Have you ever helped someone with rehab?
Tinnitus - an expert answers
"I hear something that you don't hear": Tinnitus & Co. - Dr. med. Volker Kratzsch answers frequently asked questions about the symptom Tinnitus.
Is my tinnitus really a ringing in my ear? The story of a patient.
Ms. S. is 56 years old, married, 2 sons (24 & 26 years old), and heads the human resources department of a medium-sized company. When asked, it turns out that Ms. S. is the only employee in the HR department, but is also responsible for accompanying the trainees, looking after institutions and current project tasks. The work has increased continuously in recent years, it has had to take on more responsibility, and the promised personal support has not materialized. As a further stress factor, Ms. S. has to support her parents in many everyday activities (e.g. shopping, doctor's appointments).
The reason for admission to our clinic is a sudden hearing loss 6 months ago with severe left inner ear hearing loss and chronic tinnitus with sensitivity to noise. The infusions and tablets prescribed by the ENT doctor did not lead to any noticeable improvement, which is why she did not go to the doctor later. She was on sick leave for 5 days, "more was just not possible". Since then, she has been sleeping much worse than before, often lying awake at night, brooding over the tasks of the past and coming day, or having fears about the future. For many interests and hobbies, also maintaining contacts with friends, she no longer has the strength, even a vacation has not brought any real relaxation.
Admittedly, not every patient in our clinic has such a classic history of suffering as Ms. S., but this situation is not an exception. We would like many of those affected - perhaps also the doctors treating them - to perceive the health crisis that has developed here earlier and for someone to simply say "STOP". Usually the diagnosis of burnout is then made. The correct diagnosis would be exhaustion depression, but the term depression has as negative connotations as the term burnout reflexively evokes understanding.
We like to say that Ms. S. "has a lot going on that leads to tinnitus between the ears". Behind this is the knowledge that the translation of the term tinnitus as noise in the ear is simply incorrect: Tinnitus is a noise that the person concerned perceives, but which is not caused by an external source of noise. But because we have made the experience from childhood that all auditory impressions are received through the ears from the outside, everyone speaks of a noise in the ear. However, this impression that tinnitus originates in the ears is wrong. According to scientific knowledge of the last decades, tinnitus develops in the area of the brain, we will go into more detail about it later.
As a further consequence, this misjudgment also leads to therapeutic approaches that are aimed at the ear being accepted by the patient as being targeted and causal. Unfortunately, this assumption is also used by many therapies circulating on the Internet that suggest tinnitus can be eliminated in this way. This usually leads to not very cheap and completely pointless efforts on the part of those affected to get rid of the noise in their ears. Unfortunately, the result is a kind of vicious circle of frustration, combined with increased suffering. The tinnitus increases with increasing attention in the subjective loudness, so the suffering becomes more and more stressful and the search for new, safe therapies more and more urgent. We call this a downward spiral of tinnitus. Since you are offered around 20 million links on the Internet when you enter the term tinnitus on "Dr. Google", the confusion and despair increases exponentially here rather than decreasing. At this point, a serious tinnitus therapy starts with information and education in order to stop this spiral and to separate the many pointless from realistic efforts.
How long has tinnitus been around?
Anyone who thinks tinnitus is a topic of the 20th or 21st century is wrong. The oldest sources on tinnitus date from around 1,000 BC. Even then, attempts were made to treat tinnitus:
"When the hand of the spirit seizes a man and his ears sing, you shall grind myrrh, roll it up in wool, and sprinkle it with cedar blood."
Then a spell was to be cast. Hippocrates (460-370 BC) wrote about the cause of tinnitus as a pathological disturbance of the inner harmony and the biological balance of the human being. The term tinnitus comes from Latin: tinnire means whistle, ring the bell.
At the time of the Romans, tinnitus was considered an honor of the gods: the idea was that tinnitus represented an encoded divine message that the person affected should now reveal to his fellow human beings. Martin Luther suspected that the devil was responsible for his tinnitus, Vincent van Gogh and Ludwig van Beethoven are other well-known historical examples. The most famous doctor of the Middle Ages Paracelsus (1493-1541) first described a connection to noise damage and hearing loss. Today, musicians such as Phil Collins, Campino or Bono are often mentioned tinnitus sufferers.
Symptom or illness?
Modern tinnitus research begins with a study of two Americans (Heller, Bergman 1953) who were able to show that in principle everyone has tinnitus, but that it is usually not noticed. Estimates assume that around 3% of the population in Germany have chronic tinnitus, but only half of these people (around 1.5 million) suffer from it. The first good news is that this research and figures show that many people have tinnitus but few have it. In addition, many patients lose their tinnitus again without any therapy: in the acute phase (within 3 months after first occurrence) 70-80%, the tinnitus persists for longer than 3 months (the doctor then speaks of chronic) at least 15% per year .
The second good news is that tinnitus can be annoying, but tinnitus is not a disease. H. it does not cause any damage (nothing breaks, not even hearing) and, as a rule, the subjective burden decreases over time. We speak of tinnitus as a symptom in medicine; H. Tinnitus, like pain, is a sign of the body; B. that we are out of balance. The cause of this must be clarified by a doctor.
My tinnitus: what kind of one - sometimes several - sound (s)?
Tinnitus can be perceived on one side, on both sides or in the middle of the head. The localization has nothing to do with the origin of the noise: tinnitus in the right ear does not mean that the tinnitus arises in the right ear, but only that we perceive it there. In addition to the frequent high frequency Whistle in the ear, which most patients report, is also Hum, Noise, to hum, Rare Rattle or Screeching possible.
Both the subjective loudness and the noise can change. Several tones can occur, some of which are constant or only temporary. Tinnitus must be differentiated from hallucinations or delusions if patients B. report on voices or pieces of music in the head. We know from research that objectively the tinnitus is not really loud; H. Even if the person concerned reports a very distressing, loud tinnitus, the noise can usually be masked from the outside at a low volume.
... but my tinnitus is so incredibly loud ...
Usually the tinnitus depends on the hearing threshold, i. H. If the hearing ability is normal, the tinnitus can be covered with a tone / noise of 2 to 20 dB.
In the case of a hearing loss, the threshold for coverage is then: Hearing threshold for the hearing loss plus 15 dB (e.g. for moderate hearing loss, hearing threshold 50 dB, coverage with up to 65 dB). As a rule, the tinnitus frequency is in the frequency range of the greatest hearing loss.
There is no connection between the indication of the coverage in dB and the subjective loudness that the patient perceives: a tinnitus coverage of 2 dB above the hearing threshold can be perceived as unbearably loud as 20 dB. Or vice versa, a coverage of 20 dB can perhaps be described without any exposure to the patient.
In summary, this means that the subjective loudness that the patient perceives cannot be measured objectively by hearing tests. Again, the reference to the good news: No matter how loudly you perceive your tinnitus, it can never damage your hearing.
Why does my tinnitus seem to bother me more than others?
The stress arises from the evaluation of information in the brain. We know today:
- Many regions of the brain, we speak of a neural network, are involved in the development and assessment of tinnitus. Evaluation processes in the thalamus (midbrain), which control our attention and emotions, seem to be important.
- These assessment processes are quite similar for pain and tinnitus.
- Stress can significantly increase the perception of tinnitus through changes in this network.
- Anxious and / or depressed people are more at risk of suffering from tinnitus for a long time.
- Therapeutically, approaches to change the assessment of the tinnitus and a reduced attention to the tinnitus are therefore promising (e.g. through relaxation training, exercise, behavioral therapy).
What can be the causes of my tinnitus?
We differentiate between physical and emotional causes, and it is not uncommon for us to be able to identify them clearly. By far the most common physical cause is hearing loss, which in turn can have very different causes. The background to this is that the loss of hearing impressions in certain frequencies can no longer mask the tinnitus, which is practically a background noise in all people. This is also the explanation why people who cannot hear (deaf people, deaf people) often suffer from tinnitus. Therapeutically, the provision of a hearing aid promises the renewed masking of the tinnitus noise in the perception by restoring hearing impressions in the case of hearing impairment. Many hearing impaired people therefore report that the use of a well-fitted hearing aid has significantly reduced their tinnitus.
1. Physical causes
- all forms of hearing loss, including by
- Sudden hearing loss
- chronic inflammatory processes of the ear (otitis)
- chronic noise damage or a bang dream
- Meniere's disease (hearing loss, tinnitus, attacks of dizziness)
- Old age hearing loss
- Ventilation disorders of the middle ear
- Injuries to the eardrum
- rare causes
- Functional disorders of the cervical spine and shoulder-neck muscles
- Functional disorders of the temporomandibular joint
- internal diseases, e.g. B. high blood pressure, metabolic diseases
- neurological diseases, e.g. B. multiple sclerosis, acoustic schwannoma
- very rare: objective tinnitus, e.g. B. by flow noises from vessels
2. Mental causes
- Anxiety disorders
- Stress in the context of unresolved chronic conflicts in the professional or private environment
Effects of tinnitus - what is the cause, what is the consequence?
At first glance, the question seems simple to many patients: They are convinced that tinnitus is responsible for many other stress factors, which are listed in the illustration. The direction of the arrow would therefore always lead away from the tinnitus to the other stresses.
For example, one common complaint is "I've been sleeping very poorly since I got tinnitus". When asked, however, it often turns out that even before the tinnitus, sleeping was not really good, i. H. On the one hand, a sleep disorder can increase the burden of tinnitus, on the other hand I sleep worse if the tinnitus is annoying at night. It is difficult to fall asleep because of the tinnitus, but does not wake up at night because of the tinnitus, but rather wakes up and often does not fall asleep again because of the tinnitus. The relationship is therefore more complex than the patient perceives. The interaction with tinnitus applies to all stress factors listed here except for hearing loss: it has already been explained here that the hearing loss can cause the tinnitus, but never makes tinnitus hard of hearing. This means that influencing the stresses related to tinnitus in both directions comes closer to the real situation. It follows inevitably that the patient's hope or expectation that if the tinnitus were eliminated, all other complaints would also disappear, is unrealistic.
Going further, there are many studies that suggest that tinnitus is one stress symptom among many. It would therefore be better to focus on stress as a trigger, which can intensify various stress factors, which then themselves act as stressors. One of these physical symptoms would be tinnitus.
In addition, possible social consequences of exposure to tinnitus also need to be taken into account in the context of outpatient or inpatient rehabilitation:
- Stress in the private or professional environment due to the illness and its consequences
- if applicable, long periods of incapacity for work, threatened incapacity for work
- social isolation
- financial distress due to loss of income
What exams should be done for tinnitus?
At the first occurrence of tinnitus (acute tinnitus) is yours ENT doctor first point of contact. He examines the ears, the entire hearing and other organs. In an interview, he collects the previous medical history. He asks about the beginning, about possible triggers such as noise exposure or stress and about previous illnesses. He will also let you describe the noises in your ears precisely. The following examinations are usually carried out:
- Examination of the ear (ear microscopy) and the nasopharynx
- Listening test (sound, if necessary, also speech audiometry)
- Tinnitus matching to identify the volume and frequency of the sound
- in hyperacusis: determination of the discomfort threshold
- Brain stem audiometry to check the auditory nerve (FAEP)
- Hair cell function test (OAE)
- Functional test if necessary: teeth or jaw misalignments, high blood pressure and problems of the cervical spine / shoulder-neck muscles, balance test
At chronic tinnitus (longer than 3 months) we recommend performing a one-time computed tomography or magnetic resonance tomography of the cerebellopontine angle to reliably rule out an acoustic schwannoma.
Which therapy is useful when?
The S3 guideline "Chronic Tinnitus" published in 2015 by the German Society for ENT Medicine, Head and Neck Surgery provides detailed information on the current status of therapy recommendations. In addition, in cooperation with several European tinnitus research groups, the first European tinnitus guideline for diagnosis and therapy was developed, which was published in March 2019:
Despite all the guidelines, therapy must always take into account the individual needs of the individual.
1. acute tinnitus
If a new tinnitus occurs, the doctor (ideally the ENT specialist) should be consulted within 5 working days. The doctor will then arrange the examinations listed above and advise you on how to proceed. A distinction must be made between two essential situations:
- acute tinnitus With Newly occurring hearing loss with no apparent cause:
This corresponds to the definition of sudden hearing loss (sudden hearing loss without an identifiable cause) with additional tinnitus. The hearing loss is now treated with short-term, high-dose cortisone administration (as a tablet or syringe for approx. 1 week or once locally behind the eardrum). The hope is that as hearing improves, tinnitus perception will also decrease. In addition, sick leave, exercise, relaxation.
- acute tinnitus without newly developed hearing loss:
Specific therapy for tinnitus with tablets or infusions is not available. Information, sick leave, exercise, relaxation are advised.
2. chronic tinnitus
Chronic tinnitus sufferers should be differentiated from tinnitus patients:
- Tinnitus sufferers: Have tinnitus that has persisted for more than 3 months without significant impairment of quality of life ("I have tinnitus, it would be nice if it went away, but I can essentially handle it.").
- Tinnitus patients: Have tinnitus that has persisted for more than 3 months with a marked reduction in quality of life ("Since I had tinnitus, I have slept poorly, have difficulty concentrating, I am sensitive to noise, irritable.")
In the case of tinnitus sufferers, it is primarily a matter of performing the above. Diagnostics to rule out a physical or emotional cause, extensive information on the subject of tinnitus and the reduction of fear and insecurity. Specific therapy is often neither necessary nor useful.
For people who are clearly impaired by tinnitus and a restricted quality of life, a multimodal therapy concept has proven itself. It should be communicated at the beginning that the patient's understandable hope or expectation of a cure from tinnitus through no therapeutic interventions can realistically be promised. The first and most important step on the way to improved tinnitus acceptance is therefore Agreement on an achievable therapy goal: The tinnitus patient should develop a way of dealing better with tinnitus and the subsequent symptoms through experience in different therapeutic areas.
In principle, an attempt should always be made to achieve improved tinnitus acceptance through outpatient therapy offers. In most cases, individual therapy modules (e.g. learning about relaxation training, exercise, instructions on how to reduce stress) are used here first. Inpatient rehab can only be considered if the outpatient therapy is unsuccessful.
In summary, the following have emerged in inpatient rehabilitation Therapy modules in a multimodal concept proven and are also recommended in the guidelines mentioned (comment: English "recommendation"):
- detailed information on all aspects of tinnitus, noise sensitivity, hearing loss and symptoms of dizziness (counseling)
- Behavioral interventions in individual and group therapy with the aim of reassessing tinnitus towards better acceptance ("The tinnitus has not gone, but I can sleep better again, my mood has improved significantly and the fear that tinnitus could determine my life , has taken a back seat. ") (European guideline:" strong recommendation for ")
- Exchange of experiences with other equally affected people
- Instructions on how to better deal with stress (e.g. time and conflict management)
- Mindfulness training
- Redirecting attention through awareness training
- Learning relaxation techniques (e.g. progressive muscle relaxation, QiGong, sleep school)
- Motivation for sport and movement therapy (e.g. walking, back training, balance training), occupational therapy, physiotherapy
- if necessary hearing aid advice and prescription
- Advice on social issues (GdB, reintegration, professional qualification, requirements for pensions, etc.)
- if necessary, drug support for sleep disorders or depression
- important: there is nothing that is prohibited because of your tinnitus! Absolutely avoid not doing certain things that are important or dear to you because of your tinnitus, for fear of the noise increasing. Then the trap snaps shut because you make essential aspects of your life dependent on tinnitus (wrong: e.g. "Only when my tinnitus is better can I ..." or "If I do that, my tinnitus would be tomorrow be louder again, so I have to do without it. ")
- Goal: Change in everyday life after rehab: I should integrate elements into my everyday life that did me good during rehab (without changes in everyday life, permanent improvement is not possible); improved acceptance even in stressful situations by overcoming helplessness
Conclusion - With all good and correct therapy concepts, it must be clear to you:
- Inpatient rehab is intended to initiate a process of change in thinking and acting.
- You will have to take your tinnitus home with you, not as an enemy but as a "pesky companion".
- The rehab offers you many trial courses of possibilities, at the end of which you are not treated, but should be able to assess for yourself what a good and promising way of implementation in everyday life can be in order to minimize the health burdens.
- Advice: Start with small steps of change so that your weaker self has no chance of undermining your motivation and thus preventing success.
Which therapies are helpful?
In the recently published European guideline on tinnitus (March 2019), positions are taken on many such "good" pieces of advice from alleged specialist circles, family members, friends, colleagues or the Internet. Here is an overview:
- a strong recommendation ("strong recommendation for") is pronounced for:
- cognitive behavioral therapy
- positive evaluation for ("recommendation for"):
- Relaxation procedure
- Self help
- a weak recommendation ("weak recommendation for") is pronounced for:
- Hearing aids for accompanying hearing loss and
- Cochlear implant treatment for deafness
- no recommendation ("no recommendation") is available for therapy with:
- transcranial electrical stimulation
- Vagus nerve stimulation
- acoustic neurostimulation (Acoustik CR®)
- Sound therapy (incl. Notched music therapy, "Noiser")
- a recommendation against treatment ("recommendation against") is pronounced for:
- Any drug therapy or dietary supplement (e.g. ginkgo, melatonin) for acute or chronic tinnitus. Only in the case of sudden hearing loss with tinnitus is an attempt to minimize the hearing loss by means of short-term cortisone therapy. The hope is that the restoration of hearing will reduce tinnitus in perception.
- transcranial repetitive magnetic stimulation
What is the tinnitus spiral?
An example: Aunt Herta calls and tells you that you have read an article in the magazine at the hairdresser's that the latest research results from the USA show that acupuncture itself can eliminate long-standing and stressful tinnitus. And of course she immediately thought of you. But now you should make an appointment very quickly.
You have done so much about tinnitus, but so far you haven't found the right thing and no one has been able to help. Acupuncture, you think, the ENT doctor said it wouldn't do any good, but maybe he's not yet familiar with these new American studies.
Finally, the goal of getting rid of tinnitus seems to be within reach again. Do your research on the Internet and find several therapists who offer acupuncture for tinnitus, but unfortunately all of them are more than 300 km away from your place of residence and the treatment is not cheap either. But what doesn't cost anything is no good and what does € 1,000 plus travel cost if the tinnitus disappears? Unfortunately, the therapist won't have an appointment for six months - but it suggests that it's good and many people can't be wrong.
Finally the time has come. You take 3 days of vacation and off you go. Great, modern practice, nice helpers, great service (there is a latte macchiato). Unfortunately the therapist does not have much time. Sure about the demand, but raves about the many satisfied patients. After signing the information sheet ("unfortunately it doesn't always work") and 10 pages of data protection information, the acupuncture treatment takes place. You feel much better immediately, the tinnitus is much quieter.
On Monday at work, the boss annoys you and the tinnitus celebrates a comeback. You get the impression the fellow is louder than ever. It really is maddening. What else are you supposed to do? Tonight I'll do some research on the internet.
Many patients are prepared, even against all common sense and serious advice, to repeatedly make promises of obscure therapy. An American study cited an average of $ 20,000 to $ 30,000 that patients spent to get rid of tinnitus. Let me be clear:
Anyone who promises to be able to get rid of your tinnitus is not interested in your tinnitus, but only in your wallet!
But if you had to learn - perhaps painfully - that there is no simple solution with tablets, infusions, oxygen, acupuncture or music, additional frustration threatens. In our example, you tell Aunt Herta that your proposal is meant to be kind but not promising. The old lady is really pissed off and says that if you don't want to do anything, then you are to blame for your tinnitus problem. She doesn't want to hear any more complaints from you about this in the future.
The following is a schematic representation of the downwardly directed "tinnitus spiral":
Outpatient or inpatient rehab?
Basically, outpatient options should be exhausted before inpatient rehab is initiated.
For one outpatient rehabilitation speaks:
- Significantly less effort through on-site therapy, which is particularly advantageous
- for single mothers or fathers
- with everyday duties z. B. by looking after relatives (parents, children)
- with strong professional dependency (e.g. self-employed, decision-makers)
- no artificial situation ("cheese bell") by staying in everyday life
- often sufficient therapeutic effect in patients who are not very stressed
- lower costs
For one inpatient rehabilitation speaks:
- Unsuccessful outpatient rehabilitation (outpatient therapeutic options were exhausted and could not stabilize the symptoms)
- Missing outpatient therapy offers (e.g. in rural areas)
- Physical stress such as significant sleep disturbances, pain in particular in the area of the cervical spine or shoulder-neck muscles, sensitivity to noise, dizziness, impaired performance and concentration
- severe stress in particular on mental health (depression or anxiety disorder)
- severe communication impairment, e.g. B. significantly restrict access to outpatient therapies (e.g. psychotherapy)
- The health problems have led to prolonged inability to work (with receipt of sick pay or ALG I or II).
- If you have submitted a pension application, the pension insurance will presumably propose a binding rehab.
- Substantial professional or private conflict situation that makes it seem sensible to take it out of the everyday situation in order to enable successful therapy.
- Necessary time out (e.g. for physically hard work or permanent excessive demands due to communication in the case of severe hearing impairment)
What happens after an inpatient rehab?
Basically: Without YOUR implementation of the changes learned in rehab in everyday life, no improvement in your stress levels will be achievable!
Initially, this is your responsibility, but the framework conditions for further guidance and support have currently improved, as the sensitivity to the need for a transition to outpatient therapy modules has increased significantly on all sides. In 2019, the pension insurance institutions created new structures for their aftercare concepts (e.g. T-RENA, IRENA, Psy-RENA), which are a useful addition to inpatient therapy processes.
As a future option, the introduction of refresher programs after rehabilitation would be worth considering, e.g. B. after one or two years to query and stabilize the motivation for changes and the success of the therapy achieved. Networking of outpatient and inpatient rehabilitation offers has certainly begun in some local areas of focus, but is still a long way from the standard solution.
Who is entitled to rehabilitation?
Is entitled to outpatient and / or inpatient rehabilitation basically everyone. If outpatient rehabilitation measures are not sufficient to achieve the health goals, inpatient rehabilitation can be approved (§ 40 SGB V, § 9 SGB VI). Basically, the medical premise always applies: Outpatient before inpatient therapy! Acute tinnitus (within the first three months after the first occurrence) will only be a reason for inpatient rehabilitation under very special conditions and as an absolute exception.
Using the figures on chronic tinnitus, it should be made clear how the weighting between outpatient and inpatient measures is:
According to a study by the DTL (Deutsche Tinnitus-Liga e.V.), there are around 3 million people with chronic tinnitus in Germany. Only half of them say they have tinnitus or the effects of tinnitus. It goes without saying that therapy only makes sense for these 1.5 million patients. For the vast majority of these patients, outpatient medical and / or psychological therapy procedures are sufficient to stabilize their personal situation. Inpatient rehabilitation is only necessary for a small group of patients who cannot be adequately helped on an outpatient basis.
Reliable data on the number of inpatient rehabilitation for chronic tinnitus are not available. Based on data from the DRV Bund and our own estimates, the number of 5,000-6,000 inpatient tinnitus rehab patients per year in Germany should not be exceeded.
How long does an inpatient tinnitus rehab take?
Inpatient rehabilitation services should be granted for a maximum of three weeks, but can also be approved for a longer period if this is necessary to achieve the rehabilitation goal (Section 15 (3) SGB VI, Section 40 (3) SGB V ). This means that the duration of medical rehabilitation is largely determined by the indication and the progress of therapy during the measure. If inpatient rehabilitation for tinnitus is approved, many payers have switched to approving a 4 to 5 week stay. Extensions are agreed with you as the person concerned based on your health situation and must be approved by the insurance provider. As a guide, however, count on a 4-week stay rather than a 3-week stay.
After what time interval can you repeat inpatient rehabilitation?
Medical rehabilitation benefits are not provided before four years of such or similar rehabilitation benefits, unless early benefits are urgently required for medical reasons (Section 12 (2) SGB VI, Section 40 (3) SGB V).
This point repeatedly leads to misunderstandings and justified criticism. No one is granted rehabilitation after four years from the insurance provider regardless of medical necessity, just because this specified period has passed. Rehabilitation is always made dependent on medical necessity according to justifiably strict criteria. If this medical indication is given, but also according to the legal situation, rehabilitation must always be granted regardless of certain time intervals.
In principle, the following therefore applies: rehabilitation is approved according to medical indications and if there is a corresponding urgency, regardless of time intervals.
Who pays for your inpatient rehabilitation?
To simplify matters, the following rule of thumb applies:
- For all employed persons, the Annuity insurer (DRV Bund or DRV local - formerly LVA) the costs for rehabilitation.
- For all non-employed persons (housewives, pensioners, students, unemployed) the statutory health insurance (GKV) for the costs of rehabilitation.
As with all provisions, there are a number of exceptions and special regulations. B. the statutory accident insurance (employers' liability insurance association). Rehabilitation providers for all consequences of occupational accidents.
Currently, the patient's own contribution is € 10 per day for a rehabilitation period of a maximum of 42 days. Unemployed people, welfare recipients and people without income are exempt from the additional payment. Patients with low incomes can be exempted, ask the service points here.
How and where can I apply for rehab?
With the introduction of the Social Security Code IX (SGB IX), the procedure has been made much more patient-friendly. For example, so-called joint "service points" have been set up in all rural districts and urban districts, in which all providers of rehabilitation services (statutory health insurance, pension insurance, professional associations) advise the applicant together.
Here you can do everything about
- the necessary administrative processes,
- the necessary applications,
- Sick pay,
- Transitional allowances,
- the requirements and
- the responsibilities of the individual payers as well as
- Find out upcoming costs (personal contributions and, if applicable, exemptions).
It is best to inquire directly with your health insurance company for the address of this service point near your place of residence.But patient rights have also been strengthened in other practical areas: when an application is submitted, the cost bearers first check the medical need. Once this has been established, the cost bearers must agree with each other who is responsible for the costs. In the past, this often led to a long dispute between pension insurance and health insurance, but the patient was unable to undertake the necessary rehabilitation. Today the measure is approved and can be started, the cost bearers must then come to an understanding among themselves.
There are also clear guidelines for the processing time: a decision on an application for rehabilitation must be made within a maximum of five weeks. This means that there is clarity for everyone involved within a reasonable amount of time.
That was too Right of choice and desire of the patient for the selection of the clinic significantly strengthened. As a rule, the responsible cost bearer will try to meet your clinic requirements. We therefore recommend that you: Make use of the legally granted right to choose and choose in accordance with Section 8 of Book IX of the Social Code and specify one or more medically suitable clinics of your choice when submitting your application.
The most important and decisive point for the chances of success of your rehab application is that medical certificate. Therefore, you and your doctor should make sure that some important points for the examination by the insurance provider are clearly recognizable:
- For what medical reasons is rehabilitation absolutely necessary?
- Are outpatient therapy options sufficient or why does inpatient rehabilitation seem absolutely necessary from a medical point of view? Previously performed but unsuccessful therapies should be listed to clarify the urgency and need for inpatient rehabilitation.
- In the case of employed persons: is the ability to work, perhaps even the ability to work, at risk? Can inpatient rehabilitation be expected to minimize this risk?
- Pay attention to a clear definition of the therapy goal (not the tinnitus should be eliminated, but learning how to deal with it), i. H. an improvement of the existing complaints in everyday life and the instructions for self-help.
- Please state two or three preferred clinics in which these therapeutic focuses are guaranteed.
Suggestion: For € 15 you can get the clinic guide of the German Tinnitus League. Here you will find two "sample applications" which can be an orientation for you and your doctor, but which can never take your individual situation into account. Your chances are greatest if you can explain to the expert at the health insurance company or the pension insurance company your individual burden from chronic tinnitus and the insufficient coping with it. You can do this if you combine the important information in this "sample application" with your personal situation.
What to do if your rehab application has been rejected?
Unfortunately, the first applications are sometimes rejected by the cost bearers. Do not hesitate to object if you and your doctor are convinced of the need for inpatient rehabilitation. If the objection is also rejected, which experience has shown to be much rarer, you can also file an objection. Here it is recommended to seek support, e. B. to be obtained by the VDK or the self-help organizations.
last changed on: 06/21/2019
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