Around 3,500 people receive a cochlear implant in Germany every year – with increasing tendency. At the Medical University of Hannover (MHH) alone, approximately 500 individuals with severe to profound hearing loss are now implanted every year. Many of them prefer to have their follow-up care close to home while at the same time benefiting from the expertise of the implanting centre. This is why we have established a ‘remote care’ programme, which enables patients to have their speech processor fitting carried out remotely at the practice of a local ENT physician in accordance with strict quality assurance criteria.
The technology used for this purpose was developed by auric Hörsysteme, a company based in Rheine (Germany). The firm provides a recently developed CI remote-fitting system featuring real-time HD video transmission. The expert audiologist’s computer is equipped with two monitors, and the patient has a screen showing the audiologist via video link. A microphone and free-field loudspeakers or headsets are provided for communication purposes. If there are any comprehension problems, a chat function with a keyboard is also available.
Present with the CI recipient are technically trained staff who connect the speech processor to the remote-fitting system and assist throughout the fitting process. The fitting is carried out by an experienced audiologist – as a rule, a member of staff of the German Hearing Centre (Deutsches HörZentrum, DHZ). Because of the quick reaction time and the high-definition image and sound quality of the remote-fitting system, it seems to the CI recipient as if he or she is actually sitting across from the audiologist. For the audiologist, on the other hand, the operation of the fitting software also ‘feels’completely normal.
After completing the fitting process, the usual hearing tests are carried out. The testing environment of the local ENT practice must meet the requirements of the DHZ so that the test results can be compared to previous results. At the end of the session, the test data is automatically transmitted to the central DHZ database, ensuring that all documentation and monitoring of the patient is complete. The database is even able to detect unexpectedly poor results automatically and suggest a more detailed investigation of possible causes at the DHZ. The required medical follow-up care of the CI recipient is provided by local ENT physicians who belong to the remote-care network.
A prerequisite for taking part in the remote-care programme is that a CI recipient must have three years’ experience with their implant, so that the fitting can be assumed to be more or less stable. Less experienced patients are recommended, for the time being, to continue to visit their implanting centre.
Patients who wish to continue to receive their future fitting at the DHZ are of course most welcome to do so. For all individuals implanted at MHH, it remains the case that initial fitting must be carried out at the DHZ as this requires fitting, therapy and medical check-ups to be closely linked over a period of five days. As this can only be provided by an experienced and well-coordinated interdisciplinary team with access to all available data for the patient, there is no way the initial fitting can be provided remotely.