Ärzte gegen Hörakustiker

Quelle: ÄrzteZeitung 03.07.2024 Christoph Winnat

Medizin contra Handwerk
Ärzte gegen Hörakustiker: Wem gehört der äußere Gehörgang?

Medicine versus craftsmanship
Doctors versus hearing aid specialists: To whom belongs the external auditory canal?

[Summary translation of the original German article]

Is the simple cleaning of the external auditory canal already a "practice of medicine", which according to law is reserved for doctors? A question that has sparked a dispute between ENT doctors and hearing aid specialists, which, judging by the current tone, has the potential to escalate into a war of attrition. The courts will soon be on the case. It's about the yellow substance in the ear, known in technical terms as "cerumen" and colloquially as "earwax".

"Earwax is a renewable raw material that has already provided excellent nourishment for many generations of ENT doctors", as a ENT newsletter described it. 

And now hearing aid specialists want to get involved in this. But it's not as if they started yesterday, as Jakob Baschab, leader of the Federal Guild of Hearing Aid Acousticians (Bundesinnung der Hörakustiker, biha) emphasizes. "We have always done this. If ear canal cleaning were to be classified as a medical treatment all other activities of the hearing aid acoustician in the external auditory canal would also be classified as medical treatment. This would be tantamount to a professional ban (Berufsverbot)." 

The ENT Association on the other hand states that "penetrating the ear canal with instruments represents a physical intervention that is associated with risks and complications and is taught in ENT medical training." Association members are called upon to report known cases of cerumen removal or advertisements for ear cleaning by hearing aid acousticians.

The head of the continuing education department at the guild's own Akademie für Hörakustik in Lübeck  Dr. Frederick Hahn had pointed out in an article (Cerumenentfernung – Ohrreinigende Maßnahmen im Fachgeschäft: Cerumen removal - ear cleaning measures in specialist shops"), among other things, that according to the Master Examination Ordinance (Meisterprüfungsverordnung) amended in 2022, the master craftsman's certificate entitles the initiation of ear cleaning measures. 

The ENT Association came into action and threatens with a penalty of 2,500 euros for each case of future violation, demanding Dr. Hahn to refrain from announcing and publishing that master hearing aid acousticians are authorized to carry out ear cleaning measures in the form of ear canal cleaning and/or cerumen removal from the ear canal. 

The new Master Hearing Aid Acoustics Ordinance (Meisterprüfungsverordnung) is the trigger of the dispute. In paragraph 2 various job-related skills and knowledge are listed as the basis of the “essential activities” of the hearing aid acoustician. In subsection 5 it also says: “collect and evaluate otoscopic findings (...) and initiate ear cleaning measures.”

For guild manager Baschab, the matter is clear. “Ear cleaning” in the sense of this passage is by definition not the practice of medicine, but is essential for preparing for an otoplasty, for example, and is therefore part of the work process (“job-related”) and therefore permitted for hearing aid acousticians; the new master craftsman examination regulations now only clarify what was already practiced previously.

ENT doctor Löhler, on the other hand, argues that the master craftsman examination regulations only allow health care workers to “initiate” ("einleiten") ear cleaning. “However, cerumen removal is one step in a cascade of precise diagnostics. The hearing aid acoustician may judge that cerumen removal is necessary for a customer. But then he has to send him to an ENT doctor.

The question of whether cerumen removal is a medical treatment or a craft, as a professional skill of hearing aid specialists, is not only causing discontent at the association level. The parties are already bickering on the ground. In Lower Saxony, in May, an ENT doctor demanded a neighboring hearing aid specialist to submit a cease-and-desist declaration (Unterlassungserklärung) regarding cerumen removal. The requested declaration was not submitted. The legal battle carries on.