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Table 1: Country information [Source: Wikipedia]
|Country name||Grand Duchy of Luxembourg|
|Area||998.61 sq. miles/ 2,586 km2|
|GDP (PPP)||$58.234 billion|
|Languages||Luxembourgish, French, German|
Luxembourg is a landlocked country between France, Germany, and Belgium and is about the size of the American state of Rhode Island. Its location has shaped its culture and language. It is common for Luxembourgers to speak Luxembourgish, French, and German. The major religion of the country is Roman Catholic. Historically, Luxembourg was home to much iron-ore industry and has since become one of the financial hubs of Europe. Luxembourg City hosts one of the European Union’s official capitals. The country’s political system is a representative democracy with a constitutional monarch. The Grand Duke of Luxembourg is currently Grand Duke Henri.
HISTORY OF AUDIOLOGY
There are limited audiology services in the country. Because of its small size, Luxembourg relies heavily on neighboring countries (France, Belgium, and Germany) for most services.
INCIDENCE AND PREVALENCE OF HEARING LOSS
World Health Organization considers Luxembourg as part of the High Income Region of the world. This region has 11% population with disabling hearing loss (0.5% of children, 4.9% of adult males, and 4.4% adult females). These estimates are nearly half of other regions. In high income regions, such as Luxembourg, about 18% of adults 65+ years old have hearing loss, compared to 26-48% in other regions. In 2015, the Luxembourg population of 65 years and older was 14.1% of the total population and 7.6% self-reported hearing loss.
INFORMATION ABOUT AUDIOLOGY
Specific programs for audiology are not currently available in Luxembourg. Cross-border apprenticeships to become a hearing aid specialist or speech pathologist are offered in conjunction with programs in Belgium, France, or Germany.
Since Luxembourg is a relatively small country compared to its neighbors (France, Germany, and Belgium), not all services are offered. Those that are offered are often covered by the state.
Patients in need of hearing aids first see an otolaryngologist (ENT) who confirms the need for a hearing aid. The patient then contacts Audiology Service Government sector and requests reimbursement from the National Health Department (Caisse Nationale de Santé (CNS)). When reimbursement is approved, the department schedules an appointment for the patient at a regional center. The patient meets with a hearing aid specialist (audioprothésiste) to complete a hearing test and determine the appropriate hearing aid. The patient receives a voucher for the price. Then the patient will return for a hearing aid fitting appointment. Finally, the patient will receive a letter to take to the ENT to have signed so that he/she can be reimbursed by the Health Department.
The few who do specialize in audiology and return to Luxembourg are responsible for infant through adult hearing healthcare. They perform audiometric assessments, otoacoustic emissions (OAEs), auditory evoked potential (AEP) testing, and auditory steady state response (ASSR) testing.
A small group of ENTs complete comprehensive audiologic evaluations, vestibular evaluations, cochlear implant surgeries, and consultations for tinnitus, hearing loss, and vertigo. Pediatric evaluations are often handled outside the country; however, there is a school where hearing impaired children can study and receive additional services.
Table 2: Ear and Hearing Care Professionals in Luxembourg
|Professionals||Approximate number||Ratio to the population|
|Speech-Language Pathologists||80||1: 7,203|
|Hearing Aid Specialists||20||1: 28,812|
Otolaryngologists (ENTs) perform audiometry, OAEs, tympanometry, auditory evoked potentials (AEPs), hearing aid evaluations, vestibular evaluations, and vestibular therapy.
Otologists perform surgeries for otosclerosis, ossicular chain reconstruction, bone anchored hearing aids, tympanic membrane perforations, and cholesteatomas. Although, most of these services are offered more frequently in neighboring countries (Germany, France, Belgium).
There do not appear to be neuro-otologists in Luxembourg.
Hearing aid evaluations and fittings are widely available through hearing aid dispensers and ENTs.
Cochlear implant services are generally offered in the neighboring countries of Germany, France, and Belgium.
Pediatric audiology services are offered in Germany, France, and Belgium. There is one school for children with hearing and learning difficulties (Centre de Logopédie), where children obtain services. Children can also obtain hearing aids through hearing instrument specialists trained in fitting pediatric patients.
Vestibular assessments are offered by audiologists, physical therapists and nurses.
Tinnitus services are offered by hearing instrument specialists.
Free screenings services are offered at 6 months, 30 months and in preschools by speech and language professionals.
PROFESSIONAL AND REGULATORY BODIES
There are no professional or regulatory bodies for audiological services in Luxembourg
SCOPE OF PRACTICE
There are not specific audiology programs in Luxembourg.
Hearing aid specialists are trained through cross-border apprenticeships.
ENTs are trained outside of the country in Belgium and France.
The school for children with hearing and language difficulties (Centre de Logopédie) has philanthropic initiatives.
There is also the Home of the Deaf (Maison des Sourds) that offers services for the hearing-impaired population.
CHALLENGES AND RESEARCH
Luxembourg is a small country and is surrounded by France, Belgium, and Germany that have established services for hearing healthcare. It is convenient for patients to travel across the border for services and training programs.
Audioprothésiste: Présentation du métier. Hands Up. Retrieved July 15, 2017, from www.handsup.lu/fr/metiers-formations/listing/fiche-metier/metiers-de-la-mode-sante-hygiene/audioprothesiste
Centre de logopédie. (2017). Centre De Logopédie. Retrieved July 15, 2017, from www.logopedie.lu/
Doctors in Luxembourg. (2017) Expatica. Retrieved July 15, 2017 from www.expatica.com/lu/healthcare/doctors-in-luxembourg_1149916.html
Engel de Abreu, P. M. J., Cruz-Santos, A., & Puglisi, M. L. (2014). Specific language impairment in language-minority children from low-income families. International Journal of Language & Communication Disorders, (49)6, 736-747. onlinelibrary.wiley.com/doi/10.1111/1460-6984.12107/pdf
Health care systems in transition: Luxembourg. (1999). European Observatory on Health Care Systems. www.euro.who.int/__data/assets/pdf_file/0007/95128/E67498.pdf
Hild, J. (2017) Historique de L'ALO. L'orthophonie Au Luxembourg. Retrieved Month Date, Year from www.alo.lu/index.php/en/l-association/l-historique-de-l-orthophonie-au-luxembourg
Laureyns, M., Best, L., Bisgaard, N., & Hougaard, S. (2016). Getting our numbers right on hearing loss: Hearing care and hearing aid use in Europe. EHIMA. www.ehima.com/wp-content/uploads/2016/09/Getting-our-numbers-right-on-Hearing-Loss-and-Hearing-Care-26_09_16.pdf
Luxembourg. (n.d.) Wikipedia. Retrieved October 1, 2017 from en.wikipedia.org/wiki/Luxembourg.
Oto-rhino-laryngologie et chirurgie cervico-faciale. (2017). CHL Eich. Retrieved July 15, 2017, from eich.chl.lu/fr/service/oto-rhino-laryngologie-et-chirurgie-cervico-faciale
Oto-rhino-laryngologie et chirurgie cervico-faciale pédiatrique. (2017). CHL. Retrieved from www.chl.lu/fr/service/oto-rhino-laryngologie-et-chirurgie-cervico-faciale-p%C3%A9diatrique
Perte auditive. (2016, April 8). Sante. Retrieved July 15, 2017 from www.sante.public.lu/fr/prevention/seniors/oreilles/index.html
Rapport Annuel 2014. (2014). CHL. www.chl.lu/sites/chl/files/files/divers/Rapport-annuel-CHL-2014-planche.pdf
Service audiophonologique. (2016, April 8). Sante. Retrieved July 15, 2017 from www.sante.public.lu/fr/politique-sante/ministere-sante/direction-sante/service-audiophonologique/index.html
WHO global estimates on prevalence of hearing loss. (2012). WHO. www.who.int/pbd/deafness/WHO_GE_HL.pdf?ua
- School for Hearing and Learning Impaired Children (Centre de Logopédie): http://www.logopedie.lu/
- Home for the Hearing Impaired (Maison des Sourds): http://www.lureso.be/page/fiche.php?id=778&nom=Maison_des_Sourds_de_la_province_de_Luxembourg
- Luxembourg Hospital (Centre Hospitalier de Luxembourg): https://www.chl.lu/fr/service/oto-rhino-laryngologie-et-chirurgie-cervico-faciale-p%C3%A9diatrique
Devon Beebe Palumbo graduated from the University of Texas at Dallas with her Doctor of Audiology degree. She enjoyed being a part of this group and looks forward to contributing to further parts of this global initiative.
Thanks to Oticon and their partnerships abroad for providing valuable information.