which have significant or complete deafness. There are about 7,300 sign language users in the Czech Republic.

At present, similar statistics can be deduced from the number of issued and/or registered hearing aids. In the Czech Republic, vast majority of hearing aids are fit monaurally (with the exception of children bellow 18 years of age). Around 30,000 hearing aids are issued annually.

INFORMATION ABOUT AUDIOLOGY

Education

As previously mentioned, in the Czech Republic the field of audiology is exclusively associated with the medical specialization of Otorhinolaryngology, with field of Phoniatry and Audiology as a broadening specialization.

In the Czech Republic, general medical education is studied exclusively at state-owned medical schools. Currently, there are 7 state-owned university medical schools in the country. After completing the general medical education, graduates are admitted to hospitals, where, in addition to a general overview, they begin to work in the area of their future specialization. The basic specialization for audiology is ENT. The length for this specialized training is 5 years. Higher education in audiology is broadened by additional specialization in phoniatry and audiology, which is studied as a superstructure to the basic specialization of the ENT and takes 2 years to complete (5 years ENT + 2 years Phoniatry and Audiology).

At present, there are approximately 1,200 physicians with ENT specialization and approximately 120 physicians specializing in Phoniatry and Audiology. Thus, there is approximately one ENT physician per 8,000 citizens of the Czech Republic and one phoniatry doctor per 80 – 100,000 individuals.

Postgraduate education and continuous education for achieving the specialization in Phoniatry and Audiology are provided by both individual phoniatry clinic and state-owned Institute for Postgraduate Medical Education.

A part of the audiological care is done by registered audiology nurse-specialists. Their specialized training takes one full year to complete and the course includes both theoretical facts about audiology and practical training in basic audiological diagnostic methods.

Hearing rehabilitation including hearing aids fitting is exclusively in the hands of doctors. In the Czech Republic, there are no shops offering hearing aids commercially. All paid care is carried out in accordance with health insurance by medical experts. Hearing aids can be tested, allocated and fitted only by phoniatry/audiology physicians and/or ENT doctors with a specialized certification. Today there are about 300 hearing aid issuing points in the whole country.

 

Technical audiology is the field of expertise of university-educated engineers who have been trained in the specialized technical audiology course. This one-semester course is organized by the Institute for Postgraduate Medical Education. None of these types of audiology specializations is associated with an academic degree.

 

Audiology Practice: Public Vs Private

The health care in the Czech Republic is fully covered by government health insurance. Health care is predominantly free of charge and can be provided by both state-owned private subjects.

Audiological examinations, i.e. Hearing examinations and diagnostics, can be performed at each and every ENT and/or phoniatry office in the country. At present, there are around 850 such locations capable of offering this kind of specialized examinations. Only about 1 in 20 audiological workplaces are owned and operated by the state. Thus, the vast majority of audiological examinations are in the hands of private subjects.

In the Czech Republic, standardized hearing screening for the smallest children as for the most vulnerable groups was introduced at the end of the 1990s. General hearing loss screening of all new-born children was introduced in 2012 by the Ministry of Health. The screening is performed on three levels. The first level examination is taken right in maternity hospitals by means of OAE. In case of hearing loss suspicion, the second level examination is carried out at ENT or phoniatry offices. The final screening, as the third level, is provided at specialized centers for the youngest children on the basis of specialized hearing examinations, identifying defects and hearing disorders.

Just about half of the youngest patients are cared for in large hospitals by phoniatry workplaces that may be either separate or bound to ENT departments. In the other half of the cases, private audiology/phoniatry centers provide care to the smallest children who are diagnosed there and treated for the hearing impairment.

Correction of auditory defects in children under 7 years of age is permanently and exclusively in the hands of phoniatry physicians. Binaural corrections are performed and the baby's communication skills are regularly monitored. It is phoniatry doctors who decide on the specific aftercare - hearing aids or Cochlear implants.

In the Czech Republic, the use of Cochlear implants dates back to 1993. Currently, there are 4 clinical workplaces offering this kind of patient treatment and care. Overall, about 1000 successful implant surgeries have been performed in the last 24 years. Subsequent care for these patients falls again into the hands of phoniatry physicians.

Preventive audiology focuses on observing and examining workers in noisy environments. The primary focus of this service is a timely diagnosis of hearing-sensitive workers who are in need of protection or even elimination of any harmful noise to prevent their hearing from any further damage. The workplaces and environments which are included in this preventive audiological care are based on noise measurements taken by the State Health Administration. Once the noise level study is concluded by the State Health Administration, the organization, diagnosis, and implementation of this preventive care for its workers becomes a sole responsibility of the individual companies and/or firms the employees of which are exposed to a high noise level.

The correction of adult hearing impairments is carried out through phoniatry or ENT doctors. In the Czech Republic, there is no specialized technical profession for the correction of auditory hearing defects. All of the associated services and care for adults are in the hands of medical doctors - diagnostics, indication, selection, testing and fitting of hearing aids. Hearing aids are issued in 300 workplaces across the whole Czech Republic. Only 120 phoniatry doctors can correct hearing impairments with patients in children’s age (0 – 7 years).

Hearing aids are issued within the compensatory guidelines of general health insurance.

 

Services offered by Medical Professionals

Otolaryngology offers all types of diagnostic and therapeutic methods in the Czech Republic, both medical and surgical. There is no type of otological surgery that could not be performed in the Czech Republic. These are surgical remedies for congenital malformations, splits, somatic ear surgeries, plastic surgeries for hearing impairment, and even surgical corrections of the inner ear and in the bridge-cerebellum (cochlear implants see above).

More than 90% of all surgeries are performed in public hospitals, as hospitalization is required. Outpatient surgeries (without overnight hospitalization) are performed at private practices.

Otoneurological care, which is part of both otological and neurological specializations, is also significantly developed in the Czech Republic. Imaging methods are widely and broadly distributed throughout the Czech Republic and the examinations have become the golden standard.

In the Czech Republic, phoniatry care only includes conservative methods of diagnostics and rehabilitation care for patients with hearing, voice and speech disorders. The standard is that hearing is examined for all age groups of the population, including the youngest children. The methods that used are behavioral and, of course, objective. Voice problems are diagnosed with sophisticated instruments such as laryngoscopy and stroboscopy, high-speed video laryngoscopy, videokymography, and voice analysis of various types, which are all prerequisites for more overall and comprehensive diagnoses of voice disorders. In the Czech Republic, the treatment of speech disorders, both congenital and acquired, is highly developed and is enriched by extensive rehabilitation and therapy in conjunction with speech therapy. 

Audiological Services

The basic system of medical care in the Czech Republic is a general structure of primary care provided by general practitioners (GP), which is divided into an adult on one side, and children and adolescents on the other. Each patient diagnosed with a medical problem starts their treatment with their GP, who, if the patient's condition requires a specialized kind of health care, further directs the patient to a specialist. The same is true in audiology.

The first medical specialist with whom a hearing-impaired patient comes in contact is usually an ENT physician or a phoniatry doctor in private practice. Basic ENT and audiological examinations are performed there. If surgery is required, the patient is dispatched to state-operated hospitals to perform the surgical otology needed.

In the Czech Republic, there are highly specialized centers of ENT, phoniatry, audiology or otoneurology, where the most complex diagnostic and rehabilitation processes are performed.

Research in Audiology

In the Czech Republic, there is an important research facility which deals with the basic research of the hearing functions and individual parts of the hearing organ. It is a state-run workplace of the Academy of Sciences of the Czech Republic, where professional researchers are employed. Auditory neurophysiology, morphology, physiology, and pathology of the inner ear, the development of the auditory system, aging of the auditory system, experimental audiology, and magnetic resonance imaging are the primary subjects of the research and development.

Main research topics include the function of the stria vascularis, effect of noise on the auditory system, structure, and function of the descending auditory pathway, processing complex acoustical signals including vocalizations, plasticity in the auditory system, development of the inner ear, presbycusis, and tinnitus.

Applied Research Program

The programs are related to individual university settings. The specializations of the current research can be summed up in the following items:

  • screening of hearing in the youngest children
  • screening of hearing in children of pre-school age
  • differential diagnosis of the hearing impairment in the smallest children
  • hearing diagnostics of many affected children
  • objective and behavioral examinations
  • hearing corrections
  • follow-up care post-hearing correction

Current Major Projects

The main objective of audiology, just like all medical disciplines related, is the promotion of general awareness of hearing impairment in the population. An average Czech person lacks the sufficient knowledge or understanding of hearing impairment, especially how significantly impacted the life of a hearing-impaired individual is by such a disability. It is the primary task of all parties concerned with audiology and otology to increase and broaden basic recognition of hearing loss impact on one's everyday life quality. Local and regional activities are introduced to emphasize the needs associated with human hearing.

The main focus here is the prevention and preventive approach to finding, diagnosing, early and effective treating, rehabilitation, and correcting defects and hearing disorders. In addition to the screening programs for newborns already established, there is also a comprehensive survey of pre-school aged children´s hearing.

An important part of care for hearing impaired patients is the organization of care and its inclusion as part of general disability insurance coverage. Discussions with the main provider, the General Health Insurance Company of the Czech Republic, regarding the development of audiological methods, especially preventive ones, are a permanent part of the work of Czech Audiology. The most pressing problem today is the lack of compensation for correction of auditory defects, especially the much needed binaural corrections.

PROFESSIONAL AND REGULATORY BODIES

The General Health Insurance Company, and the government administrated bodies both regulate the health policies of the country and massively influence the nature and type of the offered healthcare by means of the reimbursement of both healthcare cost and corrective aids.

On the other hand, there are professional organizations that lead, direct, correct and cultivate the field of audiology in terms of organization and expertise. The Czech Medical Society Jan Evangelista Purkyně is the supreme medical body of the Czech Republic. A significant component of this company is the Professional Society of Otorhinolaryngology and Head and Neck Surgery. It is governed by an 11-member committee. Members of the Committee are elected by all ENT physicians for 4-year terms. The Society of Otorhinolaryngology and Head and Neck Surgery of the Czech Republic segregates within its internal organization into professional sections. One of these sections is the fully autonomous Section for Phoniatry and Audiology, headed by a 5-member committee led by a president.

The Section for Phoniatry and Audiology organizes a national congress once a year and phoniatry and audiology tutorials four times a year. One of the section´s duties is maintaining a website presenting all necessary information. The Section for Phoniatry and Audiology has its own independent accreditation committee at the Czech Ministry of Health.  This committee supervises the professional level expertise of specific practices and workplaces, as well as that of individual physicians through the process of two-stage accreditation awarded to postgraduate education in the field. The same section for phoniatry also has its own certification committee, which verifies the knowledge of candidates for phoniatry and audiology for the whole Czech Republic. The current chairman of the Section for phoniatry and audiology of the Czech Republic is as. Prof. Mojmir Lejska, PhD., MD., MBA.

CHALLENGES, OPPORTUNITIES AND NOTES

  • Audiological care in the Czech Republic covers all regions.
  • In the Czech Republic, there are fully equipped individual workplaces, which only differ in the level of the care provided.
  • In the Czech Republic, there are enough specialized doctors and specialized audiometry nurses.
  • Audiological care for patients is available to every citizen.
  • Audiology is fully in the hands of the ENT physicians and phoniatrists.
  • The examinations of defects and hearing disorders and the correction of hearing defects are mostly included within outpatient care, both in state and private spheres.
  • Surgical procedures are only available only through state-run hospitals within ward hospitalization.

REFERENCES

ACKNOWLEDGEMENTS

Thank you to Mojmir Lejska, M.D., Ph.D., MBA for assistance with editing this article.

MEET OUR AUTHORS

 

 

Prim Radan Havlík, MD, PhD. is an important Czech doctor of phoniatry and audiology. He is the medical head of the AUDIO-Fon Center, the largest Czech phoniatric-audiological workplace. He is the head-trainer for Czech and Slovak physicians in the preparation for phoniatry and audiology. He is the senior head of the educational course in audiometry. He has published more than 30 professional works and has delivered more than 150 lectures. He is a co-author of the most up to date audiology textbook in the Czech Republic.

Email: radan.ha@seznam.cz; audio.fon@volny.cz

Website: www.audiofon.cz