[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.

[Grading of the Voice Handicap Index]. / Graduierung des Voice-Handicap-Index.

BACKGROUND: The Voice Handicap Index (VHI) questionnaire is currently regarded as the gold standard for the measurement of subjective suffering caused by dysphonia. The object of this study was to show how to weight or grade the result yielded by the VHI. To this end, the result obtained with the VHI was graded against the external criterion of health-related quality of life and also compared with the VHI results obtained in persons not affected by dysphonia. PATIENTS AND METHODS: A total of 101 patients (61 women, 40 men) aged between 19 and 86 (48.4 +/- 14.6) years and suffering from benign dysphonia (organic in 62%, functional in 38%: 62% and 38%, respectively in the women, 63% and 37%, respectively, in the men) took part in the study. The instruments used were a German version of the VHI and the SF-36 Health Survey on health-related quality of life, which is commercially available. RESULTS: There are two subscales to the SF-36, but only the values for physical health were significantly reduced and correlated significantly with the results on the VHI scale. This subscale was therefore used as the external standard for grading of the VHI results. Following the separation of the VHI results recorded in the nondysphonic test subjects a four-point grading of the VHI results emerged. CONCLUSIONS: VHI values of 0-11 are classified as grade 0 suffering (almost certainly not noticeable), while values of 12-28 reflect grade 1 (more likely unnoticeable than conspicuous) suffering; values of 29-56 reflect grade 2 suffering (more probably noticeable than not), and values of 57-120 suggest a classification of certainly noticeable and are graded as grade 3 suffering.

[Voice Handicap Index (VHI) in inpatient voice rehabilitation medicine]. / "Voice Handicap Index" (VHI) in der stationären Stimmrehabilitation.

BACKGROUND: The focus of this study was to determine if the Voice Handicap Index (VHI) is a valid tool for evaluating an inpatient voice rehabilitation program. PATIENTS AND METHODS: A total of 39 German-speaking patients were asked to complete a German version of the VHI questionnaire at the beginning and 3 months after attending a voice rehabilitation program on an inpatient basis at the Bad Gögging voice center. The data collected were documented and assessed using Microsoft Excel and MATLAB. RESULTS: A significant reduction of the VHI summary score was achieved by 10 of 39 patients. An increased number of voice therapy sessions before the program diminished (!) the VHI score 3 months after the program. Work disability because of the dysphonia before the beginning of the voice rehabilitation program showed no significant correlation with the VHI score. CONCLUSIONS: At present, the VHI cannot be regarded as a reliable measure to evaluate benefit derived from completing a voice rehabilitation program on an inpatient basis. Apparently, numerous prior treatment regimens constitute a negative prognostic criterion for rehabilitation success as measured subjectively by the VHI.

In vitro methods for the assessment of primary local effects of topically applied preparations.

Three 'alternative' methods for the screening of the primary irritation potentials of topically applied preparations and raw materials are presented as a test battery and their in vitro endpoints are compared with in vivo data. The first method is the intermediate test on the chorioallantoic membrane of hens' fertilized eggs, which is generally proposed for the prediction of the irritation potential of chemicals. Relevant test parameters, such as the time-dependent appearance of hemorrhages, vascular lysis and coagulation, are used to classify the test substances. Secondly, cytotoxicity tests with Balb/c 3T3 fibroblasts are used to characterize the influence of test materials on cellular homeostasis and viability, which is quantified by the dose-dependent uptake of Neutral red. As a second parameter changes in the cellular protein level can be easily measured by subsequent staining with Kenacid blue. Finally, the third approach to in vitro evaluation is presented in the form of the red blood cell assay, a rapid photometric assay which permits distinguishing basically between damage to the membrane and to proteins as endpoints which correlate with lesions observed on the conjunctiva, iris and cornea in the eye and the acute inflammatory responses evoked during epicutaneous irritancy testing. Changes in the optical behavior of oxyhemoglobin are used as the inherent indicator for monitoring both endpoints and their interrelations. These methods are proposed and can be used advantageously for testing newly developed topical preparations and their ingredients in view of their local irritation potential without further use of animal testing. Moreover, they can also be used for screening chemicals.