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  • 1. Anmyr, Lena
    et al.
    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.
    Olsson, Mariann
    Freijd, Anders
    Strengths and difficulties in children with cochlear implants: Comparing self-reports with reports from parents and teachers2012In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 76, no 8, p. 1107-1112Article in journal (Refereed)
    Abstract [en]

    Objective: The aim was to explore and compare how children with cochlear implants, their parents, and their teachers perceive the children's mental health in terms of emotional and behavioral strengths and difficulties.

    Methods: The self-report, parents', and teachers' versions of the Strengths and Difficulties Questionnaire (SDQ) were used to assess the mental health of 22 children with cochlear implants. The children's assessments were then compared to the parents' and 17 teachers' assessments. The data were analyzed using the SPSS software package.

    Results: Total difficulties (p = .000), emotional symptoms (p = .000), and conduct problems (p = .007) were greater according to the children than according to parents and teachers. Younger children (9 years, n = 12) reported more emotional symptoms than older children (12 and 15 years, n = 10). Almost a quarter of the children rated themselves in a way indicating mental ill-health. Parents and teachers each indicated mental ill-health for one child.

    Conclusions: Children with cochlear implants express greater concerns about their mental health than their parents and teachers do. This is important knowledge for adults in families, schools, and health care in order to support these children and offer treatment when needed.

  • 2. 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.

  • 3.
    Anmyr, Lena
    et al.
    Karolinska Institutet.
    Olsson, Mariann
    Karolinska Institutet.
    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.
    Freijd, Anders
    Children with hearing impairment: living with cochlear implants or with hearing aids2011In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 75, no 6, p. 844-849Article in journal (Refereed)
    Abstract [en]

    Objective

    The aim of this study was to enhance knowledge about the life circumstances of children with cochlear implants or hearing aids, regarding daily functioning and attitude to the impairment.

    Methods

    Data were obtained from 36 children with cochlear implants and 38 children with hearing aids via study-specific questionnaires with fixed answer alternatives. The questions covered (1) usage of aids and related factors, (2) hearing in different everyday situations, (3) thoughts about the children's own hearing and others’ attitudes to it, and (4) choice of language. The data were analyzed using SPSS, and presented via the theoretical frame of the International Classification of Functioning, Disability and Health, Child and Youth version (ICF-CY).

    Results

    Children with CI and HA functioned equally well in daily life, but there were also certain differences. Symptoms from neck and shoulders were more common among children with hearing aids than among children with cochlear implants (p < .001). Children with hearing aids used their aids significantly less often than those with cochlear implants (p < .001). The participation variables showed that children with hearing aids had significantly more hearing problems in team sports (p = .033) and outdoor activities (p = .019), in comparison to children with cochlear implants. The two groups had similar thoughts regarding their own hearing, mostly considering it not to be a problem. They also did not generally think that other people found their hearing to be a problem.

    Conclusions

    Children with cochlear implants and children with hearing aids have, in some aspects, equally good functioning in everyday life situations. However, certain differences were found in dimensions of functioning, regarding neck and shoulder pain, usage of aids and sign language, and hearing problems in some activities.

  • 4.
    Edfeldt, Lennart
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Kinnefors, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Strömbäck, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Köbler, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Rask-Andersen, Helge
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Surgical treatment of paediatric cholesteatoma: Long-term follow up in comparison with adults2012In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 76, no 8, p. 1091-1097Article in journal (Refereed)
    Abstract [en]

    Objective: This study was designed to analyse long-term results after surgery of acquired (ACH) and congenital cholesteatoma (CCH) of the middle ear in children and compare these with adults.

    Methods: Computer-based analysis of consecutively operated paediatric patients for ACH and CCH in a tertiary referral centre was made in 57 cases under the age of 12 operated 1983-2004 by three surgeons using identical technique. A canal wall down and total reconstruction procedure (TRP) with obliteration of the mastoid cavity, canal wall reconstruction, ossiculoplasty with consistent use of autologous bone and an "aeration enhancement procedure" (AEP) with silicon sheet in selected cases were used. Pre- and post-operative PTA (0.5-3 kHz) and pure-tone average air-bone gap (PTA-ABG) together with surgical parameters were assessed 1, 3 and 6 years following surgery.

    Results: Results showed stable hearing over 6 years with low incidence of persistent and recurrent disease comparable with results from adult patients. In nearly half of the cases, silastic sheeting was used. In 21 cases, stapes was eroded. Bone conduction thresholds levels remained unaffected 6 years after surgery. No deaf ears, postoperative facial dysfunction or other lesions related to surgery were observed. Six years after surgery every evaluated ear was found to be water-resistant and infection-free.

    Conclusion: Our results suggest that one-stage eradication of ACH and CCH in children using total reconstruction procedure (TRP) provide long-term improvement or preservation of hearing, with a low incidence of persistent or recurrent disease. No difference in surgical outcome between children and adults was found.

  • 5. Forséni, M.
    et al.
    Melhus, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Ryan, A. F.
    Bagger-Sjöbäck, D.
    Hultcrantz, M.
    Detection and localization of interleukin-6 in the rat middle ear during experimental acute otitis media, using mRNA in situ hybridization and immunohistochemistry2001In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 57, no 2, p. 115-121Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Otitis media is one of the most common diseases among children. A well-known sequela of acute, chronic, and secretory otitis media is tympanosclerosis. With the exception of surgery, there is no causal treatment available for this condition, which may cause hearing disabilities. This study aimed to describe the localization of interleukin (IL)-6 mRNA and its gene product in the rat middle ear during pneumococcal otitis media. IL-6 is known to be involved in inflammatory and bone remodeling processes. METHODS: Using an experimental model of pneumococcal acute otitis media, the expression of interleukin IL-6, was analyzed. Sprague-Dawley rats were sacrificed at different time points varying from 1 h to 6 days intervals after inoculation. The middle ears were analyzed by messenger RNA in situ hybridization, and by immunohistochemistry with cell-type specific antibodies directed against IL-6. RESULTS: Transcripts of IL-6 were observed only on day 1 post-inoculation, whereas the final gene product was observed at all intervals after inoculation. IL-6 was localized in the bony part of the bulla nearest to the mucosa, around mucosal vessels, and in the ciliae of the mucosal epithelium. The results demonstrated that IL-6 was synthesized locally as early as 1 h after bacterial middle ear challenge, and that although transcription could not be detected after 24 h, the cytokine product persisted for at least 5 days after the infection was introduced. CONCLUSIONS: IL-6 was shown to be produced early in the inflammatory process during induced pneumococcal otitis media in the rat. No production was seen after 24 h although the protein remained in the tissue for at least 5 days. IL-6 could initiate a differentiation of macrophages to osteoclasts and thereby participate in a bone remodeling process leading to tympanosclerosis development.

  • 6.
    Gisselsson-Solen, Marie
    et al.
    Univ Lund Hosp, Dept Otorhinolaryngol Head & Neck Surg, S-22185 Lund, Sweden..
    Hermansson, Ann
    Univ Lund Hosp, Dept Otorhinolaryngol Head & Neck Surg, S-22185 Lund, Sweden..
    Melhus, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infection medicine.
    Individual-level effects of antibiotics on colonizing otitis pathogens in the nasopharynx2016In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 88, p. 17-21Article in journal (Refereed)
    Abstract [en]

    Background: Although there is evidence of an association between antibiotic consumption and resistant bacteria on a population level, the relationship on an individual level has been less well studied, particularly in terms of nasopharyngeal colonization. We have therefore analysed this association, using data from a closely followed cohort of children taking part in a vaccination trial. Methods: 109 children with early onset of acute otitis media (AOM) were randomised to heptavalent pneumococcal conjugate vaccine (PCV7) or no vaccination. They were followed for three years with scheduled appointments as well as sick visits. Nasopharyngeal cultures were obtained at all visits. Antibiotic treatments were recorded, as were risk factors for AOM, including siblings, short breast-feeding and parental smoking. Data were entered into a Cox regression model, and the findings of Streptococcus pneumoniae and Haemophilus influenzae with reduced susceptibility to the penicillin group were related to the number of previous courses of antibiotics. Results: There was evidence of an association between the amount of previously consumed betalactams and colonization with beta-lactamasenegative ampicillin-resistant (BLNAR) H. influenzae (RR 1.21; 95% CI 1.03-1.43; p = 0.03), and also with the most commonly prescribed drug; amoxicillin (RR 1.39; 95% CI 1.09-1.76; p = 0.01). There was no evidence for an association between antibiotic consumption and betalactamase producing H. influenzae or S. pneumoniae with reduced susceptibility to penicillin. Furthermore, there was no evidence of an association between resistant bacteria and AOM risk factors or PCV7. Conclusion: In this subgroup of children, most of whom were given several courses of antibiotics in early childhood, there was evidence of an association between betalactam/amoxicillin consumption and nasopharyngeal colonization with BLNAR strains, bacteria that have increased in prevalence during the last 10-15 years, and that are notoriously difficult to treat with oral antibiotics.

  • 7.
    Gronseth, Torstein
    et al.
    Univ Oslo, Oslo, Norway.;Oslo Univ Hosp, Dept Otolaryngol Head & Neck Surg, Oslo, Norway..
    Vestby, Lene K.
    Norwegian Vet Inst, Oslo, Norway..
    Nesse, Live L.
    Norwegian Vet Inst, Oslo, Norway..
    Thoen, Even
    Norwegian Vet Inst, Oslo, Norway..
    Habimana, Olivier
    Univ Hong Kong, Sch Biol Sci, Pok Fu Lam Rd, Hong Kong, Hong Kong, Peoples R China..
    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 Otolaryngol Head & Neck Surg, Lorenskog, Norway.;Univ Oslo, Campus Ahus, Oslo, Norway..
    Silvola, Juha T.
    Univ Oslo, Oslo, Norway.;Akershus Univ Hosp, Dept Otolaryngol Head & Neck Surg, Lorenskog, Norway.;Univ Oslo, Campus Ahus, Oslo, Norway..
    Lugol's solution eradicates Staphylococcus aureus biofilm in vitro2017In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 103, p. 58-64Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of the study was to evaluate the antibacterial efficacy of Lugol's solution, acetic acid, and boric acid against Staphylococcus aureus biofilm. Methods: The efficacy of Lugol's solution 1%, 0.1%, and 0.05%, acetic acid 5% or boric acid 4.7% for treatment of Staphylococcus aureus biofilm in vitro was tested using 30 clinical strains. Susceptibility in the planktonic state was assessed by disk diffusion test. Antiseptic effect on bacteria in biofilm was evaluated by using a,Biofilm-oriented antiseptic test (BOAT) based on metabolic activity, a biofilm bactericidal test based on culturing of surviving bacteria and confocal laser scanning microscopy combined with LIVE/DEAD staining. Results: In the planktonic state, all tested S. aureus strains were susceptible to Lugol's solution and acetic acid, while 27 out of 30 tested strains were susceptible to boric acid. In biofilm the metabolic activity was significantly reduced following exposure to Lugol's solution and 5% acetic acid, while boric acid exposure led to no significant changes in metabolic activities. In biofilm, biocidal activity was observed for Lugol's solution 1% (30/30), 0.1% (30/30), and 0.05% (26/30). Acetic acid and boric acid showed no bactericidal activity in this test. Confocal laser scanning microscopy, assessed in 4/30 strains, revealed significantly fewer viable biofilm bacteria with Lugol's solution (1% p < 0.001, 0.1% p = 0.001 or 0.05% p = 0.001), acetic acid 5% for 10 min (p = 0.001) or 30 min (p = 0.015), but not for acetic acid for 1 min or boric acid. Conclusion: Lugol's solution 1.0% and 0.1% effectively eradicated S. aureus in biofilm and could be an alternative to conventional topical antibiotics where S. aureus biofilm is suspected such as external otitis, pharyngitis and wounds. (C) 2017 Elsevier B.V. All rights reserved.

  • 8. Hultcrantz, Elisabeth
    et al.
    Linder, Arne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Markström, Agneta
    Tonsillectomy or tonsillotomy?:  a randomized study comparing postoperative pain and long-term effects 1999In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 51, no 3, p. 171-6Article in journal (Refereed)
    Abstract [en]

    Background: tonsillectomy (TE) is currently the most common treatment for children with snoring and sleep apnea. Many of these children have not had any severe throat infections. To cure such children from their obstructive problems, without influencing the immunological function of the tonsils, tonsillotomy (TT) with CO2-laser was performed in a randomized study comparing it to regular tonsillectomy, with special attention to postoperative pain and symptom recurrence. Method: 41 children 3.5–8 years-old were included — 21 ‘TT’s’ and 20 ‘TE’s’. They were all operated under the same anesthesia and followed the same postoperative scheme for analgesia. A visual analogue scale for pain measurements with faces was used for the first 24 h. After that, each day until pain-free, the parents registered the child’s pain on a three graded scale, what the child was able to eat, and the amount of analgesic drugs used. Results: all the children were cured from their breathing obstruction. The mean time used for the surgery was the same and no postoperative bleeding was seen in either group. ‘TT children’ were pain-free after 5 days and ‘TE children’ after 8 days. Eight to ten days after surgery, the TT-children had gained weight and the TE children lost weight significantly. The TE group used twice as much analgesic drugs as the TT group during the first postoperative week. The TT group was healed with normal-looking, but small tonsils after 8–10 days; the TE group often still showed edema and crusts. At the one-year follow-up 2/21among the ‘TT-children’ snored, but did not require re-surgery. Conclusion: tonsillotomy is much less painful than TE and children recover more quickly. Results with respect to breathing obstruction are almost the same for both methods at 1-year follow-up.

  • 9. Hultcrantz, Elisabeth
    et al.
    Löfstrand Tideström, Britta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    The development of sleep disordered breathing from 4 to 12 years and dental arch morphology2009In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 73, no 9, p. 1234-1241Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To track the development of sleep disordered breathing (SDB) as well as dento-facial morphology in cohort of children by having them complete a questionnaire at ages 4, 6 and 12. Clinical examination, sleep studies (at ages 4 and 12) and orthodontic evaluation were carried out on all who were reported to snore regularly and children who did not snore at all. RESULTS: Out of the original group of 615 children, 64% (393) answered the inquiry on all three occasions. Of those, 27 snored regularly and 231 did not snore at all at the age of 12. There were differences between those groups on all answers, especially prevalence of oral breathing: 78% versus 5% (p<0.001). The prevalence of OSA decreased from 3.1% at the age of 4 to 0.8% at age 12 and the severity decreased from a mean AHI 14.8 at 4 to a mean AHI of 1.95 at age 12. The minimum prevalence of snoring regularly was estimated to 4.2% at 12 years compared to 5.3% at 4, calculated for the original cohort of 644 children. The odds for a child who snored regularly at 4 or 6 years to be snoring regularly also at age 12 was 3.7 times greater than for a not snoring child in spite of surgery (OR 3.7, 95% CI 2.4-5.7). 63 children had undergone surgery due to snoring by age 12. 14 of them never snored and 17 snored regularly at the age 12. The dental arch was narrower in the children snoring regularly at 4, 6 and 12 years compared to not snoring children. Cross-bites were more common among snoring children than among non-snoring children, at 4 and 6 as well as at 12. CONCLUSION: The prevalence of regular snoring is about the same from 4 to 12 years independent of surgery, but the prevalence of OSA decreased considerably. The children snoring regularly generally have a narrower maxilla compared to children not snoring. Surgery in young children is necessary but "cures" the snoring only temporary.

  • 10.
    Hurst, David S.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Amin, Kawa
    Sevéus, Lahja
    Venge, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Mast cells and tryptase in the middle ear of children with otitis media with effusion1999In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 49, no Suppl 1, p. S315-319Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This is the first report of the presence of tryptase, a reflection of mast cell activity, in chronic middle ear effusion of patients in whom atopic status was characterized.

    DESIGN AND METHODS: Mediator activity of mast cells and eosinophils was measured prospectively from effusion of 33 random patients and five controls with chronic otitis media with effusion (OME). Atopy was determined by enzyme-linked immunosorbent assay testing. Middle ear biopsies from a second group of eight OME patients and four controls were fixed in plastic and stained immunohistochemically for mast cells.

    RESULTS: Sixty-one percent of patients had extensive activation of mast cells in their middle ears. Among those with elevated tryptase in their effusion, 95.6% were atopic and 94.7% also had elevated effusion eosinophilic cationic protein. Tryptase was elevated only in the effusion of atopic patients as compared with controls (P < 0.01). Mast cells were present in six of eight OME ears and absent in all four normals.

    CONCLUSION: Mast cells and its mediator tryptase, both indicators of a Th2-driven immune response, are present in the majority of ears which have chronic effusion, suggesting that the inflammation within the middle ear of most OME patients is allergic in nature.

  • 11. Irander, K.
    et al.
    Borres, Magnus P.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Ghafouri, B.
    The effects of physical exercise and smoking habits on the expression of SPLUNC1 in nasal lavage fluids from allergic rhinitis subjects2014In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 78, no 4, p. 618-622Article in journal (Refereed)
    Abstract [en]

    Objective: Palate lung nasal epithelial clone (PLUNC) is a family of proteins, which are proposed to participate in the innate immune defense against infections in the upper aero-digestive tract. The aim of this study was to investigate the expression of SPLUNC1 in allergic rhinitis subjects with considerations taken to the mucosa( function and smoking habits. Methods: The participants, recruited from a cohort followed from infancy, were re-examined at the age of 18 years regarding allergy development. Based on medical histories and skin prick tests the participants were classified into groups with persistent allergic rhinitis (n = 18), intermittent allergic rhinitis (n = 8) and healthy controls (n = 13). Seven subjects (3, 2 and 2 in each group, respectively) reported smoking habits. The SPLUNC1 levels in nasal lavage fluids were analyzed by Western blot. Changes in the volume of the proper nasal cavity before and after physical exercise (Vol2(increase)) were analyzed by acoustic rhinometiy. Results: Compared to the control group the SPLUNC1 level was significantly lower in the persistent allergy group (3.8 +/- 3.4 OD vs. 1.3 +/- 1.5 OD; p = 0.02), but not in the intermittent allergy group without current exposure to allergens (3.6 +/- 4.7 OD). No differences were found in Vol2(increase) between any of the allergy groups and controls. In smokers Vol2(increase) was significantly reduced (p < 0.01) and the SPLUNC1 levels were lower compared to non-smokers. A significant correlation was found between SPLUNC1 and vol2(increase) (p<0.01; r = 0.53) in non-smokers. Conclusions: Current allergen exposure has an impact on SPLUNC1 expression in nasal lavage fluid, why allergy ought to be considered in study populations where analyses of SPLUNC1 levels are included in the reports. The normal nasal decongestion after exercise was not affected by allergy in contrast to smoking habits. The correlation between SPLUNC1 levels and Vol2(increase) in non-smokers may indicate involvement of SPLUNC1 in the regulation of the normal function of the nasal mucosa. Complementary studies are needed to confirm the smoke-related reduction of SPLUNC1 expression and to analyze the possible participation of SPLUNC1 in the nasal mucosa regulation.

  • 12.
    Knutsson, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Vastmanland Cty Hosp, Dept Otorhinolaryngol, Vasteras, Sweden.;Orebro Univ Hosp, Dept Otolaryngol, Orebro, Sweden..
    Priwin, Claudia
    Sophiahemmet Univ, Dept Otorhinolaryngol, Stockholm, Sweden..
    Hessen-Soderman, Anne-Charlotte
    Cityakuten, Dept Otorhinolaryngol, Stockholm, Sweden.;Karolinska Inst, Div Clin Sci Intervent & Technol, 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. Vastmanland Cty Hosp, Dept Otorhinolaryngol, Vasteras, Sweden.;Akershus Univ Hosp, Dept Otorhinolaryngol, Campus Ahus, Oslo, Norway.;Univ Oslo, Campus Ahus, Oslo, Norway..
    A randomized study of four different types of tympanostomy ventilation tubes: Full-term follow-up2018In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 107, p. 140-144Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the impact of tympanostomy ventilation tube material (silicone vs fluoroplastic) and shape (short vs long) regarding time to extrusion, occurrence of otorrhea, occlusion, tube removal and occurrence of persistent perforation.

    Methods and material: Four different types of ventilation tubes were used; Long Armstrong tubes, Donaldson tubes, Shepard tubes and straight tubes, representing four specific combinations of VT material (silicone or fluoroplastic) and shape (short, double flanged or long, single flanged). Four hundred children scheduled for bilateral tube insertion were included in a randomized trial. The patients received one type of tube in the right ear and another type in the left ear. The incidence of tube extrusion and complications were monitored post-operatively every third month by an otolaryngologist.

    Results: Twenty-two children were excluded during surgery. Out of the studied 378 children the mean age was 35.3 months. 63.8% were boys. Short tubes extruded earlier than long tubes; hazard ratio (HR) 4.84 (95% CI 3.50-6.69, p < 0.001). Long Armstrong tubes were least prone to extrude. Silicone tubes resulted in significantly longer time to first infection in a VT ear, HR 1.68 (95% CI 1.03-2.76, p = 0.039). Donaldson tubes rendered the longest mean time to first infection (p = 0.025). Infections did not affect tube extrusion rates significantly (p = 0.879). No significant differences were found regarding tube occlusion, tube extraction or persistent perforation.

    Conclusions: Long tubes are less prone to extrude early. Long Armstrong tubes have the least propensity to extrude early. Silicone tubes render significantly longer time to first infection. Donaldson tubes result in least infections. Infection does not affect extrusion rates significantly.

  • 13.
    Linder, Arne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Markström, Agneta
    Hultcrantz, Elisabeth
    Using the carbon dioxide laser for tonsillotomy in children1999In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 50, no 1, p. 31-6Article in journal (Refereed)
    Abstract [en]

    Carbon dioxide laser tonsillotomies were performed on 33 children aged 1-12 years for the relief of obstructive symptoms due to tonsillar hyperplasia. As opposed to conventional tonsillectomy, only the protruding part of each tonsil was removed. A carbon dioxide laser delivering 20 W was used for the excision. Twenty-one children were seen in active short-term follow-up and the records of all the children were checked for possible surgery related events up to 20-33 months after surgery. Laser tonsillotomy was uniformly effective in relieving the obstruction, with good hemostasis. The tonsillar remnants healed completely within 2 weeks. No major adverse events occurred. Post-operative pain appeared slight and easily controlled. There was no gain in operating time compared with conventional tonsillectomy. The laser tonsillotomies were in most cases done in day surgery. No recurrence of obstructive problems was reported up to 20-33 months after surgery. It was concluded that tonsillotomy, using a carbon dixoide laser, is a valid treatment for obstructive symptoms caused by enlarged tonsils, which can be performed with little bleeding and post-operative pain. The improved hemostasis may enable a shift from in-patient to day surgery.

  • 14.
    Löfstrand Tideström, Britta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Hultcrantz, Elisabeth
    Development of craniofacial and dental arch morphology in relation to sleep  disordered breathing from 4 to 12 years: Effects of adenotonsillar surgery2010In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 74, no 2, p. 137-143Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To study the development of craniofacial and dental arch morphology in children with sleep disordered breathing in relation to adenotonsillar surgery. SUBJECTS AND METHODS: From a community-based cohort of 644 children, 393 answered questionnaires at age 4, 6 and 12 years. Out of this group, 25 children who were snoring regularly at age 4 could be followed up to age 12 together with 24 controls not snoring at age 4, 6 and 12 years. Study casts were obtained from cases and controls and lateral cephalograms from the cases. Analysis regarding facial features and dento-alveolar development was performed. RESULTS: Children snoring regularly at age 4 showed reduced transversal width of the maxilla and more frequently had anterior open bite and lateral cross-bite than the controls. These conditions persisted for most cases at age 6, by which time 18/25 had been operated for snoring. In most of the cases, surgery cured the snoring temporarily, but their width of the maxilla was still smaller by age 12-even when nasal breathing was attained. At age 12, the frequency of lateral cross-bite was much reduced and anterior open bite was resolved, both in cases and controls. The children who snored regularly at age 12 operated or not operated, showed a long face anatomy and were oral breathers (this applied even to those who were operated). The seven cases who were not operated and the five who were still snoring in spite of surgery at age 12, did not have reduced maxillary width as compared to the controls. CONCLUSION: Dento-facial development in snoring children is not changed by adenotonsillar surgery regardless of symptom relief. If snoring persists or relapses orthodontic maxillar widening and/or functional training should be considered. Collaboration between otorhinolaryngologist, orthodontists and speech and language pathologists is strongly recommended.

  • 15.
    Löfstrand Tideström, Britta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Hultcrantz, Elisabeth
    The development of snoring and sleep related breathing distress from 4 to 6 years in a cohort of Swedish children2007In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 71, no 7, p. 1025-1033Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Snoring is common among both children and adults and a sign of sleep disordered breathing (SDB). Adenotonsillectomy is often the solution offered, although the effect is uncertain. There are also some who say that young children who snore will outgrow it even without treatment. The present investigation compares snoring and co-founding symptoms in parental reports for a cohort of children at age 4 and at age 6 years. METHOD: A cohort of 4 year old chidren (615) was investigated with respect to SDB [B. Löfstrand-Tideström, B. Thilander, J. Ahlqvist-Rastad, O. Jakobsson, E. Hultcrantz, Breathing obstruction in relation to craniofacial and dental arch morphology in 4 year old children, Eur. J. Orthod. 21 (1999) 323-332]. Each child was given a questionnaire. Those reporting significant symptoms also received a clinical and an orthodontic examination. Forty-eight children were diagnosed with SDB; of these 28 were operated with adenoidectomy and/or tonsillectomy. After 2 years, the same questionnaire was administered and the same children as before were further examined as well as those newly reporting significant symptoms. The results from the two occasions were compared. RESULTS: Eighty-three percent (509) of the original cohort participated. The frequency of snoring had changed from 53 to 46% for the group as a whole (p<0.05). Significant gender differences in co-founding symptoms were seen. Severity of snoring had changed on an individual basis in half of the cases; some recovered, others got worse. Of the children with SDB at 4 years who were operated, 14/28, did not snore at all, compared to 3/18 of the non-operated (p<0.05). CONCLUSION: Children who snore at the age 4 seldom "grow out of it" by age 6 and still show other signs of sleep related distress as well. Surgery does not always cure the snoring, thus postoperative follow-up is important. Since new cases develop during this age period, early intervention is not enough.

  • 16. Magnúsdóttir, Anna Björk
    et al.
    Hermansson, Ann
    Melhus, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Experimental study of the virulence of Streptococcus pneumoniae with reduced susceptibility to penicillin2000In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 55, no 1, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Streptococcus pneumoniae is a major cause of morbidity and mortality in all age groups. In a few years, penicillin non-susceptible pneumococci (PNSP) have emerged worldwide as a new threat. In order to better understand the mechanisms behind the rapid expansion of these strains, the virulence of 10 clinical and two transformed PNSP strains were compared with the virulence of three fully susceptible strains in a mouse model of bacteremia and a rat model of acute otitis media. Serotype, antibiotic susceptibility, and to some extent also genetic profile and growth rate of the strains were investigated before inoculation. The animals were monitored for up to 7 days after challenge by clinical examinations/otomicroscopy and cultures from middle ears and blood. The results of the study demonstrated that the PNSP strains had a significantly reduced ability to persist at the infectious site, and to some extent also to induce infections, compared with fully susceptible strains. The reduction was most evident for strains isolated from sources other than blood. It is therefore possible that other factors than virulence factors are of importance for the ability of PNSP strains to expand.

  • 17.
    Melhus, Åsa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Hermansson, Ann
    Forsgren, Arne
    Prellner, Karin
    A resolved pneumococcal infection protects against nontypeable Haemophilus influenzae: an evaluation of different routes of whole cell immunization in protection against experimental acute otitis media1997In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 39, no 2, p. 119-131Article in journal (Refereed)
    Abstract [en]

    A conferred cross-protection between Haemophilus influenzae type b (Hib) and nontypeable H. influenzae (NTHi) was demonstrated in a previous study of experimental recurrent otitis media. To explore cross-protection further, and to compare oral administration of whole cells with two more conventional routes for vaccination against acute otitis media (AOM), a total number of 79 rats were immunized perorally, subcutaneously and intrabullarly with H. influenzae or pneumococci and thereafter challenged in the middle ear with NTHi or Hib 4 or 9 weeks later. Otomicroscopic changes, bacterial cultures, and serum IgG antibody levels were monitored. The study demonstrated that while peroral administration did not elicit any protection, a resolved pneumococcal AOM could reduce the susceptibility to reinfection with NTHi. In the latter case no cross-reacting antibodies were detected, but the protective rate was 50% or more, and it was comparable with that found after subcutaneous or intrabullar immunization with homologous NTHi or Hib strains. The results suggest that the protection of the rat middle ear mucosa may involve unspecific responses.

  • 18.
    Melhus, Åsa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Hermansson, Ann
    Forsgren, Arne
    Prellner, Karin
    Effect of Haemophilus influenzae type b conjugate vaccine in combination with peroral immunization with Escherichia coli on experimental otitis media1996In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 36, no 1, p. 1-12Article in journal (Refereed)
    Abstract [en]

    The protective ability of a conjugated Haemophilus influenzae type b vaccine, ACT-HIB, used singly or in combination with orally administered Escherichia coli, was investigated in a rat model for acute otitis media. The humoral response to ACT-HIB was also analyzed. The study demonstrated that ACT-HIB vaccination resulted in a prompt antibody response, and that ACT-HIB was efficient in preventing middle ear infections caused by Haemophilus influenzae type b. The efficiency increased if the vaccine was combined with Escherichia coli. The results suggest that Escherichia coli could possibly be useful in the future as a vaccine vehicle, and since Haemophilus influenzae acute mastoiditis seems to be almost exclusively due to serotype b, the incidence of this infection may be reduced with the conjugated Haemophilus influenzae type b vaccines.

  • 19.
    Nakeva von Mentzer, Cecilia
    et al.
    Linköpings universitet, Institutet för handikappvetenskap (IHV).
    Lyxell, Björn
    Linköpings universitet, Institutet för handikappvetenskap (IHV).
    Sahlén, Birgitta
    Lund University, Sweden.
    Wass, Malin
    Linköpings universitet, Institutet för handikappvetenskap (IHV).
    Lindgren, Magnus
    Lund University, Sweden.
    Ors, Marianne
    Lund University, Sweden.
    Kallioinen, Petter
    Stockholm University, Sweden.
    Uhlén, Inger
    Karolinska University Hospital and Karolinska Institutet, Rosenlunds sjukhus, Stockholm, Sweden.
    Computer-assisted training of phoneme–grapheme correspondence for children who are deaf and hard of hearing: Effects on phonological processing skills2013In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 77, no 12, p. 2049-2057Article in journal (Refereed)
    Abstract [en]

    Objective

    Examine deaf and hard of hearing (DHH) children's phonological processing skills in relation to a reference group of children with normal hearing (NH) at two baselines pre intervention. Study the effects of computer-assisted phoneme–grapheme correspondence training in the children. Specifically analyze possible effects on DHH children's phonological processing skills.

    Methods

    The study included 48 children who participated in a computer-assisted intervention study, which focuses on phoneme–grapheme correspondence. Children were 5, 6, and 7 years of age. There were 32 DHH children using cochlear implants (CI) or hearing aids (HA), or both in combination, and 16 children with NH. The study had a quasi-experimental design with three test occasions separated in time by four weeks; baseline 1 and 2 pre intervention, and 3 post intervention. Children performed tasks measuring lexical access, phonological processing, and letter knowledge. All children were asked to practice ten minutes per day at home supported by their parents.

    Results

    NH children outperformed DHH children on the majority of tasks. All children improved their accuracy in phoneme–grapheme correspondence and output phonology as a function of the computer-assisted intervention. For the whole group of children, and specifically for children with CI, a lower initial phonological composite score was associated with a larger phonological change between baseline 2 and post intervention. Finally, 18 DHH children, whereof 11 children with CI, showed specific intervention effects on their phonological processing skills, and strong effect sizes for their improved accuracy of phoneme–grapheme correspondence.

    Conclusion

    For some DHH children phonological processing skills are boosted relatively more by phoneme–grapheme correspondence training. This reflects the reciprocal relationship between phonological change and exposure to and manipulations of letters.

  • 20. Rahman, Anisur
    et al.
    von Unge, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Olivius, Petri
    Dirckx, Joris
    Hultcrantz, Malou
    Healing time, long-term result and effects of stem cell treatment in acute tympanic membrane perforation2007In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 71, no 7, p. 1129-1137Article in journal (Refereed)
    Abstract [en]

    Objective

    The incidence of otitis media in children between the age of 2 and 6 years is well documented. Repeated attacks may cause acute and chronic perforations. The surgical treatment for repairing chronic perforation is quite uncomfortable for the patients of this age group because of the invasiveness of this treatment. The aim of this study was to determine the long-term influence of embryonic stem cells on acute perforations and the effect of gelatin as a vehicle for applied stem cells. The possibility of teratogenic effects of the stem cells was also observed.

    Methods

    Bilateral laser myringotomy was performed in 17 adult Sprague–Dawley rats, divided into two groups. Gelatin, a substance suitable as vehicle for bioactive material was used bilaterally around the perforation in group A, to serve as a scaffold for repairing tissue. The stem cells were used in the right tympanic membrane perforation leaving the left tympanic membrane as a control. The animals in group B received the same treatment except for the use of gelatin and in addition received an immuno-suppressive agent. After half a year of observation the mechanical stiffness of the tympanic membrane was measured by moiré interferometry for group B and the morphological study was performed by light microscopy for both groups A and B and electron microscopy for group A.

    Results

    Stem cell treated ears did not show any enhanced healing of the perforation although a marked thickening of the lamina propria was observed compared with control group. After half a year the strength and the stiffness of the tympanic membrane was almost the same for both treated and untreated ears. No evidence of teratoma was found after half a year.

    Conclusion

    This study suggests that the stem cells stimulate the proliferation of connective tissue and fibers in the lamina propria, possibly mediated by secreted substances, although the stiffness properties do not seem to be altered. The use of gelatin does not seem to enhance the healing process of the tympanic membrane perforation.

  • 21.
    Söderman, Anne-Charlotte Hessén
    et al.
    Cityakuten, Dept Otorhinolaryngol, Olof Palmes Gata 9, S-11137 Stockholm, Sweden.;Karolinska Inst, Div Clin Sci Intervent & Technol, Stockholm, Sweden..
    Knutsson, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Vasteras Hosp, Dept Otorhinolaryngol, Vasteras, Sweden..
    Priwin, Claudia
    Karolinska Inst, Div Clin Sci Intervent & Technol, Stockholm, Sweden.;Queen Sophias Hosp, Dept Otorhinolaryngol, Stockholm, Sweden..
    von Unge, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Vasteras Hosp, Dept Otorhinolaryngol, Vasteras, Sweden.;Akershus Univ Hosp, Dept Otorhinolaryngol, Campus Ahus, Oslo, Norway.;Univ Oslo, Campus Ahus, Oslo, Norway..
    A randomized study of four different types of tympanostomy ventilation tubes - One-year follow-up2016In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 89, p. 159-163Article in journal (Refereed)
    Abstract [en]

    Objective: To compare four different types of tympanostomy ventilation tubes (VT); long-shaft and short-shaft silicone tubes and long-shaft and short-shaft fluoroplastic tubes, regarding time to extrusion and events of otorrhea. Methods: A prospective randomized controlled trial in children with bilateral recurrent acute otitis media or secretory otitis media; four hundred children were randomized to receive one type of VT in the right ear and another type in the left ear. Postoperatively the children were assessed every third month by an otolaryngologist to monitor the incidence of otorrhea and tube extrusion. Results: Out of the 400 children, 22 were excluded during surgery. Mean age was 35.3 months. A majority (63.8%) were boys. Forty-eight children were lost to follow up during the first year. Significantly more short-shaft VTs were extruded after 12 months compared to long-shaft VTs, regardless of material. Significantly higher incidence of otorrhea was found in the fluoroplastic VT ears compared to the silicone ones, regardless of length of tube. Conclusion: Long-shaft VTs last longer in the eardrum during the first year of treatment. Silicone tubes render a reduced risk of otorrhea during the first year of treatment.

  • 22.
    Wang, Allen Y.
    et al.
    Univ Western Australia, Sch Surg, Ear Sci Ctr, Perth, WA, Australia.;Ear Sci Inst Australia, Perth, WA, Australia.;Sir Charles Gairdner Hosp, Dept Otolaryngol Head & Neck, Skull Base Surg, Perth, WA, Australia..
    Liew, Lawrence J.
    Univ Western Australia, Sch Surg, Ear Sci Ctr, Perth, WA, Australia.;Ear Sci Inst Australia, Perth, WA, Australia..
    Shen, Yi
    Univ Western Australia, Sch Surg, Ear Sci Ctr, Perth, WA, Australia.;Ear Sci Inst Australia, Perth, WA, Australia.;Ningbo Lihuili Hosp, Ningbo Med Ctr, Dept Otolaryngol Head & Neck Surg, Ningbo, Zhejiang, Peoples R China..
    Wang, Jeffrey T.
    Univ Western Australia, Sch Surg, Ear Sci Ctr, Perth, WA, Australia..
    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, Lorenskog, Norway.;Univ Oslo, N-0316 Oslo, Norway..
    Atlas, Marcus D.
    Univ Western Australia, Sch Surg, Ear Sci Ctr, Perth, WA, Australia.;Ear Sci Inst Australia, Perth, WA, Australia.;Sir Charles Gairdner Hosp, Dept Otolaryngol Head & Neck, Skull Base Surg, Perth, WA, Australia..
    Dilley, Rodney J.
    Univ Western Australia, Sch Surg, Ear Sci Ctr, Perth, WA, Australia.;Ear Sci Inst Australia, Perth, WA, Australia..
    Rat model of chronic tympanic membrane perforation: A longitudinal histological evaluation of underlying mechanisms2017In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 93, p. 88-96Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate histologically the progressive development and underlying mechanisms of chronic tympanic membrane perforation (TMP) in a rat model using a two-weeks ventilation tube (VT) treatment combined with topical application of mitomycin Cidexamethasone (VT-MID), compared with normal tympanic membrane and acute TMPs. Methods: Fifty male Sprague-Dawley rats were divided into three experimental groups: a normal control group (n = 5), an acute TMP group (n = 5) (i.e. 3 days post-myringotomy) and a VT-M/D group (n = 40). The TMs were regularly assessed by otoscopy. The normal control animals were sacrificed on day 0 and the acute TMP group was sacrificed 3 days post-myringotomy for histological and immunohistochemical evaluations. The VT-M/D group was sacrificed at various time points - 14 and 17 days, 3, 4, 6, 8 and 10 weeks. Results: On longitudinal histological examination, compared with normal TM and acute TMP, the perforation edges at the later time points illustrated thickened stratified squamous epithelium rimming around the edges, significant increase in keratin and collagen deposition, increased macrophage infiltration as well as reduced cellular proliferation. Three phases of TMP healing process were identified the acute healing phase (3-17 days), the transition phase (3-4 weeks) and the chronic phase (6-10 weeks). Conclusion: Based on the histological results of this study, the progressive development of chronic TMPs appeared to be associated with increased epidermal thickening, collagen and keratin deposition, macrophage infiltration and reduced cellular proliferation. After the 3-4 weeks of transition phase, the TMPs seemed to have transformed into a non-healing chronic TMP between 6 and 10 weeks. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

  • 23.
    Wang, Allen Y.
    et al.
    Univ Western Australia, Sch Surg, Ear Sci Ctr, Perth, WA, Australia.;Ear Sci Inst Australia, Perth, WA, Australia.;Sir Charles Gairdner Hosp, Dept Otolaryngol Head & Neck, Skull Base Surg, Perth, WA, Australia..
    Liew, Lawrence J.
    Univ Western Australia, Sch Surg, Ear Sci Ctr, Perth, WA, Australia.;Ear Sci Inst Australia, Perth, WA, Australia..
    Shen, Yi
    Univ Western Australia, Sch Surg, Ear Sci Ctr, Perth, WA, Australia.;Ear Sci Inst Australia, Perth, WA, Australia.;Ningbo Lihuili Hosp, Ningbo Med Ctr, Dept Otolaryngol Head & Neck Surg, Ningbo, Zhejiang, Peoples R China..
    Wang, Jeffrey T.
    Univ Western Australia, Sch Surg, Ear Sci Ctr, Perth, WA, Australia..
    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, Oslo, Norway.;Univ Oslo, Oslo, Norway.
    Dilley, Rodney J.
    Univ Western Australia, Sch Surg, Ear Sci Ctr, Perth, WA, Australia.;Ear Sci Inst Australia, Perth, WA, Australia..
    In response to the letter to the editor regarding: Rat model of chronic tympanic membrane perforation: Ventilation tube with mitomycin C and dexamethasone2017In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 100, p. 256-257Article in journal (Other academic)
  • 24.
    Wang, Allen Y.
    et al.
    Univ Western Australia, Sch Surg, Ear Sci Ctr, Perth, WA 6009, Australia.;Ear Sci Inst Australia, Perth, WA, Australia.;Sir Charles Gairdner Hosp, Skull Base Surg, Dept Otolaryngol Head & Neck, Perth, WA, Australia..
    Shen, Yi
    Univ Western Australia, Sch Surg, Ear Sci Ctr, Perth, WA 6009, Australia.;Ear Sci Inst Australia, Perth, WA, Australia.;Ningbo Lihuili Hosp, Ningbo Med Ctr, Dept Otolaryngol Head & Neck Surg, Ningbo, Zhejiang, Peoples R China..
    Liew, Lawrence J.
    Univ Western Australia, Sch Surg, Ear Sci Ctr, Perth, WA 6009, Australia.;Ear Sci Inst Australia, Perth, WA, Australia..
    Wang, Jeffrey T.
    Univ Western Australia, Sch Surg, Ear Sci Ctr, Perth, WA 6009, Australia..
    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, Oslo, Norway.;Univ Oslo, N-0316 Oslo, Norway..
    Atlas, Marcus D.
    Univ Western Australia, Sch Surg, Ear Sci Ctr, Perth, WA 6009, Australia.;Ear Sci Inst Australia, Perth, WA, Australia.;Sir Charles Gairdner Hosp, Skull Base Surg, Dept Otolaryngol Head & Neck, Perth, WA, Australia..
    Dilley, Rodney J.
    Univ Western Australia, Sch Surg, Ear Sci Ctr, Perth, WA 6009, Australia.;Ear Sci Inst Australia, Perth, WA, Australia..
    Rat model of chronic tympanic membrane perforation: Ventilation tube with mitomycin C and dexamethasone2016In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 80, no 1, p. 61-68Article in journal (Refereed)
    Abstract [en]

    Objective: Chronic tympanic membrane perforation (TMP) in a clinical setting may attract surgical intervention. With the advent of modern biomaterials, new options are available for myringoplasty but safety and efficacy need evaluation in a chronic TMP animal model. The aim of this study was to evaluate the efficacy of ventilation tube (VT) insertion in conjunction with topical application of mitomycin Cl dexamethasone (M/D) for the creation of chronic TMP in rats. Methods: Thirty male Sprague-Dawley rats underwent myringotomy of the right tympanic membrane (TM) and were divided into three experimental groups: spontaneous healing (myringotomy control), VT insertion for 2 weeks and VT insertion for 2 weeks in conjunction with topical application of M/D (VT-M/D). All TMs were regularly assessed by otoscopy for 10 weeks and then animals were sacrificed for histological evaluation. Results: In the VT-M/D group, seven out of ten (70%) perforations were patent at 10 weeks (mean patency, 57.9 days; P < 0.01). The VT group had two out of ten (20%) perforations patent at 10 weeks (mean patency, 26.5 days; P < 0.01), while all TMPs from the myringotomy control group were closed by day 9 (mean patency, 7.2 days). Histologically, the TMPs patent at week 10 had a stratified squamous epithelialized rim, keratinocyte layer thickening around the perforation edge as well as increased collagen deposition and macrophage infiltration. Conclusion: Chronic TMP in a rat model was successfully created by VT insertion and the efficacy was increased in combination with topical application of M/D.

  • 25. Wang, Allen Y.
    et al.
    Shen, Yi
    Liew, Lawrence J.
    Wang, Jeffrey T.
    von Unge, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Atlas, Marcus D.
    Dilley, Rodney J.
    Searching for a rat model of chronic tympanic membrane perforation: Healing delayed by mitomycin C/dexamethasone but not paper implantation or iterative myringotomy2015In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 79, no 8, p. 1240-1247Article in journal (Refereed)
    Abstract [en]

    Objectives: Surgical intervention such as myringoplasty or tympanoplasty is an option in the current clinical management of chronic tympanic membrane perforation (TMP). Animal models of chronic TMP are needed for pre-clinical testing of new materials and to improve existing techniques. We evaluated several reported animal model techniques from the literature for the creation of chronic TMPs. The aim of this study was to evaluate production of chronic TMPs in a rat model using topical mitomycin C/dexamethasone, paper insertion into middle ear cavity (MEC) or re-myringotomy. Methods: Forty male Sprague-Dawley rats underwent myringotomy of the right tympanic membrane (TM) and were randomly divided into 3 experimental groups: application of topical mitomycin C/dexamethasone, paper insertion into middle ear cavity, or re-myringotomy. Control perforations were allowed to close spontaneously. TMs were assessed regularly with otoscopy for 8 weeks. At the end of 8 weeks, animals were sacrificed for histology. Results: The closure of TMPs was significantly delayed by mitomycin C/dexamethasone (mean patency, 18.9 days; P <= 0.01) compared with the control (mean patency, 7 days), but was not significantly delayed in the paper insertion group (mean patency, 9.4 days; P = 0.74). Repeated myringotomy of closed perforations (mean number of myringotomies, 8.9 per ear) stimulated acceleration of closure rather than delay. Histologically, the mitomycin C/dexamethasone group had almost normal TM morphology, while the paper insertion group revealed inflammatory and granulomatous responses. The re-myringotomy group had a thickened TM fibrous layer with collagen deposition. Conclusions: Mitomycin C/dexamethasone delayed TMP closure in rats but the effect was not sufficiently long-lasting to be defined as a chronic TMP. Neither paper insertion into middle ear cavity nor re-myringotomy created chronic TMP in rats. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

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