We must face the fact that hearing becomes impaired as a result of old age. The question is: flow should we deal with this as doctors in order to improve the quality of life of those afflicted, which is what the patients expect of us? Like the aging process itself, one cannot treat the cause of old-age hearing impairment; therefore, the treatment can only consist of our efforts to compensate for the existing hearing impairment as best we can. This is only possible by means of hearing aids. Between 11-12 million people in Germany are hearing impaired, yet only about 1.8 million of these have hearing aids, varying regionally from 35-65% in both ears; 85% of all people who own hearing aids are 60 or older. Hearing impairment, especially in old age, is usually recognized too late for optimal treatment. This situation could be improved by better educating the population and increasing the attentiveness of family doctors with early screening examinations in case old-age hearing impairment is suspected. Helping the hearing-impaired to overcome their inhibitions, to accept their handicap and decide to wear a hearing aid is the special task of the ear doctor: this requires psychological empathy and the careful development of a trustful relationship, in addition to a clear diagnosis; but it also requires, on the part of the ear doctor, a sound knowledge of the capabilities of hearing aids, the technology, adjustment and problems connected with hearing aids. It can only be in the interest of the hearing impaired to receive the best possible treatment and reliable quality at the lowest expense to themselves. They want to be able to hear,normally" again, ,,like before". But this cannot be achieved by any hearing aid in existence today. An especially difficult part of any in-depth discussion between the ear doctor and the hearing impaired is to explain that the hearing aid will be of great advantage, but that he will have to learn to hear differently. Among the specific problems, the financial aspect is foremost and is shared by all patients with statutory health insurance. The wearer of a hearing aid today knows that he will have to do without better hearing aids if he cannot afford additional payment. There is no provision for hardship cases. Despite claims of health care politicians and health insurance representatives to the contrary, the German statutory health insurance operates on the basis of a typical twoclass health care system: Only those who are able and willing to pay have access to the better-quality hearing aids. This is all the more incomprehensible since the overall costs for hearing aids only make up 0.2% of the total expenses of the statutory health insurance. What are better hearing aids from the point of view of the hearing impaired? A hearing aid should be small, light and as inconspicuous as possible. Most wearers of hearing aids are still not able to wear their hearing aid with the same self-confidence with which they wear glasses. The more pronounced the hearing loss, however, the less important are cosmetic considerations. Therefore people with middle or severe hearing impairment should have a hearing aid that ensures the same improvement in intelligibility and a pleasant hearing experience in all situations, with minimal battery requirements and without inherent noises or feedback. Hearing aids are considered to be of better quality in proportion to their ease of operation. The best use of technology for an optimal adjustment in connection with detailed advice by the ear-nose-and-throat doctor and the hearing aid technician is expected. As modern hearing aids become more highly developed, the adjustment process also becomes more complex. The frequency of the hearing aid must be adjusted as precisely as possible, while avoiding over-control. A modern hearing system with 20 channels, each with its own frequency-dependent amplifier and limiter, and additional multi-microphone technology - this can only be adjusted with the help of special computer software. An important fundamental question is then: to treat one or both ears? Now or later? The immediate prescription of hearing aids for both ears as the only sensible treatment for hearing impairment in both ears as far as this is technically and patho-physiologically possible - has increasingly become standard practice in Germany, if with considerable delay, however surprisingly inconsistently. For example, the federal guild of hearing aid acoustic technicians indicates a national average of 35%, while in some areas a rate of 60-65% has been achieved. The majority of cases in the average ENT practice does not as a rule concern the problematic forms, neither severe nor middle hearing impairment, but rather the low to middle hearing impairment of old age - and in practice, other factors are decisive here; for example, ease of operation, convenience, a pleasant hearing experience and cosmetic aspects are much more central with respect to the needs and expectations of the patient. The most difficult problem, indeed the chief problem in any hearing aid treatment is still the extremely variable conditions under which the hearing aids must work in order to ensure the best possible intelligibility. There has been much progress in this area over the past few years due to the automatically regulating amplifiers. The fully-automatic models most nearly fulfill the needs of especially older hearing aid wearers, since they want to simply put the hearing aid in their ear and turn it on and be able to hear well. This need is evidently being pursued by the further hearing aid development.
