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  • 1. A, Borgström
    et al.
    P, Nerfeldt
    Friberg, Danielle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Questionnaire OSA-18 has poor validity compared to polysomnography in pediatric obstructive sleep apnea.2013In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464Article in journal (Refereed)
  • 2.
    Abrahamsson, Lotta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Ljung, Ida-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Bliss i interaktion: - En samtalsanalytisk fallstudie av hur blissanvändare och tolkare tillsammans bygger upp yttranden2008Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
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  • 3.
    Adnan, Ali
    et al.
    Univ Gothenburg, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Dept Otorhinolaryngol Head & Neck Surg,Inst Clin, Gothenburg, Sweden..
    Högmo, Anders
    Karolinska Hosp, Canc Ctr Karolinska, Dept Oncol & Pathol, Stockholm, Sweden..
    Sjödin, Helena
    Karolinska Hosp, Canc Ctr Karolinska, Dept Oncol & Pathol, Stockholm, Sweden..
    Gebre-Medhin, Maria
    Lund Univ, Skane Univ Hosp, Dept Oncol & Radiat Phys, Lund, Sweden..
    Laurell, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Reizenstein, Johan
    Örebro Univ Hosp, Dept Oncol, Örebro, Sweden.;Örebro Univ, Örebro, Sweden..
    Farnebo, Lovisa
    Linköping Univ, Fac Hlth Sci, Dept Clin & Expt Med, Div Otorhinolaryngol, Linköping, Sweden..
    Norberg, Lena S.
    Umeå Univ, Dept Clin Sci ENT, Umeå, Sweden..
    Notstam, Isak
    Umeå Univ, Dept Clin Sci ENT, Umeå, Sweden..
    Holmberg, Erik
    Sahlgrens Univ Hosp, Reg Canc Ctr Western Sweden, Gothenburg, Sweden..
    Cange, Hedda H.
    Univ Gothenburg, Sahlgrenska Acad, Sahlgrenska Univ Hosp, Dept Oncol,Inst Clin Sci, Gothenburg, Sweden..
    Hammerlid, Eva
    Univ Gothenburg, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Dept Otorhinolaryngol Head & Neck Surg,Inst Clin, Gothenburg, Sweden..
    Health-related quality of life among tonsillar carcinoma patients in Sweden in relation to treatment and comparison with quality of life among the population2020In: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 42, no 5, p. 860-872Article in journal (Refereed)
    Abstract [en]

    Background The health-related quality of life (HRQOL) of tonsillar carcinoma survivors was explored to investigate any HRQOL differences associated with tumor stage and treatment. The survivors' HRQOL was also compared to reference scores from the population. Methods In this exploratory cross-sectional study patients were invited 15 months after their diagnosis and asked to answer two quality of life questionnaires (EORTC QLQ- C30, EORTC QLQ- HN35), 405 participated. Results HRQOL was associated with gender, with males scoring better than females on a few scales. Patients' HRQOL was more associated with treatment than tumor stage. Patients' HRQOL was worse than that in an age- and sex-matched reference group from the normal population, the largest differences were found for problems with dry mouth followed by problems with sticky saliva, senses, swallowing and appetite loss. Conclusions The tonsillar carcinoma patients had a worse HRQOL compared to the general population one year after treatment.

  • 4.
    Ager, Emma
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Solli, Elin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    The PhonicStick: A Swedish Study: How do children age 5 and 6 handle the PhonicStick and will the use of it affect their phonological awareness?2009Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Phonological awareness is the ability to recognise, identify and manipulate components in words. Phonological awareness is an important part of the early literacy learning, although researchers disagree on how the connection arises. In the United Kingdom, synthetic phonics is a recommended way to teach literacy and the Jolly Phonics is a common approach within this method. In Sweden, mostly synthetic but also analytic methods are used for literacy teaching. The PhonicStick is developed as a communication device for impaired people and is based on the Jolly Phonics. In this study, the PhonicStick was being tested on children aged 5 and 6 years in mainstream pre-school classes to evaluate the use of it and its use for improvement of phonological awareness. The participating children were randomly divided into a test and a control group. All children were pre- and post-tested to analyse the possible improvement of parts of the phonological awareness. The test group went through three PhonicStick sessions, including different games and tests. The results from the pre- and post-tests of phonological awareness showed no significant differences between the test and control group. However, four out of five PhonicStick tests showed a significant improvement between session 1 and session 3. This shows that the children in the study were able to handle the PhonicStick after only three sessions, including remembering phonics the without visual information and producing words including two or three phonics.

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    Ager Solli 2009
  • 5.
    Agrawal, Sumit
    et al.
    Western Univ, Dept Otolaryngol Head & Neck Surg, London, ON, Canada.
    Schart-Moren, Nadine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Liu, Wei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Ladak, Hanif M.
    Western Univ, Dept Otolaryngol Head & Neck Surg, London, ON, Canada;Western Univ, Dept Med Biophys, London, ON, Canada;Western Univ, Dept Elect & Comp Engn, London, ON, Canada.
    Rask-Andersen, Helge
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Li, Hao
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    The secondary spiral lamina and its relevance in cochlear implant surgery2018In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, no 1, p. 9-18Article in journal (Refereed)
    Abstract [en]

    Objective: We used synchrotron radiation phase contrast imaging (SR-PCI) to study the 3D microanatomy of the basilar membrane (BM) and its attachment to the spiral ligament (SL) (with a conceivable secondary spiral lamina [SSL] or secondary spiral plate) at the round window membrane (RWM) in the human cochlea. The conception of this complex anatomy may be essential for accomplishing structural preservation at cochlear implant surgery.

    Material and methods: Sixteen freshly fixed human temporal bones were used to reproduce the BM, SL, primary and secondary osseous spiral laminae (OSL), and RWM using volume-rendering software. Confocal microscopy immunohistochemistry (IHC) was performed to analyze the molecular constituents.

    Results: SR-PCI reproduced the soft tissues including the RWM, Reissner's membrane (RM), and the BM attachment to the lateral wall (LW) in three dimensions. A variable SR-PCI contrast enhancement was recognized in the caudal part of the SL facing the scala tympani (ST). It seemed to represent a SSL allied to the basilar crest (BC). The SSL extended along the postero-superior margin of the round window (RW) and immunohistochemically expressed type II collagen.

    Conclusions: Unlike in several mammalian species, the human SSL is restricted to the most basal portion of the cochlea around the RW. It anchors the BM and may influence its hydro-mechanical properties. It could also help to shield the BM from the RW. The microanatomy should be considered at cochlear implant surgery.

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  • 6.
    Aittomäki, Minna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Winell, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Grammatisk språkförståelse vid fyra år - testar vi det vi tror?: En jämförande studie av två grammatiska språkförståelsetest2011Independent thesis Advanced level (degree of Master (One Year)), 30 credits / 45 HE creditsStudent thesis
    Abstract [en]

    Many studies have investigated the development of children's language production, yet knowledge about how and when language comprehension develops is scarce. Researchers are agreed that comprehension generally precedes production, even though some grammatical structures are produced before the child fully comprehends them. Testing language comprehension is difficult, requiring the child to perform some kind of action in order to show his or her understanding. The aim of this study is to examine two grammatical comprehension tests, Nya SIT and TROG-2, and to compare both their content, and the results they generate. Seventy-six monolingual Swedish and bilingual 4-year-old children were tested with both tests. The conclusion is that the results of the two tests for all the children correlate fairly well, 0.7 according to Spearman's rank correlation. The correlation for the bilingual children is 0.6 and for the monolingual Swedish children 0.5. A regression analysis shows that language is the factor that has the greatest influence on the results, and that gender and age have less influence. The analysis of the test items shows that TROG-2 is a more thorough test of grammar than Nya SIT which only partly reveals the child's understanding of grammar.

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  • 7.
    Albinsson, Sophie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Berglund, Julia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Testbatteri för talapraxi: Utformning och pilotnormering av ett artikulationstest2010Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Apraxia of speech (AOS) is a motor speech disorder that affects the planning and programming of speech, resulting in articulatory and prosodic distortions. To this date there is no available test in Swedish for assessment of AOS. Therefore, the aim of this study was to construct a test battery that enables the assessment of level of severity of the disorder, including mild AOS. A pilot standardization was performed on 50 healthy speakers. In order to determine whether the performance on the test battery is affected by sex, age or level of education, the selection of participants was stratified by these variables.

    The tasks were constructed based on previous research regarding the perceptual characteristics of AOS, taking into account also the types of tasks that have proved to be challenging for patients with AOS.

    The performance varied between different tasks of the test battery. On some tasks a high portion of the participants got very high scores, while other tasks were shown to be challenging even for healthy speakers. No significant sex differences were found on any of the tasks. However, age and level of education significantly affected the performance on some of the tasks. Overall, the effect sizes for level of education were larger than for age.

    In the future, the test battery should be able to determine the presence or absence and severity of AOS. For further development of the test battery, the standardization should continue using a larger sample. A clinical validation on patients with diagnosed AOS is also of great importance.

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  • 8.
    Alex, A.
    et al.
    Danderyd Hosp, Dept Rehabil Med, Entrevagen8, SE-18288 Stockholm, Sweden..
    Gonzalez Lindh, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Speech-Language Pathology.
    Palmcrantz, S.
    Danderyd Hosp, Dept Rehabil Med, Entrevagen8, SE-18288 Stockholm, Sweden.;Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Assessing eating and swallowing in adults born with intellectual and motor disabilities: Face and content validity of a Swedish translation of the Dysphagia Assessment Package2023In: Journal of Intellectual Disability Research, ISSN 0964-2633, E-ISSN 1365-2788, Vol. 67, no 11, p. 1174-1189Article in journal (Refereed)
    Abstract [en]

    Purpose: Adults born with intellectual disabilities (ID) and motor disabilities (MD) have higher risk of dysphagia and should be assessed to decrease risk of severe complications. However, standardised assessment tools in Swedish are lacking.

    Methods: The Dysphagia Assessment Package (DAP) was cross-culturally translated from English to Swedish (DAP-SE) and tested for content validity by an expert group. Face validity was assessed by five speech and language therapist (SLT) during meal observations (n = 10), and the clinical relevance was reported in a study-specific questionnaire.

    Results: The DAP-SE was culturally adapted within the process of translation and was found to contain clinically relevant aspects to assess and suggest further interventions for adults with ID and MD. Face and content validity was confirmed by the expert group.

    Conclusion: This study, in which the DAP-SE was tested in a small sample size, provides the first indications of the instrument's validity with respect to evaluating mealtimes, swallowing function and swallowing safety in adults born with ID and MD. The study adds to the knowledge on how to translate and culturally adapt an assessment tool to clinically assess dysphagia on a complex and vulnerable patient group.

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  • 9.
    Alm, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    A new framework for understanding stuttering: The dual premotor model2007In: Research, Treatment, and Self-Help in Fluency Disorders: New Horizons : Proceedings of the Fifth World Congress on Fluency Disorders, Dublin, 25-28th July 2006 / [ed] James Au-Yeung and Margaret M. Leahy, Dublin: The International Fluency Association , 2007, p. 77-83Conference paper (Other academic)
  • 10.
    Alm, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Cluttering: a neurological perspective2011In: Cluttering: a handbook of research, intervention, and education / [ed] D. Ward & K. Scaler Scott, London: Psychology Press , 2011Chapter in book (Other academic)
  • 11.
    Alm, Per
    Department of Clinical Neuroscience and Department of Psychology, Lund University.
    Stuttering and sensory gating: a study of acoustic startle prepulse inhibition2006In: Brain and Language, ISSN 0093-934X, E-ISSN 1090-2155, Vol. 97, no 3, p. 317-321Article in journal (Refereed)
    Abstract [en]

    It was hypothesized that stuttering may be related to impaired sensory gating, leading to overflow of superfluous disturbing auditory feedback and breakdown of the speech sequence. This hypothesis was tested using the acoustic startle prepulse inhibition (PPI) paradigm. A group of 22 adults with developmental stuttering were compared with controls regarding the degree of PPI. No significant differences were found between the stuttering adults and the control group; the groups showed similar means and distribution. Likewise, no relation between the degree of PPI and the effect of altered auditory feedback on stuttering was found. In summary, the results of the study indicate that there is no relation between stuttering and PPI.

  • 12.
    Andersz, Caroline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Hansson, Anna-Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    The use of the PhonicStick in group training: Can South African children age 5-6 improve their phonological awareness by using the PhonicStick?2010Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Phonological awareness is the ability to recognize, reflect on and manipulate sound structures of a language. This ability has been shown to be crucial when acquiring literacy. The PhonicStick is a speech-generation communication device, which was initially developed for individuals with complex communication needs (CCN) though more recent research has focused on the effects of the device on factors important for literacy acquisition. In the present study the effects on phonological awareness were evaluated after seven group training sessions with the PhonicStick. The participants of the study were 20 typically developing South African 5-6 year old children. All participants where pre and post tested with The Phonological Awareness Test part c) isolation and a PhonicStick test which tested the ability to produce isolated phonemes and combinations of three phonemes with the device. The results of the study showed that training with the PhonicStick did not appear to improve results on The Phonological Awareness Test part c) isolation. However, it was found that the participants of the training group had improved their ability to manoeuvre the PhonicStick and to produce isolated phonemes and combinations of three phonemes.

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  • 13. Anmyr, Lena
    et al.
    Olsson, Mariann
    Freijd, Anders
    Larsson, Kjerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation.
    Sense of coherence, social networks, and mental health among children with a cochlear implant2015In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 79, no 4, p. 610-615Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to explore the personal and social resources of children with a cochlear implant from a child's perspective. Method: This descriptive cross-sectional study included 19 children with cochlear implants, aged 9-12 years. Data was collected, using the children's sense of coherence (CSOC) scale, the Network map, and the strengths and difficulties questionnaire (SDQ). The data was analyzed using descriptive and correlation statistics. Results: Most children had a strong sense of coherence. School life was an important arena for their social network. The mental health was comparable to normal hearing children. Still, some of the children with implants had low SOC and poor mental health. High SOC and closeness of the social network, especially in school, were associated with good mental health. Conclusion: This study shows that Swedish school-aged children with cochlear implants as a group have access to personal and social resources as strong sense of coherence and social networks. Still, there are individual children with psychosocial problems who need support and treatment.

  • 14.
    Anniko, Matti
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Acta Oto-Laryngologica2018In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 138, no 3, p. 192-193Article in journal (Other academic)
  • 15.
    Arbin, Linn
    et al.
    Vasteras Hosp, Dept Otorhinolaryngol, S-72189 Vasteras, Sweden..
    Enlund, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Dept Anaesthesiol, Cty Hosp, S-72189 Vasteras, Sweden..
    Knutsson, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Dept Otorhinolaryngol, Vasteras Cent Hosp, S-72189 Vasteras, Sweden..
    Post-tonsillectomy pain after using bipolar diathermy scissors or the harmonic scalpel: a randomised blinded study2017In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 274, no 5, p. 2281-2285Article in journal (Refereed)
    Abstract [en]

    To compare the postoperative pain following bipolar diathermy scissors tonsillectomy (higher temperature dissection) with harmonic scalpel tonsillectomy (lower temperature dissection). Sixty patients aged 7-40 years planned for tonsillectomy with no other concurrent surgery were randomised to either bipolar diathermy scissors or harmonic scalpel as surgical technique. Blinded to the surgical technique, the patients recorded their pain scores (VAS, 0-10) at awakening and the worst pain level of the day in the postoperative period. All intake of pain medication was also recorded. No statistically significant differences were found between the two groups regarding postoperative pain levels or consumption of pain medication. Usage of the harmonic scalpel does not render less postoperative pain following tonsillectomy when compared with usage of the bipolar diathermy scissors.

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  • 16.
    Assadian, Farzaneh
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Sandström, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Bondeson, Kåre
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infection medicine.
    Laurell, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Lidian, Adnan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Svensson, Catharina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Akusjärvi, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Bergqvist, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Punga, Tanel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Distribution and Molecular Characterization of Human Adenovirus and Epstein-Barr Virus Infections in Tonsillar Lymphocytes Isolated from Patients Diagnosed with Tonsillar Diseases2016In: PLOS ONE, E-ISSN 1932-6203, Vol. 11, no 5, article id e0154814Article in journal (Refereed)
    Abstract [en]

    Surgically removed palatine tonsils provide a conveniently accessible source of T and B lymphocytes to study the interplay between foreign pathogens and the host immune system. In this study we have characterised the distribution of human adenovirus (HAdV), Epstein-Barr virus (EBV) and human cytomegalovirus (HCMV) in purified tonsillar T and B cell-enriched fractions isolated from three patient age groups diagnosed with tonsillar hypertrophy and chronic/recurrent tonsillitis. HAdV DNA was detected in 93 out of 111 patients (84%), while EBV DNA was detected in 58 patients (52%). The most abundant adenovirus type was HAdV-5 (68%). None of the patients were positive for HCMV. Furthermore, 43 patients (39%) showed a co-infection of HAdV and EBV. The majority of young patients diagnosed with tonsillar hypertrophy were positive for HAdV, whereas all adult patients diagnosed with chronic/recurrent tonsillitis were positive for either HAdV or EBV. Most of the tonsils from patients diagnosed with either tonsillar hypertrophy or chronic/recurrent tonsillitis showed a higher HAdV DNA copy number in T compared to B cell-enriched fraction. Interestingly, in the majority of the tonsils from patients with chronic/recurrent tonsillitis HAdV DNA was detected in T cells only, whereas hypertrophic tonsils demonstrated HAdV DNA in both T and B cell-enriched fractions. In contrast, the majority of EBV positive tonsils revealed a preference for EBV DNA accumulation in the B cell-enriched fraction compared to T cell fraction irrespective of the patients' age.

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  • 17.
    Astradsson, Thorsteinn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Laurell, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Ahlberg, Alexander
    Karolinska Univ Hosp, Dept Otorhinolaryngol Head & Neck Surg, Stockholm, Sweden.
    Nikolaidis, Polymnia
    Karolinska Univ Hosp, Dept Physiotherapy, Stockholm, Sweden.
    Johansson, Hemming
    Karolinska Univ Hosp, Dept Oncol Stat, Stockholm, Sweden.
    Ehrsson, Ylva Tiblom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Trismus in patients with head and neck cancer and 5-year overall survival2018In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 138, no 12, p. 1123-1127Article in journal (Refereed)
    Abstract [en]

    Background: Trismus is a common complication of radiotherapy for head and neck cancer but its impact on survival is unknown.

    Aims/Objectives: This prospective study evaluates the incidence of trismus in patients with head and neck cancer receiving radiotherapy and the impact of trismus on 5-year overall survival.

    Material and methods: Two hundred forty-four patients with head and neck cancer were included. All patients received instructions on jaw exercises and were evaluated before initiation of radiotherapy and at 2, 6, and 12 months after termination of radiotherapy.

    Results: One year after treatment 25% had a reduced maximum interincisal opening (MIO) of 13 mm or more as compared to the pretreatment MIO. Trismus was most prevalent in patients with oral and oropharyngeal cancer. A trend towards worse 5-year overall survival was seen among patients with trismus.

    Conclusions: The trismus rate was approximately 30% at 12 months. Jaw exercises should primarily be offered to patients with oral and oropharyngeal cancer who are most likely to benefit. Further studies are required to investigate the effect of trismus on survival.

    Significance: This study identifies patients likely to benefit from jaw exercises and provides basis for further research on trismus and survival.

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  • 18.
    Atturo, Francesca
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Barbara, Maurizio
    Rask-Andersen, Helge
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Is the Human Round Window Really Round?: An Anatomic Study With Surgical Implications2014In: Otology and Neurotology, ISSN 1531-7129, E-ISSN 1537-4505, Vol. 35, no 8, p. 1354-1360Article in journal (Refereed)
    Abstract [en]

    Hypothesis: Human round window (RW) presents anatomic variations that may influence surgical approach. Background: The true shape of the human RW has been divisive since its first description in 1772 by Antonio Scarpa. Introduction of novel surgical strategies in recent years have raised its significance. Here, the human RW size and shape variations were documented in microdissected human temporal bones. Methods: An archival collection of human microdissected temporal bones was analyzed. RW rim could be delineated and photographed from the labyrinthine aspect and its topography assessed. Results: Human RW is seldom round but ovoid or orthogonal, skewed, and nonplanar (saddlelike). Membrane is fan shaped or conical with an anteroinferior and a posterosuperior part. The mean longest diameter was 1.90 mm, and the smallest one is 1.54 mm. The mean diameter from the crista fenestra was 1.31 mm. The mean area of the RW was 2.08 mm(2), which varied between 0.99 and 3.20 mm(2). The crista fenestrae of the anterior component form a "doorstep" that may limit the entry to the scala tympani from the RW niche. Conclusion: The alternate anatomic features of the human RW may influence its surgical access and designs of implants aimed at targeting this region.

  • 19.
    Atturo, Francesca
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Schart-Moren, Nadine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Larsson, Sune
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Rask-Andersen, Helge
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery. Uppsala Univ Hosp, Otolaryngol Sect, Dept Surg Sci Head & Neck Surg, Uppsala, Sweden.
    Li, Hao
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    The Human Cochlear Aqueduct and Accessory Canals: a Micro-CT Analysis Using a 3D Reconstruction Paradigm2018In: Otology and Neurotology, ISSN 1531-7129, E-ISSN 1537-4505, Vol. 39, no 6, p. e429-e435Article in journal (Refereed)
    Abstract [en]

    Objective: We sought to study the anatomic variations of the cochlear aqueduct and its accessory canals in human temporal bones using micro-CT and a 3D reconstruction paradigm. More knowledge about the anatomic variations of these structures, particularly at the basal turn of the cochlea and round window niche, may be important to better preserve residual hearing as well as the neural supply during cochlear implant surgery.

    Methods: An archival collection of 30 human temporal bones underwent micro-CT and 3D reconstruction. A surface enhancement paradigm was applied. The application displays reconstructed slices as a 3D object with realistic 3D visualization of scanned objects. Virtual sectioning or cropping of the petrous bone presented subsequent areas. Thereby, the bony canals could be followed from inside the basal turn of cochlea and middle ear to the jugular foramen.

    Results: The cochlear aqueduct was always paralleled by an accessory canal containing the inferior cochlear vein. It ran from the basal turn of the cochlea and exited laterally in the jugular foramen. In 70% of the cases, a secondary accessory canal was observed and it derived mostly from a depression or infundibulum located in the floor of the round window niche. This canal also exited in the jugular foramen. The secondary accessory canal occasionally anastomosed with the primary accessory canal suggesting that it contains a vein that drains middle ear blood to the cranial sinus.

    Conclusion: Micro-CT with 3D surface reconstruction paradigm offers new possibilities to study the topographic anatomy of minor details in the human inner ear. The technique creates simulated transparent castings of the labyrinth with a coinciding surface view through enhancement of contrast between boundaries. Accessory canals that drain blood from the cochlea, spiral ganglion, and middle ear could be characterized three-dimensionally.

  • 20.
    Backlund, Charlotte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Lindström, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Stavningsförmåga och allografisk förmåga hos vuxna personer med dyslexi: Preklinisk validering av STAVUX och Kasttranskription2010Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The aim of this study was to determine if STAVUX (spelling test for adults) and Kasttranskription are suitable tests to use in the assessment of adults with spelling difficulties. At present, there are no such tests with norms for people older than 18 years. STAVUX was developed by Nilsson and Pettersson (2009) and consists of 45 words and 45 pseudo words of varying difficulty. The words are chosen to represent the different spelling patterns of the Swedish language and the pseudo words to represent the Swedish phonetic structure. A between group’s design was used to find out if STAVUX is a suitable test to use in the assessment of spelling difficulties. STAVUX was validated on 23 persons with dyslexia, aged 18-64 years, and the results were compared to a control group of 23 persons, aged 18-62 years. In this study it was also investigated if there was any correlation between spelling ability and allographic ability. The participants performed a case transcription task, where the participants were supposed to convert lower to upper case letters and upper to lower case letters, while time was measured. The test is named Kasttranskription and was designed by Hansson and Häägg (2008). The results of this study show that particularly the word part of STAVUX, contributes to the prediction of dyslexia. The dyslexic group performed significantly lower than the control group on both subtests (words and pseudo words). Both groups followed the same pattern in type of spelling errors. The majority of the participants in each group managed to perform Kasttranskription correctly. There was a significant difference in time of performance of Kasttranskription. The dyslexic group performed significantly worse in terms of time compared to the control group. The subtests of STAXUX and Kasttranskription were highly correlated with each other.

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    FULLTEXT02
  • 21.
    Backlund, Josefine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Lindqvist, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Snabb automatiserad benämning som screeninginstrument vid kognitiva störningar: En klinisk studie baserad på AQT2009Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    A Quick Test (AQT) Color-Form is a test that uses rapid automatized naming in order to identify cognitive impairment. It is divided into three parts, each of which consists of 40 stimuli that are to be named as quickly as possible. Previous studies have indicated that AQT separates patients with Alzheimer’s disease from normal controls with higher accuracy than the commonly used Mini-Mental State Examination (MMSE). The purpose of this study was to investigate, for the first time, whether AQT results collected from a consecutive series of patients at a Memory Clinic would be able to predict the diagnosis. Another aim was to study the possible relation between AQT results and Cerebrospinal Fluid (CSF) biomarkers for neurodegenerative diseases. 492 forms from AQT Color-Form tests were analyzed and diagnostic prediction and correlation with level of CSF biomarkers were determined for the first 374 patients. The results imply that AQT Color-Form may be sensitive to some symptoms of benign memory impairment that is found in patients admitted to a Memory Clinic, but that it is not always sensitive to mild degrees of dementia. Further research consecutive series of patients is needed in order to determine the diagnostic abilities of discrimination in clinical practice.

    Download full text (pdf)
    FULLTEXT01
  • 22. Bagger-Sjoback, Dan
    et al.
    Strömbäck, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Hultcrantz, Malou
    Papatziamos, Georgios
    Smeds, Henrik
    Danckwardt-Lillieström, Niklas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Tideholm, Bo
    Johansson, Ann
    Hellstrom, Sten
    Hakizimana, Pierre
    Fridberger, Anders
    High-frequency hearing, tinnitus, and patient satisfaction with stapedotomy: A randomized prospective study2015In: Scientific Reports, E-ISSN 2045-2322, Vol. 5, article id 13341Article in journal (Refereed)
    Abstract [en]

    Otosclerosis is a common disorder that leads to conductive hearing loss. Most patients with otosclerosis also have tinnitus, and surgical treatment is known to improve hearing as well as tinnitus. Some patients however experience worsening of tinnitus after the operation, but there are no known factors that allow surgeons to predict who will be at risk. In this prospective observational study on 133 patients undergoing stapedotomy, we show that postoperative air conduction thresholds at very high stimulus frequencies predict improvement of tinnitus, as assessed with proportional odds logistic regression models. Young patients were significantly more likely to experience reduction of tinnitus and patients whose tinnitus became better were also more satisfied with the outcome of the operation. These findings have practical importance for patients and their surgeons. Young patients can be advised that surgery is likely to be beneficial for their tinnitus, but a less positive message should be conveyed to older patients.

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    fulltext
  • 23.
    Bengtsson, Caroline
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Nasal obstruction – impact on insomnia symptoms and sleep-disordered breathing2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Nasal obstruction is very common in the general population, but the role of nasal obstruction in sleep quality is not clear. Nasal obstruction is also prevalent in patients with obstructive sleep apnoea (OSA) and may contribute to poor adherence to continuous positive airway pressure (CPAP) treatment.

    Aims: To investigate the impact of subjective nasal obstruction, as a single symptom or as part of chronic rhinosinusitis (CRS), in both objective and subjective sleep quality, in three different population based cohorts. Another aim was to investigate the usefulness of the Sinonasal Outcome Test-22 (SNOT-22) and peak nasal inspiratory flow (PNIF) in the treatment of OSA patients.

    Methods and results: In paper I (the SHE-study), a community-based sample of 400 women were investigated with polysomnography and questions on sleep quality, daytime- and nasal symptoms. Women with nasal obstruction at night (n=30) had significantly higher prevalence of several night time symptoms and excessive daytime sleepiness (EDS), but the polysomnography was normal.

    In paper II (the GA2LEN study, n= 26, 647) and paper III (RHINE II and RHINE III studies, n= 5, 145) questionnaires on sleep quality, daytime- and nasal symptoms were used, and CRS was defined according to the epidemiological diagnostic criteria of the European Position Paper of Rhinosinusitis and Nasal Polyps (EPOS). In paper II, sleep problems were highly prevalent in CRS, and there was a dose-response relationship between the disease severity of CRS and sleep problems. The addition of persistent allergic rhinitis to CRS further increased the risk of sleep problems.

    In paper III, 2.7% of individuals without nasal symptoms at baseline had developed CRS at follow-up 10 years later. Strong associations between incident CRS and impaired sleep quality and EDS were found. Three insomnia symptoms at baseline increased the risk for CRS at follow-up.

    In paper IV, 197 OSA patients initiating CPAP treatment were investigated before starting CPAP and at the follow-up 3-4 weeks later. SNOT-22 scores were generally high among all OSA patients indicating a large sinonasal disease burden, and improved among those with CPAP adherence ≥ 4 hours/night. A low PNIF value increased the risk for poor CPAP adherence.

    Conclusions: Subjective nasal obstruction at night impairs subjective sleep quality in women, but does not affect objective sleep quality. CRS impairs subjective sleep quality, and insomnia symptoms may be a risk factor for CRS. SNOT-22 and PNIF may be useful tools in the treatment of OSA patients.

    List of papers
    1. Impact of nasal obstruction on sleep quality: a community-based study of women
    Open this publication in new window or tab >>Impact of nasal obstruction on sleep quality: a community-based study of women
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    2015 (English)In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 272, no 1, p. 97-103Article in journal (Refereed) Published
    Abstract [en]

    The aim of the study was to analyse the impact of self-reported nasal obstruction on sleep quality in women. A community-based sample of 400 women underwent a full night of polysomnography. Airway diseases, allergies and sleep-related symptoms were assessed by questionnaires. Women with subjective nasal obstruction were subdivided into three groups: persistent nasal obstruction (PNO, n = 46), hay fever (n = 88) and nasal obstruction at night (NON, n = 30). Sleep problems and related daytime symptoms were most prevalent among women with NON. After adjusting for age, BMI, smoking and asthma, NON was an independent predictor of 'Difficulties inducing sleep due to nasal obstruction' [adjusted odds ratio (95 % CI): 89.5 (27.0-296.7)], 'Snoring' [4.2 (1.7-10.2)], 'Sweating at night' [2.6 (1.1-6.1)], 'Difficulties maintaining sleep' [2.7 (1.2-6.2)], and 'Waking up hastily gasping for breath' [32.2 (8.7-119.1)]. 'Dry mouth on awakening' [7.7 (3.2-18.4)], 'Waking up unrefreshed' [2.7 (1.2-6.0)], 'Excessive daytime sleepiness' [2.6 (1.1-6.0)], and 'Daytime nasal obstruction' [12.2 (4.8-31.2)] were also associated with NON. Persistent nasal obstruction and hay fever were both associated with some reported sleep problems due to an overlap with NON. When women with NON were excluded, only 'Daytime nasal obstruction' was still significantly associated with PNO, while hay fever was associated with 'Daytime nasal obstruction' and 'Waking up hastily gasping for breath'. There were no significant differences in objectively measured sleep variables between any of the three subgroups and the study cohort. Self-reported nasal obstruction at night in women has a significant effect on several subjective day- and nighttime symptoms, but it does not appear to affect objectively measured sleep quality.

    National Category
    Otorhinolaryngology
    Identifiers
    urn:nbn:se:uu:diva-231393 (URN)10.1007/s00405-014-3067-6 (DOI)000347292000014 ()24792065 (PubMedID)
    Available from: 2014-09-08 Created: 2014-09-08 Last updated: 2019-10-12Bibliographically approved
    2. Chronic rhinosinusitis impairs sleep quality: Results of the GA(2)LEN study
    Open this publication in new window or tab >>Chronic rhinosinusitis impairs sleep quality: Results of the GA(2)LEN study
    Show others...
    2017 (English)In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 40, no 1, article id zsw021Article in journal (Refereed) Published
    Abstract [en]

    STUDY OBJECTIVES: To analyse the prevalence of sleep problems in subjects with CRS and to determine whether the disease severity of CRS affects sleep quality.

    METHODS: Questionnaires were sent to a random sample of 45 000 adults in four Swedish cities. Questions on CRS, asthma, allergic rhinitis, co-morbidities, tobacco use, educational level and physical activity were included. CRS was defined according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) epidemiological criteria. The disease severity of CRS was defined by the number of reported CRS symptoms. Sleep quality was assessed using the Basic Nordic Sleep Questionnaire.

    RESULTS: Of the 26 647 subjects, 2249 (8.4%) had CRS. Reported sleep problems were 50-90% more common among subjects with CRS compared with those without or the total population. The prevalence of reported sleep problems increased in conjunction with the severity of CRS. After adjusting for gender, BMI, age, tobacco use, asthma, somatic diseases, physical activity level and educational level, participants with four symptoms of CRS (compared with subjects without CRS symptoms) displayed a higher risk of snoring (adj. OR (95% CI): 3.13 (2.22-4.41)), difficulties inducing sleep (3.98 (2.94-5.40)), difficulties maintaining sleep (3.44 (2.55-4.64)), early morning awakening (4.71 (3.47-6.38)) and excessive daytime sleepiness (4.56 (3.36-6.18)). The addition of persistent allergic rhinitis to CRS further increased the risk of sleep problems.

    CONCLUSIONS: Sleep problems are highly prevalent among subjects with CRS. The disease severity of CRS negatively affects sleep quality.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-311304 (URN)10.1093/sleep/zsw021 (DOI)000394125700021 ()27692055 (PubMedID)
    Funder
    Swedish Heart Lung Foundation
    Available from: 2016-12-22 Created: 2016-12-22 Last updated: 2019-10-12Bibliographically approved
    3. Incident Chronic Rhinosinusitis Is Associated With Impaired Sleep Quality: Results of the RHINE Study
    Open this publication in new window or tab >>Incident Chronic Rhinosinusitis Is Associated With Impaired Sleep Quality: Results of the RHINE Study
    Show others...
    2019 (English)In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 15, no 6, p. 899-905, article id PII jc-18-00575Article in journal (Refereed) Published
    Abstract [en]

    Study Objectives: Chronic rhinosinusitis (CRS) is a common inflammatory disease of the nasal cavity and paranasal sinuses. Associations between CRS and poor sleep quality have been reported. This 10-year follow-up study investigates possible associations between incident CRS and sleep quality. Methods: A questionnaire was sent to 16,500 individuals in Sweden, Norway, Denmark, Iceland and Estonia in 2000. It included questions on airway diseases, age, sex, body mass index, smoking habits, comorbidities, education and sleep quality. In 2010, a second questionnaire was sent to the same individuals, with a response rate of 53%. A subgroup of 5,145 individuals without nasal symptoms in 2000 was studied. Multiple logistic regression was performed to examine associations between CRS (defined according to the European position paper on rhinosinusitis and nasal polyps epidemiological criteria) at follow-up and sleep quality, with adjustment for potential confounders. Individuals with the respective sleep problem at baseline were excluded. Results: Over 10 years, 141 (2.7%) of the individuals without nasal symptoms in 2000 had developed CRS. CRS was associated with difficulties inducing sleep (adjusted odds ratio 2.81 [95% CI 1.67-4.70]), difficulties maintaining sleep (2.07 [1.35-3.18]), early morning awakening (3.03 [1.91-4.81]), insomnia (2.21 [1.46-3.35]), excessive daytime sleepiness (2.85 [1.79-4.55]), and snoring (3.31 [2.07-5.31]). Three insomnia symptoms at baseline increased the risk of CRS at follow-up by 5.00 (1.93-12.99). Conclusions: Incident CRS is associated with impaired sleep quality and excessive daytime sleepiness. Insomnia symptoms may be a risk factor for the development of CRS.

    Place, publisher, year, edition, pages
    AMER ACAD SLEEP MEDICINE, 2019
    Keywords
    chronic rhinosinusitis, CRS, epidemiology, insomnia, sleep quality
    National Category
    Otorhinolaryngology
    Identifiers
    urn:nbn:se:uu:diva-389988 (URN)10.5664/jcsm.7846 (DOI)000471747600013 ()31138385 (PubMedID)
    Funder
    Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Heart Lung FoundationSwedish Asthma and Allergy Association
    Available from: 2019-08-02 Created: 2019-08-02 Last updated: 2019-12-19Bibliographically approved
    4. Sinonasal outcome test-22 and peak nasal inspiratory flow: valuable tools in obstructive sleep apnoea
    Open this publication in new window or tab >>Sinonasal outcome test-22 and peak nasal inspiratory flow: valuable tools in obstructive sleep apnoea
    Show others...
    2020 (English)In: Rhinology, ISSN 0300-0729, E-ISSN 1996-8604, Vol. 58, no 4, p. 341-348Article in journal (Refereed) Published
    Abstract [en]

    Background: Sinonasal complaints contribute to low adherence to continuous positive airway pressure (CPAP) treatment. We aimed to investigate sinonasal health in obstructive sleep apnoea (OSA) patients, using the sinonasal outcome test-22 (SNOT-22), and to analyse whether SNOT-22 is affected by CPAP adherence. We also aimed to investigate whether peak nasal inspiratory flow (PNIF) was able to predict adherence to CPAP. Methods:The study population comprised 197 OSA patients (60 females) initiating CPAP treatment The SNOT-22, PNIF and the Epworth Sleepiness Scale were assessed at baseline and follow-up. One-night polygraphy, the Hospital Anxiety and Depression Scale, peak expiratory flow and health-related issues were assessed at baseline. At follow-up, the patients were categorised into adherent (>4 hours/night) and non-adherent (<4 hours/night) to CPAP treatment. Results: The average time for following up CPAP treatment was (mean +/- SD) 24.0 +/- 23.9 days and it did not differ significantly between the groups.The SNOT-22 score was elevated among all OSA patients, 36.1 +/- 19.4.There was a larger improvement in the SNOT-22 score at follow-up among adherent CPAP users compared with non-adherent users (-10.4 +/- 13.9 vs. -3.2 +/- 15.4). A PNIF value of < 100 litres/min increased the risk of non-adherence to CPAP with an adjusted odds ratio (OR) of 2.40 ((95% CI 1.16-5.00)). Conclusions: The SNOT-22 was elevated in patients with OSA, indicating a considerable sinonasal disease burden.The SNOT-22 improved with good CPAP adherence. A low PNIF value was able to predict poor CPAP adherence. Both the SNOT-22 and PNIF can be valuable tools in the evaluation of OSA patients and in the management of CPAP treatment.

    National Category
    Clinical Medicine Otorhinolaryngology Respiratory Medicine and Allergy
    Research subject
    Medical Science
    Identifiers
    urn:nbn:se:uu:diva-393558 (URN)10.4193/Rhin19.189 (DOI)000562561400006 ()32415827 (PubMedID)
    Funder
    Swedish Heart Lung Foundation
    Available from: 2019-10-02 Created: 2019-10-02 Last updated: 2020-10-16Bibliographically approved
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  • 24.
    Bengtsson, Caroline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Grote, Ludger
    Sahlgrens Univ Hosp, Sleep Disorders Ctr, Pulm Dept, Gothenburg, Sweden.;Gothenburg Univ, Sahlgrenska Acad, Ctr Sleep & Wake Disorders, Gothenburg, Sweden..
    Ljunggren, Mirjam
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Ekström, Magnus
    Lund Univ, Fac Med, Dept Clin Sci Lund Resp Med & Allergol, Resp Med & Allergol, Lund, Sweden..
    Palm, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Research and Development, Gävleborg.
    Nasal polyposis is a risk factor for nonadherence to CPAP treatment in sleep apnea: the population-based DISCOVERY study2023In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 19, no 3, p. 573-579Article in journal (Refereed)
    Abstract [en]

    Study Objectives: The aim was to evaluate nasal polyposis as a risk factor for nonadherence to continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA).

    Methods: This was a population-based, longitudinal analysis of patients starting CPAP treatment for OSA in the Swedish quality registry Swedevox between 2010 and 2018. Data were cross-linked with national registries. The impact of nasal polyposis on CPAP adherence was analyzed using uni-and multivariable logistic and linear regression models. Relevant confounders (age, sex, usage of nasal and oral steroids) were identified using a direct acyclic graph.

    Results: Of 20,521 patients with OSA on CPAP treatment (29.5% females), 331 (1.6%) had a diagnosis of nasal polyposis at baseline. At the 1-year follow-up, nasal polyposis was associated with an increased risk of CPAP usage < 4 hours/night (unadjusted odds ratio [OR] 1.21; 95% confidence interval [CI] 0.95-1.55); adjusted OR 1.38; 95% CI 1.08-1.77). In this group, unadjusted nocturnal mean CPAP usage was 15.4 minutes (95% CI-31.62 to 0.83) shorter and was an adjusted 24.1 minutes (95% CI-40.6 to-7.7) shorter compared with patients with OSA without nasal polyposis.

    Conclusions: Nasal polyposis is associated with reduced CPAP usage per night. These results highlight the importance of diagnosing nasal polyposis in patients with OSA before the start of CPAP treatment. Treatment of the condition may improve adherence, efficacy, and patient outcomes.

  • 25.
    Bengtsson, Caroline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Jonsson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Holmstrom, Mats
    Karolinska Univ Hosp, Dept Clin Sci Intervent & Technol, Div Ear Nose & Throat Dis, Huddinge, Sweden.
    Hellgren, Johan
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Otorhinolaryngol Head & Neck Surg, Gothenburg, Sweden.
    Franklin, Karl
    Umea Univ, Surg, Dept Surg & Penoperat Sci, Umea, Sweden.
    Gislason, Torarinn
    Univ Iceland, Dept Resp Med & Sleep, Reykjavik, Iceland.
    Holm, Mathias
    Univ Gothenburg, Dept Occupat & Environm Med, Gothenburg, Sweden.
    Johannessen, Ane
    Univ Bergen, Ctr Int Hlth, Dept Global Publ Hlth & Primary Care, Bergen, Norway;Haukeland Hosp, Dept Occupat Med, Bergen, Norway.
    Jõgi, Rain
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Schluenssen, Vivi
    Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark;Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Incident Chronic Rhinosinusitis Is Associated With Impaired Sleep Quality: Results of the RHINE Study2019In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 15, no 6, p. 899-905, article id PII jc-18-00575Article in journal (Refereed)
    Abstract [en]

    Study Objectives: Chronic rhinosinusitis (CRS) is a common inflammatory disease of the nasal cavity and paranasal sinuses. Associations between CRS and poor sleep quality have been reported. This 10-year follow-up study investigates possible associations between incident CRS and sleep quality. Methods: A questionnaire was sent to 16,500 individuals in Sweden, Norway, Denmark, Iceland and Estonia in 2000. It included questions on airway diseases, age, sex, body mass index, smoking habits, comorbidities, education and sleep quality. In 2010, a second questionnaire was sent to the same individuals, with a response rate of 53%. A subgroup of 5,145 individuals without nasal symptoms in 2000 was studied. Multiple logistic regression was performed to examine associations between CRS (defined according to the European position paper on rhinosinusitis and nasal polyps epidemiological criteria) at follow-up and sleep quality, with adjustment for potential confounders. Individuals with the respective sleep problem at baseline were excluded. Results: Over 10 years, 141 (2.7%) of the individuals without nasal symptoms in 2000 had developed CRS. CRS was associated with difficulties inducing sleep (adjusted odds ratio 2.81 [95% CI 1.67-4.70]), difficulties maintaining sleep (2.07 [1.35-3.18]), early morning awakening (3.03 [1.91-4.81]), insomnia (2.21 [1.46-3.35]), excessive daytime sleepiness (2.85 [1.79-4.55]), and snoring (3.31 [2.07-5.31]). Three insomnia symptoms at baseline increased the risk of CRS at follow-up by 5.00 (1.93-12.99). Conclusions: Incident CRS is associated with impaired sleep quality and excessive daytime sleepiness. Insomnia symptoms may be a risk factor for the development of CRS.

  • 26.
    Bengtsson, Caroline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Jonsson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Holmström, Mats
    Svensson, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Impact of nasal obstruction on sleep quality: a community-based study of women2015In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 272, no 1, p. 97-103Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to analyse the impact of self-reported nasal obstruction on sleep quality in women. A community-based sample of 400 women underwent a full night of polysomnography. Airway diseases, allergies and sleep-related symptoms were assessed by questionnaires. Women with subjective nasal obstruction were subdivided into three groups: persistent nasal obstruction (PNO, n = 46), hay fever (n = 88) and nasal obstruction at night (NON, n = 30). Sleep problems and related daytime symptoms were most prevalent among women with NON. After adjusting for age, BMI, smoking and asthma, NON was an independent predictor of 'Difficulties inducing sleep due to nasal obstruction' [adjusted odds ratio (95 % CI): 89.5 (27.0-296.7)], 'Snoring' [4.2 (1.7-10.2)], 'Sweating at night' [2.6 (1.1-6.1)], 'Difficulties maintaining sleep' [2.7 (1.2-6.2)], and 'Waking up hastily gasping for breath' [32.2 (8.7-119.1)]. 'Dry mouth on awakening' [7.7 (3.2-18.4)], 'Waking up unrefreshed' [2.7 (1.2-6.0)], 'Excessive daytime sleepiness' [2.6 (1.1-6.0)], and 'Daytime nasal obstruction' [12.2 (4.8-31.2)] were also associated with NON. Persistent nasal obstruction and hay fever were both associated with some reported sleep problems due to an overlap with NON. When women with NON were excluded, only 'Daytime nasal obstruction' was still significantly associated with PNO, while hay fever was associated with 'Daytime nasal obstruction' and 'Waking up hastily gasping for breath'. There were no significant differences in objectively measured sleep variables between any of the three subgroups and the study cohort. Self-reported nasal obstruction at night in women has a significant effect on several subjective day- and nighttime symptoms, but it does not appear to affect objectively measured sleep quality.

  • 27.
    Bengtsson, Caroline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Jonsson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Holmström, Mats
    Institutionen för klinisk vetenskap,intervention och teknik, Karolinska Institutet.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Sinonasal outcome test-22 and peak nasal inspiratory flow: valuable tools in obstructive sleep apnoea2020In: Rhinology, ISSN 0300-0729, E-ISSN 1996-8604, Vol. 58, no 4, p. 341-348Article in journal (Refereed)
    Abstract [en]

    Background: Sinonasal complaints contribute to low adherence to continuous positive airway pressure (CPAP) treatment. We aimed to investigate sinonasal health in obstructive sleep apnoea (OSA) patients, using the sinonasal outcome test-22 (SNOT-22), and to analyse whether SNOT-22 is affected by CPAP adherence. We also aimed to investigate whether peak nasal inspiratory flow (PNIF) was able to predict adherence to CPAP. Methods:The study population comprised 197 OSA patients (60 females) initiating CPAP treatment The SNOT-22, PNIF and the Epworth Sleepiness Scale were assessed at baseline and follow-up. One-night polygraphy, the Hospital Anxiety and Depression Scale, peak expiratory flow and health-related issues were assessed at baseline. At follow-up, the patients were categorised into adherent (>4 hours/night) and non-adherent (<4 hours/night) to CPAP treatment. Results: The average time for following up CPAP treatment was (mean +/- SD) 24.0 +/- 23.9 days and it did not differ significantly between the groups.The SNOT-22 score was elevated among all OSA patients, 36.1 +/- 19.4.There was a larger improvement in the SNOT-22 score at follow-up among adherent CPAP users compared with non-adherent users (-10.4 +/- 13.9 vs. -3.2 +/- 15.4). A PNIF value of < 100 litres/min increased the risk of non-adherence to CPAP with an adjusted odds ratio (OR) of 2.40 ((95% CI 1.16-5.00)). Conclusions: The SNOT-22 was elevated in patients with OSA, indicating a considerable sinonasal disease burden.The SNOT-22 improved with good CPAP adherence. A low PNIF value was able to predict poor CPAP adherence. Both the SNOT-22 and PNIF can be valuable tools in the evaluation of OSA patients and in the management of CPAP treatment.

  • 28.
    Berg, Malin
    et al.
    Sahlgrenska Acad Univ Gothenburg, Sahlgrenska Univ Hosp,Inst Clin Sciences, Dept Otorhinolaryngology,Head & Neck Surg, Gothenburg, Sweden..
    Adnan, Ali
    Sahlgrenska Acad Univ Gothenburg, Sahlgrenska Univ Hosp,Inst Clin Sciences, Dept Otorhinolaryngology,Head & Neck Surg, Gothenburg, Sweden..
    Hogmo, Anders
    Karolinska Univ Hosp, Dept Oto,Rhino,Laryngology,Head & Neck Surg, Stockholm, Sweden..
    Sjodin, Helena
    Karolinska Univ Hosp, Theme Canc, HHLH, Stockholm, Sweden..
    Gebre-Medhin, Maria
    Skane Univ Hosp, Lund Univ, Dept Oncology & Radiat Phys, Lund, Sweden..
    Laurell, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Reizenstein, Johan
    orebro Univ Hosp, orebro Univ, Dept Oncology, Örebro, Sweden..
    Farnebo, Lovisa
    Operat & Specialty Surg Ctr, Dept Otorhinolaryngology, Dept BioMed & Clin Sciences, Anaesthet, Linköping, Sweden..
    Norberg, Lena Spaak
    Umeå Univ, Dept Clin Sciences, Umeå, Sweden..
    Notstam, Isak
    Umeå Univ, Dept Clin Sciences, Umeå, Sweden..
    Holmberg, Erik
    Sahlgrens Univ Hosp, Reg Canc Ctr w Sweden, Gothenburg, Sweden..
    Cange, Hedda Haugen
    Sahlgrens Univ Hosp, Sahlgrenska Acad Univ Gothenburg, Inst Clin Sciences, Dept Oncology, Gothenburg, Sweden. Univ Gothenburg, Gothenburg, Sweden..
    Hammerlid, Eva
    Sahlgrenska Acad Univ Gothenburg, Sahlgrenska Univ Hosp,Inst Clin Sciences, Dept Otorhinolaryngology,Head & Neck Surg, Gothenburg, Sweden..
    A national study of health-related quality of life in patients with cancer of the base of the tongue compared to the general population and to patients with tonsillar carcinoma2021In: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 43, no 12, p. 3843-3856Article in journal (Refereed)
    Abstract [en]

    Background This exploratory, registry-based, cross-sectional study aimed to evaluate patients' health-related quality of life (HRQOL) in a subsite of oropharyngeal cancer: cancer of the base of the tongue (CBT). Methods CBT patients, treated with curative intent, completed the EORTC QLQ-C30 and QLQ-H&N35 questionnaires 15 months after diagnosis. The HRQOL of CBT patients was compared to reference scores from the general population and to that of tonsillar carcinoma patients. Results The 190 CBT patients scored significantly worse than members of the general population on most scales. CBT patients with human papilloma virus (HPV)-positive tumors had significantly better HRQOL on 8 of 28 scales than HPV-negative patients. Compared to 405 tonsillar carcinoma patients, CBT patients had significantly worse HRQOL on 8 of the 28 scales, the majority local head and neck related problems. Conclusion One year after treatment, CBT patients' HRQOL was significantly worse in many areas compared to that of the general population and slightly worse than that of tonsillar carcinoma patients.

  • 29.
    Berg, Thomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Medical Treatment and Grading of Bell's Palsy2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The main aim of this thesis was to evaluate the effect of prednisolone and valaciclovir in a large number of Bell's palsy patients. The incidence and intensity of pain around the ear, in the face or in the neck during the first two months of palsy, and its prognostic value, was also assessed. We also investigated how study design and choice of analysis method affect the rate of facial recovery. Furthermore, the agreement between the Sunnybrook, House-Brackmann and Yanagihara facial grading systems was evaluated.

    From May 2001 to September 2007, a prospective, randomised, double-blind, placebo-controlled, multicentre trial with 12-month follow-up was performed in patients with Bell's palsy. Of 839 randomised patients, 829 were included in the intention-to-treat analysis; 206 received placebo plus placebo, 210 prednisolone plus placebo, 207 valaciclovir plus placebo, and 206 prednisolone plus valaciclovir. Time to recovery was significantly shorter in the 416 patients who received prednisolone compared with the 413 who did not (p<0.0001). At 12 months, 300 of 416 patients (72%) in the prednisolone group had recovered compared with 237 of 413 patients (57%) in the no prednisolone group (p<0.0001). Valaciclovir was not found to affect time to facial recovery or outcome at 12 months. Prednisolone and/or valaciclovir did not affect the incidence or intensity of pain. Presence of pain at day 11 to 17 indicated a worse prognosis for facial recovery at 12 months. We also found that recovery rates in a Bell's palsy trial are substantially affected by the choice of analysis method and definition of facial recovery.

    We used weighted Kappa statistics in 100 examinations of patients with facial palsy to assess the agreement between the Sunnybrook, House-Brackmann and Yanagihara scales. The highest agreement was found between the regional Sunnybrook and Yanagihara scales. An evaluative difference between the Sunnybrook and House-Brackmann systems was observed.

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  • 30.
    Berg, Thomas
    et al.
    Department of Plastic Surgery, Rigshospitalet, Oslo.
    Jonsson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Are patients with Bell's palsy receiving the right treatment?2015In: Tidsskrift for Den norske lægeforening, ISSN 0029-2001, E-ISSN 0807-7096, Vol. 135, no 11, p. 1026-1027Article in journal (Refereed)
  • 31.
    Berg, Thomas
    et al.
    Department of Plastic Surgery, Rigshospitalet, Oslo.
    Stjernquist-Desatnik, Anna
    Kanerva, Mervi
    Hultcrantz, Malou
    Engström, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Jonsson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Bells pares ger resttillstånd hos 30 procent av vuxna patienter: Tidig behandling med kortison ökar utläkningen2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, p. 1-5, article id C6RDArticle in journal (Refereed)
  • 32.
    Berglin, Cecilia Engmer
    et al.
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Otorhinolaryngol, Stockholm, Sweden..
    Pierre, Pernilla Videhult
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery. Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden..
    Ekborn, Andreas
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Otorhinolaryngol, Stockholm, Sweden..
    Bramer, Tobias
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Edsman, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Hultcrantz, Malou
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Otorhinolaryngol, Stockholm, Sweden..
    Laurell, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Local treatment of the inner ear: A study of three different polymers aimed for middle ear administration2015In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 135, no 10, p. 985-994Article in journal (Refereed)
    Abstract [en]

    Conclusion: A formulation based on sodium hyaluronate (NaHYA) was the most promising candidate vehicle for intra-tympanic drug administration regarding conductive hearing loss, inflammatory reactions, and elimination. Objectives: Recent advances in inner ear research support the idea of using the middle ear cavity for drug administration to target the inner ear. This paper presents rheological and safety assessments of three candidate polymer formulations for intra-tympanic drug administration. Method: The formulations were based on sodium carboxymethyl cellulose (NaCMC), sodium hyaluronate (NaHYA), and poloxamer 407 (POL). Rheological studies were performed with a controlled rate instrument of the couette type. Safety studies were performed in guinea pigs subjected to an intra-tympanic injection of the formulations. Hearing function was explored with ABR before and 1, 2, and 3 weeks after the injection. Elimination of the formulations marked with coal was explored with an endoscopic digital camera 1, 2, and 3 weeks after injection. Middle and inner ear morphology was examined with light microscopy 6 days after injection. Results: The results speak in favor of NaHYA, since it did not cause prolonged hearing threshold elevations. The results of the elimination and morphological investigations support the conclusion of NaHYA being the most promising candidate for intra-tympanic administration.

  • 33.
    Berglund, Malin
    et al.
    NAL Med Ctr, Dept Otorhinolaryngol, S-46185 Trollhattan, Sweden.
    Florentzson, Rut
    Sahlgrens Univ Hosp, Dept Otorhinolaryngol, Gothenburg, Sweden.
    Fransson, Mattias
    Skane Univ Hosp, Dept Otorhinolaryngol, Lund, Sweden.
    Hultcrantz, Malou
    Karolinska Inst, Stockholm, Sweden;Karolinska Univ Hosp, Dept Otorhinolaryngol, Stockholm, Sweden.
    Eriksson, Per Olof
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Englund, Erling
    Sundsvall Hosp, Cty Council Vasternorrland, Dept Res & Dev, Sundsvall, Sweden.
    Westman, Eva
    Umea Univ, Dept Clin Sci, Otorhinolaryngol, Umea, Sweden.
    Myringoplasty Outcomes From the Swedish National Quality Registry2017In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 127, no 10, p. 2389-2395Article in journal (Refereed)
    Abstract [en]

    Objectives/Hypothesis: Data from patients registered for myringoplasty during 2002 to 2012 in the Swedish National Quality Registry for Myringoplasty.

    Study Design: Both conventional myringoplasty and fat-graft techniques were used aimed at healing the tympanic membrane in noninfected ears.

    Methods: Analysis was performed on data in a national database collected from 32 ear, nose, and throat clinics. Surgical procedures and outcomes, and patient satisfaction from a questionnaire were studied.

    Results: The database was comprised of 3,775 surgical procedures, with follow-up available for analysis. One-third were children under the age of 15 years. The most common indication for surgery was infection prophylaxis. The overall healing rate of the tympanic membrane after surgery was 88.5%, with a high mean patient satisfaction. Complications registered were postoperative infection, tinnitus, or taste disturbance that occurred in 5.8% of patients.

    Conclusions: Swedish results for a large number of patients who completed myringoplasty are presented. The success rate in this study is comparable to other studies, and good patient-reported outcome measures of myringoplasty are presented. Databases for surgical procedures and clinical audits are systematic processes for continuous learning in healthcare. This study shows that clinical databases can be utilized to analyze national results of surgical procedures.

  • 34.
    Berglund, Malin
    et al.
    Department of Otorhinolaryngology NU Hospital Group Trollhättan Sweden;Department of Biomaterials Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Olaison, Sara
    Department of Otorhinolaryngology Örebro University Hospital Örebro Sweden.
    Bonnard, Åsa
    Department of Otorhinolaryngology Karolinska University Hospital Stockholm Sweden;Division of CLINTEC Department of Otorhinolaryngology Karolinska Institute Stockholm Sweden.
    Fransson, Mattias
    Department of Otorhinolaryngology Lund University Hospital Lund Sweden.
    Hultcrantz, Malou
    Division of CLINTEC Department of Otorhinolaryngology Karolinska Institute Stockholm Sweden.
    Florentzson, Rut
    Department of Otorhinolaryngology Sahlgrenska University Hospital Gothenburg Sweden.
    Dahlin, Christer
    Department of Biomaterials Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden;Department of Oral &amp; Maxillofacial Surgery NU Hospital Group Trollhättan Sweden.
    Eriksson, Per Olof
    Department of Surgical Sciences, Otorhinolaryngology Uppsala University Hospital Uppsala Sweden.
    Westman, Eva
    Department of Clinical Sciences, Otorhinolaryngology Umeå University, site Sundsvall Umeå Sweden.
    Hearing outcome after myringoplasty in Sweden: A nationwide registry‐based cohort study2020In: Clinical Otolaryngology, ISSN 1749-4478, E-ISSN 1365-2273, Vol. 45, no 3, p. 357-363Article in journal (Refereed)
  • 35. Berglund, Malin
    et al.
    Olaison, Sara
    Westman, Eva
    Eriksson, P. O.
    Steger, Lena
    Bonnard, Åsa
    Validation of the Swedish Quality Register for Ear Surgery – SwedEar2023In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 23, no 1, article id 240Article in journal (Refereed)
  • 36.
    Berglund, Malin
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Biomat, Gothenburg, Sweden;NU Hosp Grp, Dept Otorhinolaryngol, S-46185 Trollhattan, Sweden.
    Suneson, Petter
    Malarsjukhuset Hosp, Dept Otorhinolaryngol, Eskilstuna, Sweden.
    Florentzson, Rut
    Sahlgrens Univ Hosp, Dept Otorhinolaryngol, Gothenburg, Sweden.
    Fransson, Mattias
    Skane Univ Hosp, Dept Otorhinolaryngol, Lund, Sweden.
    Hultcrantz, Malou
    Karolinska Univ Hosp, Dept Otorhinolaryngol, Stockholm, Sweden.
    Westman, Eva
    Umea Univ, Dept Clin Sci, Otorhinolaryngol, Umea, Sweden.
    Eriksson, Per Olof
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Tinnitus and taste disturbances reported after myringoplasty: Data from a national quality registry2019In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 129, no 1, p. 209-215Article in journal (Refereed)
    Abstract [en]

    Objectives/Hypothesis: Postoperative tinnitus and taste disturbances after myringoplasty are more common than previously reported.

    Study Design: This study was a retrospective analysis of prospectively collected data from the Swedish National Quality Registry for Myringoplasty.

    Methods: The analysis was performed on extracted data from all counties in Sweden collected from database A from 2002 to 2012 and database B from 2013 to 2016. Tinnitus and taste disturbance complications 1 year after myringoplasty were analyzed in relation to gender, age, procedure, and success rate. In database A, physicians reported tinnitus and taste disturbances. In database B, patients reported the complications.

    Results: A major difference was found when the complications were reported by physicians compared to when the complications were reported by patients. In database A, tinnitus was reported in 1.2% of the patients and taste disturbances in 0.5%. In database B, the frequencies were 12.3% and 11.2%, respectively. Tinnitus and taste disturbances were more frequent after conventional myringoplasty compared to those after fat grafting and were more frequent after primary compared to those after revision surgery when reported by physicians. Patients, however, reported the same frequency of tinnitus after fat graft myringoplasty compared to that after conventional myringoplasty (12.0% vs. 12.6%) and fewer taste disturbances after revision surgery. In follow-up assessments, complications persisted after surgery over a long time period.

    Conclusion: Tinnitus and taste disturbances are more common after myringoplasty when patients report their symptoms than when physicians report the symptoms.

  • 37.
    Bergström, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Due, Sofia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Att mäta kommunikativ förmåga: Utvecklandet av ett självskattningsinstrument2009Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Working with communication is a key element in professional speech and language therapy. The aim of this study was to develop a self-report instrument that measures communicative ability, with a possibility to capture both positive and negative aspects of communication. The instrument was developed in accordance with classical measurement theory. A first evaluation of the instrument with 13 respondents was conducted. As a result the number of items, ie questions, was reduced from 133 to 78 and individual items were altered when needed. 254 respondents then answered the revised form on the internet. Four factors could be extracted from the material. These were: behavior in social situations, functional communication, linguistic skills and receptive skills plus voice. The four factors explained 30,4% of the variance within the material. Cronbach's alpha for all 78 items was α = 0,76. The result of this study is an instrument in need of further revision and development, primarily with respect to validation.

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  • 38.
    Berling Holm, Katarina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Bornefalk Hermansson, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Knutsson, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery. Department of Otolaryngology, Örebro University Hospital.
    von Unge, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery. Department of Otorhinolaryngology, Akershus University Hospital and University of Oslo.
    Surgery for chronic otitis media causes greater taste disturbance than surgery for otosclerosis2019In: Otology and Neurotology, ISSN 1531-7129, E-ISSN 1537-4505, Vol. 40, no 1, p. e32-e39Article in journal (Refereed)
    Abstract [en]

    Objectives: 

    Patients with otosclerosis more often complain about postoperative taste disturbance than patients with chronic otitis media, which seems paradoxical. We aim to investigate if and potentially why this seems to be the case, since the chorda tympani nerve (CTN) is thought to be severely traumatized less frequently during surgery in the former than in the latter.

    Study Design: 

    Prospective cohort study.

    Setting: 

    Department of Otorhinolaryngology at Hospital of Vastmanland, Vasteras, Sweden.

    Patients: 

    Sixty-five adults undergoing primary middle ear surgery were included. Thirty-seven were operated on for chronic suppurative otitis media with or without cholesteatoma (CSOM) and 28 for otosclerosis.

    Interventions: 

    Middle ear surgery due to otosclerosis or CSOM. Subjective and objective taste measurements and quality of life (QoL) questionnaire.

    Main Outcome Measures: 

    Taste was assessed using electrogustometry (EGM) and the filter paper disc (FPD) method before and up to 1 year after surgery. Questionnaires on taste disturbance, including a visual analogue scale (VAS), and QoL were completed before and up to 1 year after surgery.

    Results: 

    Subjective taste disturbance anytime during the 1-year follow-up were reported by 62 and 46%, respectively. The difference in EGM 1 week after surgery compared with preoperative EGM was significantly greater among CSOM patients than otosclerosis. One year postoperatively, the difference is non-significant.

    Conclusion: 

    Surgery for CSOM causes greater initial and more long-lasting taste disturbances as compared with surgery for otosclerosis. One-year postoperative taste normalizes for both CSOM and otosclerosis patients according to VAS and EGM measurements. No real change in QoL was seen 1-year postoperatively.

  • 39.
    Berling Holm, Katarina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Knutsson, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Strömbäck, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Danckwardt-Lillieström, Niklas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Papatziamos, Georgios
    Karolinska Univ Hosp, ENT Dept, Stockholm, Sweden.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    von Unge, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Akershus Univ Hosp, Dept Otorhinolaryngol, Lorenskog, Norway; Univ Oslo, N-0316 Oslo, Norway.
    Taste disturbance after stapes surgery: an evaluation of frequency, severity, duration, and quality-of-life2017In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 37, no 1, p. 39-43Article in journal (Refereed)
    Abstract [en]

     Conclusion: The incidence of taste disturbance after stapes surgery is high (61.9 %), whereas the majority (94.8 %) recovers within 1 year. More severe surgical nerve trauma caused more disturbance, implying that the nerve should be handled carefully during surgery.

     

    Objectives: Patients operated on for otosclerosis seem more often to complain about post-operative taste disturbance than those operated on for chronic otitis media, although the chorda tympani nerve more seldom becomes maltreated in stapedotomy. These observations seem paradoxical. It is unclear to what extent a post-operative taste disturbance affects the quality-of-life. This study aims to shed light on the occurrence of post-operative taste disturbances, on possible prognostic factors, and to what extent post-operative taste disturbance impairs the quality-of-life.

     

    Methods: One hundred and thirty-four adults undergoing primary stapedotomy were included. Questionnaires on taste disturbance and quality-of-life (SF-36) were answered before and after surgery, until 1 year post-operatively.

     

    Results: Eighty-three (61.9%) study persons reported post-operative taste disturbance. Seven (5.2%) reported persisting disturbance at 1 year. Surgically more traumatized chorda tympani nerves correlated with more severe taste disturbance post-operatively than less traumatized.  Taste disturbance at 1 year post-operatively correlate with a decrease of the physical function domain in the SF-36.

  • 40.
    Berling, Katarina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Mannstrom, Paula
    Ulfendahl, Mats
    Lillieström, Niklas Danckwardt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Von Unge, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    The chorda tympani degenerates during chronic otitis media: an electron microscopy study2015In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 135, no 6, p. 542-548Article in journal (Refereed)
    Abstract [en]

    Conclusion: Chorda tympani nerve specimens from ears with chronic inflammatory middle ear disease exhibit structural signs of degeneration. These correlate well with taste disturbance. Simultaneously, they exhibit signs of regeneration, which may explain the ability for taste recovery. Objectives: The chorda tympani, the major taste nerve, runs uncovered through the middle ear cavity. This situation exposes it to various forms of middle ear pathology. A difference has been noticed regarding taste symptoms pre- and postoperatively between inflammatory and non-inflammatory diseases. The present study aimed to investigate ultrastructural changes of chorda tympani in different forms of inflammatory middle ear disease, such as chronic suppurative otitis media and cholesteatoma, as compared with normal. Methods: Five chorda tympani specimens were collected from healthy middle ears of patients subjected to surgery for acoustic neuroma, to be used as normal controls, and five from middle ears with chronic otitis media or cholesteatoma, where the nerve could not be saved during the operation. Light and electron microscopy were performed. Results: For all five nerves from diseased ears, microscopy showed a higher percentage of axon and myelin sheath degeneration than in the normal controls. Furthermore, three of the five also exhibited sprouting.

  • 41.
    Bohman, Anton
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Juodakis, Julius
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Obstet & Gynecol, Gothenburg, Sweden.
    Oscarsson, Martin
    Skaraborg Hosp, Dept Otorhinolaryngol, Skovde, Sweden.
    Bacelis, Jonas
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Obstet & Gynecol, Gothenburg, Sweden.
    Bende, Mats
    Skaraborg Hosp, Dept Otorhinolaryngol, Skovde, Sweden.
    Naluai, Asa Torinsson
    Univ Gothenburg, Sahlgrenska Acad, Inst Biomed, Dept Microbiol & Immunol, Gothenburg, Sweden.
    A family-based genome-wide association study of chronic rhinosinusitis with nasal polyps implicates several genes in the disease pathogenesis2017In: PLOS ONE, E-ISSN 1932-6203, Vol. 12, no 12, article id e0185244Article in journal (Refereed)
    Abstract [en]

    Background: The pathogenesis of chronic rhinosinusitis with nasal polyps is largely unknown. Previous studies have given valuable information about genetic variants associated with this disease but much is still unexplained. Our goal was to identify genetic markers and genes associated with susceptibility to chronic rhinosinusitis with nasal polyps using a family-based genome-wide association study.

    Methods: 427 patients (293 males and 134 females) with CRSwNP and 393 controls (175 males and 218 females) were recruited from several Swedish hospitals. SNP association values were generated using DFAM (implemented in PLINK) and Efficient Mixed Model Association eXpedited (EMMAX). Analyses of pathway enrichment, gene expression levels and expression quantitative trait loci were then performed in turn.

    Results: None of the analysed SNPs reached genome wide significant association of 5.0 x 10-(8). Pathway analyses using our top 1000 markers with the most significant association p-values resulted in 138 target genes. A comparison between our target genes and gene expression data from the NCBI Gene Expression Omnibus database showed significant overlap for 36 of these genes. Comparisons with data from expression quantitative trait loci showed the most skewed allelic distributions in cases with chronic rhinosinusitis with nasal polyps compared with controls for the genes HLCS, HLA-DRA, BICD2, VSIR and SLC5A1.

    Conclusion: Our study indicates that HLCS, HLA-DRA, BICD2, VSIR and SLC5A1 could be involved in the pathogenesis of chronic rhinosinusitis with nasal polyps. HLA-DRA has been associated with chronic rhinosinusitis with nasal polyps in previous studies and HLCS, BICD2, VSIR and SLC5A1 may be new targets for future research.

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  • 42.
    Bohman, Anton
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Oscarsson, Martin
    Skaraborg Hosp, Dept Otorhinolaryngol, Skovde, Sweden.
    Holmberg, Kenneth
    Univ Gothenburg, Sahlgrenska Acad, Dept Otorhinolaryngol, Gothenburg, Sweden.
    Johansson, Leif
    Skaraborg Hosp, Dept Otorhinolaryngol, Skovde, Sweden.
    Millqvist, Eva
    Univ Gothenburg, Sahlgrenska Acad, Dept Internal Med Resp Med & Allergol, Gothenburg, Sweden.
    Nasic, Salmir
    Skaraborg Hosp, Res & Dev Ctr, Skovde, Sweden.
    Bende, Mats
    Skaraborg Hosp, Dept Otorhinolaryngol, Skovde, Sweden.
    Relative frequencies of symptoms and risk factors among patients with chronic rhinosinusitis with nasal polyps using a case-control study2018In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 138, no 1, p. 46-49Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to investigate the relative frequency of important symptoms of chronic rhinosinusitis with nasal polyps (CRSwNP), the link between CRSwNP and the lower airways and the importance of smoking in CRSwNP.

    Method: Three hundred and sixty-eight patients with CRSwNP and 1349 controls were recruited to the study and underwent a structured interview about symptoms from the upper and lower airways, and about smoking habits. Furthermore, all participants were clinically examined using nasal endoscopy.

    Results: Due to interactions between the outcome variables, a multiple logistic regression model was fitted to the data. Nasal secretions, nasal blockage and impaired sense of smell were symptoms associated with CRSwNP. Furthermore, male gender, increasing age and asthma were also associated with the disease. Current smoking was less frequent among patients with CRSwNP.

    Conclusion: By comparing symptoms and risk factors of patients with CRSwNP with those of a large population-based control group and testing them in a multiple logistic regression model, we have been able to generate data that address key research interests in CRSwNP.

  • 43.
    Bohman, Anton
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Oscarsson, Martin
    Holmberg, Kenneth
    Johansson, Leif
    Millqvist, Eva
    Nasic, Salmir
    Torinsson-Naluai, Asa
    Bende, Mats
    Heredity of nasal polyps2015In: Rhinology, ISSN 0300-0729, E-ISSN 1996-8604, Vol. 53, no 1, p. 25-28Article in journal (Refereed)
    Abstract [en]

    Background: Nasal polyps is a common disease but little is known about its' pathogenesis. Our hypothesis was that there are genetic factors involved in the development of this disease. The aim of this study was to examine close relatives of patients with nasal polyps and comparing them with a general population with regard to prevalence of polyps. Methodology: Patients with nasal polyps who attended the clinic were recruited to the study and were asked whether they had any close adult relatives (siblings, parents or children). We intended to recruit two relatives per patient, one of each gender, for nasal endoscopy. The prevalence of nasal polyps in these relatives was compared with the prevalence of nasal polyps in a general population. Results: During a 4-year period, 368 patients and 410 relatives were recruited to the study. Although we were unable to recruit two close relatives for every patient, we were able to calculate nasal polyp prevalence within families as being 19.2%. Compared with the prevalence of nasal polyps among individuals in a general Swedish population from the same geographical area, the relative risk for polyps among relatives was almost five times higher. Conclusion: This study strongly indicates that heredity is a factor of importance for development of nasal polyps.

  • 44.
    Borgström, Anna
    et al.
    Department of Otorhinolaryngology, Karolinska University Hospital, and Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, Stockholm, Sweden.
    Nerfeldt, Pia
    Department of Otorhinolaryngology, Karolinska University Hospital, and Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, Stockholm, Sweden.
    Friberg, Danielle
    Department of Otorhinolaryngology, Karolinska University Hospital, and Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, Stockholm, Sweden.
    Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT2017In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 139, no 4, article id e20163314Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Adenotonsillectomy (ATE) is a well-established and effective treatment of pediatric obstructive sleep apnea (OSA). In recent years, a more conservative method, adenotonsillotomy (ATT), has gained popularity because it is associated with less postoperative morbidity. Yet no previous randomized study has compared these 2 methods regarding their effectiveness in treating pediatric OSA in terms of polysomnographic data, which was the primary aim of this study. The hypothesis was that ATT is noninferior to ATE after 1 year.

    METHODS: Seventy-nine children, aged 2 to 6 years, with OSA (Apnea-Hypopnea Index [AHI] 5–30) were randomized to ATT (n = 40) or ATE (n = 39). Polysomnography (PSG) and questionnaire OSA-18 were assessed at baseline and 1 year postsurgery.

    RESULTS: Mean difference between groups in the primary outcome, change in AHI, was 0.83, 95% confidence interval –3.2 to 4.9, not exceeding the noninferiority margin of 5. After ATE, AHI decreased from median 12.7 (interquartile range 8.3–19.1) to 2.0 (1.2–3.1) and after ATT from 15.8 (8.5–21.2) to 4.0 (1.2–5.1). For both groups, significant improvements of PSG and OSA-18 questionnaire outcomes were observed, with no significant differences between groups. Five children (13%) in the ATT group needed repeated surgery for tonsil regrowth and recurrence of OSA.

    CONCLUSIONS: The results suggest that ATT is noninferior to ATE in treating pediatric OSA regarding PSG outcomes after 1 year. ATT could be considered an alternative to ATE for treatment of pediatric OSA. However, after ATT, there is a nonnegligible risk of recurrence of OSA, and this should be taken into account when selecting surgical method.

  • 45.
    Borgström, Anna
    et al.
    Karolinska Inst, Dept Clin Sci Intervent & Technol, CLINTEC, Stockholm, Sweden.
    Nerfeldt, Pia
    Karolinska Univ Hosp, Karolinska Inst, Dept Otorhinolaryngol, CLINTEC, Stockholm, Sweden.
    Friberg, Danielle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Postoperative pain and bleeding after adenotonsillectomy versus adenotonsillotomy in pediatric obstructive sleep apnea an RCT2019In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 276, no 11, p. 3231-3238Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Our previous randomized controlled trial (RCT) of children with obstructive sleep apnea (OSA) showed no significant differences between adenotonsillectomy (ATE) and adenotonsillomy (ATE) in improving nocturnal respiration and symptoms after one year. This is the continuous report with the evaluation of postoperative morbidity concerning bleeding and pain.

    METHODS: A double-blinded RCT including 79 children, aged 2-6 years, with moderate to severe OSA, randomized to either ATE (n = 40) or ATT (n = 39). From one to ten days postoperatively, parents filled in a logbook with six pain-related outcomes (parent and child grading pain at different levels, days of analgesic use and return to normal diet). Peri- and postoperative bleeding were also registered.

    RESULTS: 63 patients (80%) returned the logbook. There were significant differences between groups in only two of the six pain-related outcomes in favor of the ATT group; first day when the children graded themselves as pain free (p = 0.021, Log Rank Test), and first day the caregiver estimated pain VAS ≤ 5 (p = 0.007, Log Rank Test). Two (5%) cases of postoperative bleeding occurred in the ATE group, one of which needed a return to theatre. No case of postoperative bleeding was seen in the ATT group.

    CONCLUSIONS: The results from this RCT are in line with previous comparative studies between ATT and ATE. Children operated with ATT had significantly less postoperative pain in one-third of the outcomes, and less bleeding than ATE. However, as the differences in morbidity between the surgical methods were minor the clinical significance is uncertain.

    TRIAL REGISTRATION: This study was approved by the Swedish Regional Ethics Board in Stockholm, Sweden (Dnr 2011/925-32 and 2013/2274-32) and registered at ClinicalTrials.gov (Trial registration number NCT01676181).

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  • 46.
    Borgström, Anna
    et al.
    Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, Stockholm Sweden.
    Nerfeldt, Pia
    Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, Stockholm Sweden.
    Friberg, Danielle
    Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, Stockholm Sweden.
    Sunnergren, Ola
    Department of Otorhinolaryngology, Ryhov County Hospital, Jönköping, Sweden.
    Stalfors, Joacim
    Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
    Trends and changes in paediatric tonsil surgery in Sweden 1987-2013: a population-based cohort study.2017In: BMJ Open, E-ISSN 2044-6055, Vol. 7, no 1Article in journal (Refereed)
    Abstract [en]

    Objectives The objective of this study was to longitudinally describe the history of tonsil surgery in Swedish children and adolescents regarding incidence, indications for surgery, surgical methods and the age and gender distributions.

    Setting A retrospective longitudinal population-based cohort study based on register data from the Swedish National Patient Register (NPR) and population data from Statistics Sweden.

    Participants All Swedish children 1–<18 years registered in the NPR with a tonsil surgery procedure 1987–2013.

    Results 167 894 tonsil surgeries were registered in the NPR 1987–2013. An increase in the total incidence rate was observed, from 22/10 000 person years in 1987 to 47/10 000 in 2013. The most marked increase was noted in children 1–3 years of age, increasing from 17 to 73/10 000 person years over the period. The proportion children with obstructive/sleep disordered breathing (SDB) indications increased from 42.4% in 1987 to 73.6% in 2013. Partial tonsillectomy, tonsillotomy (TT), increased since 1996 and in 2013 55.1% of all tonsil procedures were TTs.

    Conclusions There have been considerable changes in clinical practice for tonsil surgery in Swedish children over the past few decades. Overall, a doubling in the total incidence rate was observed. This increase consisted mainly of an increase in surgical procedures due to obstructive/SDB indications, particularly among the youngest age group (1–3 years old). TT has gradually replaced tonsillectomy as the predominant method for tonsil surgery.

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  • 47.
    Boëthius, Helena
    et al.
    Reg Ostergotland, Dept Otorhinolaryngol, Anaesthet Operat & Specialty Surg Ctr, Linköping, Sweden.;Linköping Univ, Dept Biomed & Clin Sci, Reg Ostergotland, Linköping, Sweden..
    Saarto, Tiina
    Helsinki Univ Hosp, Comprehens Canc Ctr, Dept Palliat Care, Helsinki, Finland.;Univ Helsinki, POB 263, Helsinki 00029, Finland..
    Laurell, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Farnebo, Lovisa
    Reg Ostergotland, Dept Otorhinolaryngol, Anaesthet Operat & Specialty Surg Ctr, Linköping, Sweden.;Linköping Univ, Dept Biomed & Clin Sci, Reg Ostergotland, Linköping, Sweden..
    Mäkitie, Antti A.
    Univ Helsinki, POB 263, Helsinki 00029, Finland.;Helsinki Univ Hosp, Dept Otorhinolaryngol Head & Neck Surg, POB 263, Helsinki 00029, Finland.;Univ Helsinki, Fac Med, Res Program Syst Oncol, Helsinki, Finland.;Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Ear Nose & Throat Dis, Stockholm, Sweden.;Karolinska Hosp, Stockholm, Sweden..
    A Nordic survey of the management of palliative care in patients with head and neck cancer2021In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 278, p. 2027-2032Article in journal (Refereed)
    Abstract [en]

    Background: The five Nordic countries with a population of 27M people form a rather homogenous region in terms of health care. The management of Head and Neck Cancer (HNC) is centralized to the 21 university hospitals in these countries. Our aim was to survey the current status of organization of palliative care for patients with HNC in the Nordic countries as the field is rapidly developing.

    Materials and methods: A structured web-based questionnaire was sent to all the Departments of Otorhinolaryngology-Head and Neck Surgery and Oncology managing HNC in the Nordic countries.

    Results: All 21 (100%) Nordic university hospitals responded to the survey. A majority (over 90%) of the patients are discussed at diagnosis in a multidisciplinary tumor board (MDT), but the presence of a palliative care specialist is lacking in 95% of these MDT's. The patients have access to specialized palliative care units (n = 14, 67%), teams (n = 10, 48%), and consultants (n = 4, 19%) in the majority of the hospitals.

    Conclusion: The present results show that specialized palliative care services are available at the Nordic university hospitals. A major finding was that the collaboration between head and neck surgeons, oncologists and palliative care specialists is not well structured and the palliative care pathway of patients with HNC is not systematically organized. We suggest that early integrated palliative care needs to be included as an addition to the already existing HNC care pathways in the Nordic countries.

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  • 48. Browaldh, N
    et al.
    Bring, J
    Friberg, Danielle
    Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden.
    SKUP3: 6 and 24 months follow-up of changes in respiration and sleepiness after modified UPPP.2018In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 128, no 5, p. 1238-1244Article in journal (Refereed)
    Abstract [en]

    Objective

    Our previous randomized controlled trial of patients with obstructive sleep apnea syndrome (OSAS) showed that modified uvulopalatopharyngoplasty (UPPP), including tonsillectomy, significantly improved nocturnal respiration, daytime sleepiness, and quality of life in the intervention group compared to controls who had delayed surgery after 6 months. This is the continuous report with the 6‐ and 24‐month postoperative results.

    Study Design

    Single‐center prospective cohort study.

    Methods

    Sixty‐five patients with apnea–hypopnea index (AHI) ≥ 15, body mass index (BMI) < 36, Epworth Sleepiness Scale (ESS) ≥ 8, and Friedman stage I or II underwent UPPP after failing nonsurgical treatment. The results from polysomnography and ESS at 6 and 24 months were compared to baseline.

    Results

    Eight percent and 20% dropped out from the 6‐ and 24‐month follow‐ups, respectively. The AHI value decreased significantly from mean (standard deviation) 52.9 (20.5) at baseline to 23.6 (20.2) after 6 months, and to 24.1 (20.9) after 24 months (P < 0.001). Patients with tonsil size 2, and 3 to 4, had significant reductions in the AHI after both follow‐ups. The median ESS score decreased significantly from 13 (range 8–21) to 6.5 (1–18) after 6 months, and to 5 (2–17) after 24 months (P < 0.001). The BMI remained unchanged. There were significant modest correlations for the reductions in AHI and ESS after 24 months.

    Conclusion

    Modified UPPP was effective in improving nocturnal respiration and daytime sleepiness in OSAS patients at both 6‐ and 24‐month follow‐up. Patients with tonsil size 2, and 3 to 4, benefitted similarly from surgery with improved respiration.

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  • 49. Browaldh, N
    et al.
    Bring, J
    Friberg, Danielle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    SKUP(3) RCT; continuous study: Changes in sleepiness and quality of life after modified UPPP.2016In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 26, no 6Article in journal (Refereed)
    Abstract [en]

    Objectives/Hypothesis

    Our previous study showed that modified uvulopalatopharyngoplasty (UPPP), including tonsillectomy, significantly improved nocturnal respiration in obstructive sleep apnea syndrome (OSAS) patients. This is a continuous study of changes in daytime sleepiness and quality of life.

    Study Design

    Prospective randomized controlled trial (RCT), two parallel arms.

    Methods

    Sixty‐five patients with apnea‐hypopnea index ≥ 15, body mass index < 36, Epworth Sleepiness Scale (ESS) ≥ 8, Friedman stage I or II, failing nonsurgical treatment. The intervention group (n = 32) underwent surgery, and the controls (n = 33) had no treatment. At baseline and the 7‐month follow‐up, polysomnography, questionnaires, and vigilance tests were implemented.

    Results

    All patients answered the questionnaires, and 48 took the vigilance test. Epworth Sleepiness Scale decreased significantly in the intervention group, from a mean (standard deviation) of 12.5(3.2) to 6.8(3.9), but nonsignificantly in the control group, from 12.9(3.1) to 12.5(3.9), a significant group difference (P < 0.001). The physical and mental component score on the Short Form‐36 questionnaire increased significantly in the intervention group, from a mean 47.8(8.3) to 51.2(8.8) and from 42.1(10.6) to 48.1(9.7), respectively, but with nonsignificant changes in the controls: 49.0(9.0) to 48.3(9.1) and 41.0(10.2) to 42.7(11.5), significant group differences (P = 0.007, P = 0.031), respectively. The sleep latency/vigilance test showed a significant mean increase in the intervention group of 7(12.4) minutes and a decrease in the controls of 2.2(10.6), a significant group difference (P = 0.011). There were significant correlations between changes in subjective outcomes and nocturnal respiration.

    Conclusion

    This RCT shows that modified UPPP was effective in improving daytime sleepiness and quality of life in OSAS patients. It strengthens the body of evidence on the potential effect of surgery offered to selected patients.

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  • 50.
    Brunnegård, Karin
    et al.
    Umea Univ, Dept Clin Sci, Speech & Language Pathol, SE-90187 Umea, Sweden..
    Hagberg, Emilie
    Karolinska Univ Hosp, Stockholm Craniofacial Team, Stockholm, Sweden.;Karolinska Univ Hosp, Funct Area Speech & Language Pathol, Stockholm, Sweden.;Karolinska Inst, Div Speech & Language Pathol, CLINTEC, Stockholm, Sweden..
    Havstam, Christina
    Sahlgrens Univ Hosp, Dept Otorhinolaryngol, Speech Language Pathol, Gothenburg, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Speech Language Pathol Unit, Gothenburg, Sweden..
    Okhiria, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Klintö, Kristina
    Skane Univ Hosp, Dept Otorhinolaryngol, Div Speech & Language Pathol, Malmo, Sweden.;Lund Univ, Dept Clin Sci, Malmo, Sweden..
    Reliability of Speech Variables and Speech-Related Quality Indicators in the Swedish Cleft Lip and Palate Registry2020In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 57, no 6, p. 715-722Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the reliability of speech variables and speech-related quality indicators in the Swedish quality registry for cleft lip and palate (CLP).

    Design: Retrospective study.

    Setting: Primary care university hospitals.

    Participants: Fifty-two 5-year-old children with unilateral CLP and 41 with bilateral CLP.

    Main Outcome Measures: Registry data for "percent nonoral errors" and "perceived velopharyngeal competence" (VPC) were compared to reassessments by 4 independent judges based on audio recordings. Interjudge agreement for "percent consonants correct" (PCC) and the reliability of 3 quality indicators were also assessed. Agreement was calculated with single measures intraclass correlation coefficient (ICC) for articulation outcomes, quadratic weighted kappa and ICC for VPC, and percentage agreement and kappa for quality indicators.

    Results: When the agreement between registry data and the judges' reassessments was assessed, the ICC was 0.79 for percent nonoral errors. For VPC, the kappa coefficient was 0.66 to 0.75 and the ICC was 0.73. Interjudge agreement for PCC calculated with ICC was 0.85. For the quality indicator "proportion of children with >= 86% correct consonants," all 4 judges were in agreement for 72% of the cases. For "proportion of children without nonoral speech errors" and "proportion of children with competent or marginally incompetent velopharyngeal function," the agreement between registry data and the 4 judges was 89% and 85%, respectively.

    Conclusions: The results indicate that registry data on PCC, percent nonoral errors, VPC, and the quality indicators "proportion of children without nonoral speech errors" and "proportion of children with competent or marginally incompetent velopharyngeal function" are reliable.

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