Global Audiology/Europe/Luxembourg

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 Catholicism. Historically, Luxembourg was home to much iron ore industry and has since become one of the financial hubs of Europe. Luxembourg City is one of the European Union’s official capitals. The country’s political system is a representative democracy with a constitutional monarchy. The Grand Duke of Luxembourg is currently Grand Duke Henri.

The World Health Organization considers Luxembourg to be part of the high-income region of the world. This region has 11% of the population with disabling hearing loss (0.5% of children, 4.9% of adult males, and 4.4% of adult females). These estimates are nearly half those of other regions. In high-income regions, such as Luxembourg, about 18% of adults 65 and older 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.

History
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.

Educational Institutions
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.

Audiology Practice: Public and Private
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 the audiology service in the 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 or she can be reimbursed by the Health Department.

The few who do specialize in audiology and return to Luxembourg are responsible for infants' through adults 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 completes 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.

Services Offered by Otolaryngologists, Otologists and Otoneurologists
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, and Belgium), there do not appear to be any neuro-otologists in Luxembourg.

Audiological Services
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 screening 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 no 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 === Luxembourg is a small country and is surrounded by France, Belgium, and Germany, which have established services for hearing healthcare. It is convenient for patients to travel across the border for services and training programs.


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