Global Audiology/Europe/Czech Republic

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 October 21, 2013, the Czech Republic is the 6th safest and most peaceful country in the world. It is based on the rule of law in a liberal 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 the 31 richest countries. The Human Development Index (HDI) ranks the Czech Republic as the 28th-richest country 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 terms of 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.

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 relation to the severity of hearing impairment. The data depends on the definition and criteria determining hearing loss. The WHO bases its estimates for the adult population on so-called “disabling” hearing impairment (a hearing loss greater than 41 dB at 0.5–4.0 kHz on the better ear), which represents a relatively significant hearing loss. The estimates for the Czech Republic are about 0.5 million hearing impaired (5%), most of whom are elderly individuals. About 15,000 hearing impaired people were either born with hearing loss, or acquired hearing loss during childhood (0.15%), fewer than 8,000 of whom 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, the vast majority of hearing aids are fitted monaurally (with the exception of children under 18 years of age). Around 30,000 hearing aids are issued annually.

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

In the Czech Republic, all audiological examinations are performed by registered nurse specialists whose first university degree in nursing (a 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 of hearing aid fitting and audiological rehabilitation are phoniatrists.

It is widely recognized that the founder of 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.

Education
As previously mentioned, in the Czech Republic, the field of audiology is exclusively associated with the medical specialization of otorhinolaryngology, with the fields of Phoniatry and Audiology as broadening specializations.

In the Czech Republic, general medical education is studied exclusively at state-owned medical schools. Currently, there are seven 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 specialty for audiology is ENT. The length of 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 of 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 clinics and the 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 aid 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 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 and Private
The healthcare system 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 and private entities.

Audiological examinations, i.e. Hearing examinations and diagnostics can be performed at every ENT and/or phoniatry office in the country. At present, there are around 850 such locations capable of offering this kind of specialized examination. 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 and 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 in maternity hospitals by means of the OAE. In cases of suspected hearing loss, 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 that identify 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 and phoniatry centers provide care to the smallest children, who are diagnosed and treated for the hearing impairment.

The 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 the 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 four clinical workplaces offering this kind of patient treatment and care. Overall, about 1,000 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 that 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 become the sole responsibility of the individual companies and/or firms whose employees are exposed to a high noise level.

The correction of adult hearing impairments is carried out by 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 in children ages (0–7 years).

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

Audiological Services
The basic system of medical care in the Czech Republic is a general structure of primary care provided by general practitioners (GPs), which is divided into adult care 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 undergo the necessary surgery.

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.

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).

More than 90% of all surgeries are performed in public hospitals because 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 gold 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.

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 healthcare offered by means of the reimbursement of both healthcare costs 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 to maintain 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 ===
 * 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 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 the public and private sectors.
 * Surgical procedures are only available through state-run hospitals within the context of ward hospitalization.