[Postoperative legal disputes involving patients with cochlear implants]. / Postoperative Rechtsstreitigkeiten bei Trägern von Cochleaimplantaten.

BACKGROUND: After the implantation of one or two cochlear implants additional problems often arise concerning the question which further costs have to be covered by statutory insurances or other insurance providers, e.g. within the framework of integration aid. OBJECTIVE: This article provides an overview of judgments rendered by the German social courts. It was investigated whether and in which cases it is advisable for a patient to go to court, and how long the proceedings may take. MATERIAL AND METHODS: A search was made for judgments in the two biggest commercial legal databases and in the database of the German social courts, using combinations of the search parameters "Cochlear", "Cochlea", "Implant", and "Implantat". The reviewed judgments were issued between 2002 and 2017. RESULTS: A total of 13 judgments were found. The results varied according to the specifics of the individual case and 54% of the patients won their cases. The court procedures took between 2 months (starting from the filing of a complaint, date of application in this case unknown), and 6 years and 11 months. CONCLUSION: This study showed that it is uncertain whether costs that are not caused directly by the surgery or the postoperative treatment will be remunerated. As each case is in principle unique, the results vary. Nevertheless, taking legal action is recommended after thorough consideration in cases where statutory insurances or other providers refuse to meet expenses incurred.

[Cochlear implants in the social courts]. / Das Cochleaimplantat in der sozialgerichtlichen Rechtsprechung.

BACKGROUND: Since the indication for receiving a cochlear implant (CI) has widened (single-sided deafness [SSD], electric acoustic stimulation [EAS], bilateral CI, CI for long-term deafness), more and more patients come into consideration for such a treatment. Hence, disputes increasingly arise between patients and their insurance companies concerning the question of whether surgery and follow-up treatment have to be paid for by statutory health insurance. OBJECTIVE: This work provides an overview of judgments rendered by the German social courts. We investigated whether and in which cases it is advisable for a patient to go to court, and how long the proceedings may take. MATERIALS AND METHODS: We looked for judgments in the two biggest commercial legal databases and in the database of the German social courts, using combinations of the search parameters "Cochlear," "Cochlea," "Implant," and "Implantat." Three verdicts were attained by directly contacting the court; another one was mentioned in an article. The reviewed judgements were issued between 2003 and 2017. RESULTS: A total of 12 judgments were found. The patients won in all but one of the main proceedings. The case that was lost concerned exceptional circumstances. One patient didn't get the desired interim measure, but won in the main proceedings. The proceedings took between 1 year and 8 months, and 9 years and 5 months. CONCLUSION: Despite the amount of time the patient has to invest, taking legal action is worthwhile. The proceedings at the social courts are generally exempt from charges. In most cases, the statutory health insurance is ordered to pay for a CI.

[Speech developmental delay in preschool children: evaluation of screening with anamnesis questions]. / Sprachentwicklungsstörungen bei Vorschulkindern: Bewertung des Screenings mit Anamnesefragen.

BACKGROUND: In western societies, delay of speech development is frequent and important as it may affect the entire development of a child. Therefore, early diagnosis and treatment is of outstanding relevance. For screening purposes in clinical practice, questionnaires focussing on speech development are assumed to be both valid and economic assessment tools. In this study, results of a questionnaire based on "milestones in early childhood development" as previously reported by Michaelis for German children were compared with results of systematic German speech development tests. PATIENTS AND METHODS: In a retrospective study, data were collected from 25 German preschool children. Their parents had completed a questionnaire on their child's development prior to the examination with 4 questions focussing on speech development. In this report, the answers on these 4 questions are evaluated against the background of systematic German speech development tests, i.e. the H-SET and PLAKSS, and an unsystematic examination by an experienced speech and language phonologist. RESULTS: The questionnaire had a sensitivity of 50% and a specificity of 7%. The positive and negative predictive values were 55.9% and 5%, respectively. CONCLUSION: A questionnaire based on "milestones in early childhood development" as previously reported by Michaelis for German children, is clinically invalid for screening speech development in preschool children.

[Intelligibility of children with bilateral and unilateral cleft lip and palate]. / Sprachverständlichkeit von Kindern mit bilateralen und unilateralen Lippen-Kiefer-Gaumen-Spalten.

OBJECTIVE: Data about the effect of unilateral or bilateral cleft lip and palate (CLP) on speech quality are inconsistent. In this study we firstly quantify the intelligibility of children with unilateral and bilateral CLP objectively by means of automatic speech recognition system (ASR). METHODS: Speech data of 72 German speaking children (8.7+/-3.0 years) with CLP thereof 17 children with bilateral CLP, 23 with CLP on the right side, and 32 on the left, were compared. A group of 159 children aged 9.1+/-2.9 years served as control group. To quantify intelligibility we calculated the word recognition rate (WR) as the percentage of correctly recognized words of a standardized speech test (PLAKSS). RESULTS: Between the 3 cleft groups, there was no significant difference in WR. Compared to the control group (WR mean 63.5%+/-12.1%), the patient group (WR mean 48.1%+/-16.3%) shows significant lower WR (p< 0.001). The WR rises with increasing age in the control group and in the patient groups with unilateral cleft significantly. This couldn't be observed in the children with bilateral CLP. In this group the males showed a significantly higher WR than the females. In the control group as in the patient groups with unilateral cleft there is no significant difference between girls and boys. CONCLUSIONS: Despite the greater extent of the malformation of children with a bilateral CLP, there is no significant difference to the children with only a unilateral cleft lip and palate.

[Satisfaction of dysphonic patients with psychosomatic assessment and intervention]. / Zufriedenheit dysphoner Patienten mit einer psychosomatischen Diagnostik und Intervention.

BACKGROUND: Comorbid physical and psychological complaints are more common in patients with dysphonia than in the general population. In a prospective randomized study the effects of structured psychosomatic diagnostics and verbal intervention on the satisfaction of patients with dysphonia were investigated. MATERIALS AND METHODS: A total of 54 dysphonic patients (33 women, 21 men, age 51.1+/-16.4 years) with dysphonia (organic n=36, functional n=18) were examined and their subjective experiences were collected by the following psychometric questionnaires: voice-related quality of life (VRQOL), hospital anxiety and depression scale (HADS-D) and the "Giessener Beschwerdebogen" (Giessen questionnaire on physical complaints GBB). Patients were randomized into 2 groups: group 1 (n=27) filled in the questionnaires and the answers were reviewed within the medical consultation. This was followed by an interview on patient satisfaction. In the control group 2 (n=27) a medical examination and consultation were carried out and then questioned on patient satisfaction. The psychometric questionnaires were completed by the patients shortly before leaving the department. RESULTS: The study group 1 was significantly more satisfied than group 2 on different statistic levels according to the items compared. CONCLUSIONS: Patients suffering from dysphonia are positively influenced with respect to patient satisfaction by a structured psychosomatic diagnostic and intervention.