Global Audiology/Europe/Germany
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General Information
Germany, officially the Federal Republic of Germany, is a country in Central Europe. It lies between the Baltic Sea and the North Sea to the north and the Alps to the south. German is the official and predominantly spoken language in Germany. Recognised native minority languages in Germany are Danish, Low German, Low Rhenish, Sorbian, Romani, North Frisian and Saterland Frisian; they are officially protected by the European Charter for Regional or Minority Languages. The most used immigrant languages are Turkish, Arabic, Kurdish, Polish, Italian, Greek, Spanish, Serbo-Croatian, Bulgarian and other Balkan languages, as well as Russian.
History of Audiology
The development of Audiology in Germany as a scientific discipline started in the 19th century. An important milestone was the publication by the German physicist and physician Hermann von Helmholtz entitled "On the sensations of tone as a physiological basis for the theory of music" in 1863. After World War II, Audiology was defined as a sub-discipline of Otorhinolaryngology. In 1949 the working group ADA („Arbeitsgemeinschaft Deutscher Audiologen“) was founded at the first conference of ENT physicians and expanded in 1973 by including Otology and Neurotology („Arbeitsgemeinschaft Deutschsprachiger Audiologen und Neurootologen“). The first chairman was Prof. Dr. Alf Meyer zum Gottesberge. ADANO still exists as a working group of the German Society for Otorhinolaryngology, Head and Neck Surgery (Deutsche Gesellschaft für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie e.V.). In 1979, the subgroup AG-ERA („Arbeitsgruppe Elektrische Reaktionsaudiometrie“, working group electric response audiometry) was founded by Prof. Dr. Günter Stange in Hannover. At annual meetings of the AG-ERA the latest developments in objective audiometry are discussed.
By way of example, several historically significant developments in German audiology may be highlighted here. In 1970, Professor Walter Kumpf, Head of the Department of Audiology at the Department of Otorhinolaryngology of the University Hospital Münster, published the first case report on spontaneous otoacoustic emissions perceived by him. Professor Harald Feldmann, Director of the University Department of Otorhinolaryngology in Münster from 1976 to 1991, discovered the masking effect of tinnitus and contributed substantially to medico-legal assessment through his work on noise-induced hearing loss and its role as an occupational disease. In 2009, universal newborn hearing screening was implemented and mandated in Germany.
In 1996, the German Society of Audiology (DGA, Deutsche Gesellschaft für Audiologie) was founded in Münster as an independent interdisciplinary scientific association of experts who deal with hearing, hearing disorders, and their diagnosis, therapy, rehabilitation, and prevention. As a scientific society, the DGA promotes professional exchange, the further development of audiological standards, and networking among its members from medicine, natural sciences, engineering, education, psychology, and related disciplines. Today, the DGA has more than 600 society members. A detailed description of the development of Audiology in Germany is given in[1].
In Germany, Phoniatrics and Pediatric Audiology exists as a distinct medical specialization derived from Otorhinolaryngology. As the medical discipline of communication disorders, it integrates expertise in hearing loss in infants, children, and adolescents with knowledge of speech, language, and voice disorders. In children with hearing loss, the specialty therefore also addresses language and communication development, related disorders, and their treatment. The German Society of Phoniatrics and Pediatric Audiology (DGPP, Deutsche Gesellschaft für Phoniatrie und Pädaudiologie) was founded in 1983 as the scientific association of German-speaking physicians specializing in Phoniatrics and Pediatric Audiology, with Prof. Dr. med. Gerhard Kittel serving as its founding president.
Incidence and Prevalence of Hearing Loss
Epidemiological data on the prevalence of hearing disorders in Germany are sparse. In 2017, a study conducted in two regions in Germany found hearing impairment in approximately 16% of adults when applying the WHO criterion of 2016[2]. The results are in good agreement with other European studies and show differences to US American results. A 2022 study conducted in the city of Mainz and the neighboring Mainz-Bingen district reported a prevalence of 25.5% when applying the WHO criterion of 2021 [3].
In 2024 a self-report study on the prevalence and co-prevalence of the audiovestibular symptoms hearing loss, tinnitus and dizziness in the Pomerania region of Germany reported a weighted prevalence of 14.2% for hearing loss, 9.7% for tinnitus, and 13.5% for dizziness in the population of 8134 study participants. Prevalence increased with age and differed among the sexes. 28% of the study participants reported more than one symptom at once[4].
In a population-based cohort study evaluating the outcome of the universal newborn hearing screening (UNHS) program in the German federal state of Hesse, including 17,439 screened newborns, the prevalence of unilateral and bilateral hearing loss was 2.7 per 1,000 newborns, while the prevalence of permanent bilateral hearing loss was 2.1 per 1,000. In the UNHS cohort, children with permanent hearing loss were diagnosed at a median age of 3.1 months and received treatment at a median age of 3.5 months. The corresponding ages in a non-UNHS cohort from Hesse were 17.8 and 21.0 months, respectively[5]. In a later study including 150,000 screened infants, the median age at diagnosis was 3.7 months and the median age at treatment initiation was 5.8 months[6].
A population-based two-staged ‘screening’ and ‘follow-up’ newborn hearing screening program in North-Rhine, Germany and a hospital-based screening at a University Hospital was conducted for the 2007–2016 period. The 10-year coverage rate for these newborns was 98.7%, the referral rate after a failed two-step screening was 3.4%, and the lost-to-follow-up rate was 1% but no information on final diagnosis was provided.[7]
Information About Audiology
Bachelor and Master courses in Audiology (audiologists)
Though the job title „Audiologist“ is not an officially protected professional title, it is usually used for people with an academic education on bachelor (B.Sc.) or master level (M.Sc.). There are two universities of applied sciences in Germany offering a bachelor program and two universities offering master courses. They are located in Oldenburg and Lübeck. In total, around 20 students finish their academic courses per year. In addition, a significant number of audiologists have primary education in physics, engineering and other related disciplines with appropriate individual training.
Services offered by Technical Audiologists
Technical audiologists work primarily in hospitals and specialized hearing clinics, where they support the diagnosis and treatment of hearing disorders under the supervision of an ENT physician. Their responsibilities include performing audiological assessments, conducting objective hearing measurements, assisting in the evaluation and follow-up of cochlear implant patients, and managing technical aspects of audiological equipment. They are also involved in the programming and technical support of cochlear implant systems, as well as patient counseling related to implant use and rehabilitation.
Services offered by Otolaryngologists
ENT doctors perform physical examination and all necessary audiometric tests for diagnosis of hearing loss. In particular, they perform subjective and objective tests in order to determine the cause and extent of hearing loss. Associated disorders such as Tinnitus, Hyperacusis and vestibular disorders are also diagnosed by ENT specialists. When no causative treatment of hearing loss is available, Hearing Aids (HAs) are prescribed. The regulatory basis for hearing aid prescription is the Guideline for assistive devices ("Hilfsmittelrichtlinie"). Roughly, specific audiometric criteria for puretone tresholds and speech recognition have to be fulfilled in order to justify HA prescription. A comprehensive description of the process is given in [8].
Services offered by Phoniatricians & Pediatric Audiologists
The scope of Phoniatrics and Pediatric Audiology encompasses the diagnosis, treatment, and research of childhood hearing loss, auditory processing disorders and other listening difficulties, developmental language and speech sound disorders, acquired communication disorders such as aphasia, as well as voice and swallowing disorders. Physicians specialized in Phoniatrics and Pediatric Audiology provide early identification of childhood hearing loss through universal newborn hearing screening, highly specialized pediatric audiological diagnostics, initiation and monitoring of hearing aid, cochlear implant, and other auditory implant provision, as well as assistive technologies, and family-centered rehabilitation for children with hearing loss. Associated conditions such as childhood tinnitus, hyperacusis, misophonia, and vestibular disorders are also diagnosed and treated by these specialists.
The prescription of hearing aids and assistive listening devices is guided by two consensus papers [9][10], a clinical practice guideline[11], and the Medical Aids Directive of the Federal Joint Committee. Cochlear implant provision and rehabilitation are regulated by a separate clinical practice guideline[12], as are interventions for developmental language disorders in children with hearing loss[13][14].
The specialty is inherently interdisciplinary, involving close collaboration with Otorhinolaryngology, Pediatrics, Maxillofacial Surgery, Orthodontics, Neurology, Psychology, education and special education, hearing care professionals, and speech and language therapy. These collaborations support the management of hearing, speech, language, voice, and swallowing disorders, including augmentative and alternative communication.
Services offered by Hearing Aid Acousticians
Hearing Aid Acousticians (HAA) are non-academic craftsmen. Based on the prescription they select appropriate hearing aids and perform the HA fitting. Powers and duties are regulated by the "Hörakustikermeisterverordnung". As demanded by §30 in the Hilfsmittelrichtlinie the success of an HA provision is confirmed by an ENT doctor at the end of the trial period. Standard health insurance covers costs for hearing aids up to about 800 € per HA including otoplastic and fitting.
Services offered by Pedagogical Audiologists
Pedagogical Audiologists (or: Educational Audiologists) have an academic qualification in special needs education and practical experience in teaching children who are deaf or hard of hearing. They should be qualified in a training programme in accordance with the BDH and BUDIKO standards ("Grundsatzpapier Pädagogische Audiologie") (2020). Pedagogical audiologists carry out hearing and speech audiometry. They analyse test results and assess hearing, speech and communication behaviour to provide advice for parents and caretakers in (pre-)school environments.
Services offered by Audiometrists
Hearing healthcare is primarily part of ENT doctors in cabinets. Audiometry is usually done by specialized nurses or audiometrists. Audiometrists have usually an education as medical technologist („Medizinischer Technologe, MTF“).
Scope of Practice and Licensing
In Germany, Austria and Switzerland, ‘audiologist’ is not a regulated profession and is not a legally protected professional title. Various professional groups with differing levels of education work in the field of audiology. In Germany, there are no recognition authorities for university degrees leading to unregulated professions. Applications for jobs on the labour market must be addressed directly to the employer. The employer in question decides on suitability at their own discretion. Potential employers include, for example, hospitals, doctors’ practices, hearing aid manufacturers and implant manufacturers.
In Germany, hearing aids are fitted by hearing aid specialists in specialized shops. Such a shop must always be run by a “Meister” hearing aid specialist. “Meister” hearing aid specialist is a regulated profession that requires the successful completion of the Meister’s examination in this skilled trade (see Handwerksordnung). The requirements for obtaining the Meister craftsman qualification are set out in the Regulations on the Meister Craftsman Examination for the Hearing Aid Dispensing Trade (Meisterprüfungsordnung des Hörakustiker-Handwerks). Typically, in the hearing aid dispensing trade, an apprenticeship is first completed, culminating in a journeyman’s examination. Passing the journeyman’s examination is usually a prerequisite for preparing for the Meister craftsman examination and subsequently sitting the examination. Employment in a specialist hearing aid shop is also possible without the journeyman’s certificate. In this case, the employee works under the professional supervision of a Meister craftsman. Self-employment, however, requires the acquisition of the Meister craftsman’s qualification. With regard to foreign qualifications, an equivalence assessment procedure can be initiated at the local Chamber of Crafts. Upon application, the Chamber of Crafts will assess whether the professional qualification obtained abroad is equivalent to the German master craftsman’s examination or the journeyman’s examination. The Chambers of Crafts provide advice prior to the application. The Chambers of Crafts then determine whether the qualification obtained abroad corresponds to the job profile of a German Meister hearing aid acoustician or that of a journeyman. Further training measures are also possible to address any specific gaps.
In Germany, a bachelor’s degree with a focus on audiology can currently be obtained at the Technical University of Lübeck (programme Hörakustik) and Jade University of Applied Sciences in Oldenburg (Hearing Technology and Audiology programme). Both programmes have a more technical and less clinical focus than audiology programmes abroad. They lead to the regulated higher education profession of Engineer – Hearing Technology and Audiology (Ingenieur/in – Hörtechnik und Audiologie).
Audiologists are included in the list of shortage occupations in Germany (see Group 226). In this list, audiologists are mentioned alongside speech therapists. Speech therapist (also known as a logopaedist) is a regulated profession in Germany.
In Germany, specialist training in Phoniatrics and Pediatric Audiology typically takes five years, similar to training in Otorhinolaryngology and other medical specialties. Phoniatrics and Pediatric Audiology is the youngest recognized medical specialty in Germany. It is a combined medical and surgical discipline. Although surgery does not represent the main focus of daily clinical practice, the specialty also includes otologic procedures such as paracentesis and tympanostomy tube insertion.
In recent years, the European Academy of Phoniatrics, founded in Germany, has offered international training courses for physicians in this field. Since 2025, under the umbrella of the European Board Examination in Otorhinolaryngology – Head and Neck Surgery, the first board examinations leading to the qualification of European Phoniatrician have also been introduced. Within this medical specialization, audiology represents an important pillar.
Phoniatrics and Pediatric Audiology also maintains close links with logopedics, the discipline concerned with therapeutic interventions for disorders of language, speech, voice, hearing, and swallowing. Many phoniatric and pediatric audiology institutions in Germany are affiliated with training schools for speech-language pathologists, where students receive their theoretical and practical education in close collaboration with departments and clinics of Phoniatrics and Pediatric Audiology.
Professional and Regulatory Bodies
Professional organizations within Audiology in Germany are:
· Deutsche Gesellschaft für Audiologie (DGA)
· Deutsche Gesellschaft für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC)
· Deutsche Gesellschaft für Phoniatrie und Pädaudiologie (DGPP)
· Berufs- und Fachverband Hören und Kommunikation (BDH)
· Europäische Union der Hörakustiker (EUHA)
· Bundesinnung der Hörakustiker (biha)
· Dachverband für Technologen/-innen und Analytiker/-innen in der Medizin Deutschland (DVTA)
· Berufsverband der Audiologie-Assistenten (BAA)
Ongoing audiology research
Audiology research is done in clinics, in technical and psychological departments as well in biological departments at universities. Scienitifc exchange is mainly organized by the Deutsche Gesellschaft für Audiologie (DGA) at annual conferences. The DGA comprises five working groups ("Fachausschüsse") focusing on
- Audiometry and Quality Assurance
- Hearing Aid Technology and Hearing Aid provision
- Pediatric Audiology
- Cochlear Implant Provision
- Neurotology and Vestibular System
Official publication organ of the DGA is the open access journal Zeitschrift für Audiologie.
Challenges, Opportunities and Notes
Germany pioneered social health insurance in 1883 based on the social legislation of Otto von Bismarck. Today Germany's health system is strong and hearing healthcare is mainly covered by social insurance. Newborn hearings screening was established in 2009 and is completely covered by social insurance. Additionally, hearing diagnostics and therapy (including hearing aids and cochlear implants) are usually paid in total or partly by the statutory health insurance. However, several challenges remain. For example, according to the Euro Trak Germany survey in 2025, the adoption rate of hearing aids is only 47% of those with self-declared hearing loss and about 5.1% of the total population.
Audiology Charities
The largest foundation for hearing research is the KIND Hörstiftung. According to its statutes, the KIND Hörstiftung aims to reduce the impact of hearing impairment and to foster full participation in social life of hearing impaired people. The foundation's instruments are funding of hearing research projects. Furthermore, it organizes a biennial interdisciplinary colloquium and awards a Foundation Prize for outstanding scientific work in the field of Audiology. Decisions regarding the allocation of funds are made by the Scientific Board and the Foundation Council.
There are several self-help groups for Tinnitus (Deutsche Tinitus Liga, DTL), hearing loss (Deutscher Schwerhörigenbund, DSB) , and Cochlear Implants (Deutsche Cochlea Implantat Gesellschaft, DCIG). The latter two groups combined their forces in Deutscher Hörverband.
References
- ↑ Kießling, Jürgen (2021-08-01). "Die Entwicklung der Audiologie - von Helmholtz bis heute". Zeitschrift für Medizinische Physik. Special Issue: Audiology 31 (3): 238–253. doi:10.1016/j.zemedi.2020.08.003. ISSN 0939-3889. https://www.sciencedirect.com/science/article/pii/S0939388920300933.
- ↑ von Gablenz, Petra; Hoffmann, Eckehardt; Holube, Inga. "Prevalence of hearing loss in Northern and Southern Germany". HNO 65: S130-S135. doi:DOI 10.1007/s00106-016-0318-4.
- ↑ Hackenberg, Berit; Döge, Julia; Lackner, Karl J.; Beutel, Manfred E.; Münzel, Thomas; Pfeiffer, Norbert; Nagler, Markus; Schmidtmann, Irene et al. (2022-09). "Hearing Loss and Its Burden of Disease in a Large German Cohort-Hearing Loss in Germany". The Laryngoscope 132 (9): 1843–1849. doi:10.1002/lary.29980. ISSN 1531-4995. PMID 34904723. https://pubmed.ncbi.nlm.nih.gov/34904723.
- ↑ Ihler, Friedrich; Brzoska, Tina; Altindal, Reyhan; Dziemba, Oliver; Völzke, Henry; Busch, Chia-Jung; Ittermann, Till (2024-07-31). "Prevalence and risk factors of self-reported hearing loss, tinnitus, and dizziness in a population-based sample from rural northeastern Germany". Scientific Reports 14 (1): 17739. doi:10.1038/s41598-024-68577-3. ISSN 2045-2322. PMID 39085387. PMC 11291685. https://pubmed.ncbi.nlm.nih.gov/39085387.
- ↑ Neumann, Katrin; Gross, Manfred; Böttcher, Peter; Euler, Harald A.; Spormann-Lagodzinski, Marlies; Polzer, Melanie (2006). "Effectiveness and Efficiency of a Universal Newborn Hearing Screening in Germany". Folia Phoniatrica et Logopaedica 58 (6): 440–455. doi:10.1159/000095004. ISSN 1021-7762. https://karger.com/article/doi/10.1159/000095004.
- ↑ Neumann K (2010) Newborn hearing screening in Germany and the State of Hesse. In: World Health Organization (ed.) Neonatal and infant hearing screening. Current issues and guiding principles for action. Outcome of a WHO Informal consultation held at WHO Head-quarters, Geneva, Switzerland, 09--10 November, 2009. (p. 19). WHO, Geneva, Switzerland, ISBN 978 92 4 159994 6
- ↑ Thangavelu, Kruthika; Martakis, Kyriakos; Feldmann, Silke; Roth, Bernhard; Herkenrath, Peter; Lang-Roth, Ruth (2023-10-23). "Universal Newborn Hearing Screening Program: 10-Year Outcome and Follow-Up from a Screening Center in Germany". International Journal of Neonatal Screening 9 (4): 61. doi:10.3390/ijns9040061. ISSN 2409-515X. PMID 37873852. PMC 10594500. https://www.mdpi.com/2409-515X/9/4/61.
- ↑ Hoppe, Ulrich; Hesse, Gerhard. "Hearing aids: indications, technology, adaptation, and quality control". GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery 16. doi:10.3205/cto000147. ISSN 1865-1011..
- ↑ Wiesner T, Bohnert A, Limberger A, Massinger C, Nickisch A, Fleischer K, Kruse E, Heinemann M, Schönweiler R. Konsenspapier der DGPP zur Hörgeräte-Versorgung bei Kindern, Vers. 4.0. last update 2019. https://dgpp.de/de/wp-content/files/KonsensDGPP-HG-Anpassung_bei_Kindern-Vers40.pdf
- ↑ Hohl B, Lang-Roth R, Mahlke H, Mörler W, Renzelberg G, Tiede K, Wiesner T, Zastrau Z Bogner B, Bohnert A, Flügel T, Hirschfelder A, Husstedt H, Plotz K, Matulat P, Napiontek U, Reichmuth K, Schönfeld R, Vietheer I. Interdisziplinäres Konsensuspapier zur Umfangsbestimmung von Zusatztechnik im inklusiven Schulalltag von Schüler:innen mit peripherer Hörschädigung. 2021. https://dgpp.de/de/wp-content/files/Konsensuspapier_UmfangsbestimmungZusatztechnikDrahtloseUebertragungsanlage-20220110.pdf
- ↑ Arbeitsgemeinschaft Deutschsprachiger Audiologen, Neurootologen und Otologen der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie. S2k-Leitlinie „Implantierbare Hörgeräte“. AWMF-Register-Nr. 017/073. 2017. https://dgpp.de/de/wp-content/files/S2k_Implantierbare-Hoergeraete_2018-06-abgelaufen.pdf
- ↑ DGHNO-KC-Deutsche Gesellschaft für Hals-Nasen-Ohrenheilkunde, Kopf und Hals-Chirurgie e.V. S2k-Leitlinie Cochlea-Implantat Versorgung [Internet]; AWMF-Register-Nr. 017/071; 2020. www.awmf.org/uploads/tx_szleitlinien/017-071l_S2k_Cochlea-Implantat-Versorgung-zentral-auditorische-Implantate_2020-12.pdf
- ↑ Neumann K, Kauschke C, Fox-Boyer A, Lüke C, Sallat S, Kiese-Himmel C: Clinical practice guideline: Interventions for developmental language delay and disorders. Dtsch Arztebl Int 2024; 121: 155–62. DOI: 10.3238/arztebl.m2024.0004
- ↑ Neumann K, Kauschke C, Lüke C, Fox-Boyer A, Sallat S, Bolotina A, Euler HA, Kiese-Himmel C, Leitliniengruppe. Therapie von Sprachentwicklungsstörungen. Interdisziplinäre S3-Leitlinie, Version 1.1, AWMF-Registernr. 049-015, Deutsche Gesellschaft für Phoniatrie und Pädaudiologie (DGPP) (Hrsg.), 2022; verfügbar unter https://register.awmf.org/de/leitlinien/detail/049-015
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 Contributor to the original text | |
| Ulrich Hoppe | ||
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