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  • 1.
    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.

  • 2.
    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.

  • 3.
    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).

  • 4.
    Elinder, Karolina
    et al.
    Vasteras Hosp, Dept Otorhinolaryngol, Vasteras, Sweden..
    Soderman, Anne-Charlotte Hessen
    Karolinska Inst, Div Clin Sci Intervent & Technol, Dept Otorhinolaryngol Aleris Sabbatsberg, Stockholm, Sweden..
    Stalfors, Joacim
    Univ Gothenburg, Sahlgrenska Univ Hosp, Dept Otorhinolaryngol, Gothenburg, Sweden.;Univ Gothenburg, Inst Clin Sci, Sahlgrenska Acad, Gothenburg, 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..
    Factors influencing morbidity after paediatric tonsillectomy: a study of 18,712 patients in the National Tonsil Surgery Register in Sweden2016In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 273, no 8, p. 2249-2256Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to examine factors affecting morbidity after tonsillectomy in children. Data from the National Tonsil Surgery Register in Sweden on 18,712 patients who underwent tonsillectomy with or without simultaneous adenoidectomy between 1 and 18 years of age were analysed. This register includes data on sex, gender, surgical indication, and the surgical and haemostasis techniques used for each patient, as well as patient-reported outcomes for haemorrhage, analgesic use and antibiotic use. Comparison of patients who underwent surgery for infection versus upper airway obstruction revealed a significant increase in haemorrhage complications in the infection group. However, no significant difference remained after the adjustments for confounders in multivariable regression analysis. Instead, the increased risk among patients who underwent surgery for infection was mainly attributable to the use of bipolar diathermy and increased patient age. Patients who received surgery for infection reported more days of analgesic use, as well as more unplanned contacts with a health care service provider due to pain, compared with those who underwent surgery for upper airway obstruction. These results remained significant in multivariate analysis. The use of bipolar diathermy for haemostasis resulted in an increased risk, while the use of cold steel surgical instruments, a younger patient age and female sex led to a decreased risk. The surgical and haemostasis techniques used are the most important factors that affect morbidity after tonsillectomy in the paediatric age group. The choice of surgical techniques is of utmost importance for decreasing morbidity in these patients.

  • 5. Guo, Rui
    et al.
    Zhang, HongLei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Chen, Wei
    Zhu, XiaoQuan
    Liu, Wei
    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.
    The inferior cochlear vein: surgical aspects in cochlear implantation2016In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 273, no 2, p. 355-361Article in journal (Refereed)
    Abstract [en]

    The patency of the inferior cochlear vein (ICV) may be challenged in cochlear implantation (CI) due to its location near the round window (RW). This may be essential to consider during selection of different trajectories for electrode insertion aiming at preserving residual hearing. Venous blood from the human cochlea is drained through the ICV. The vein also drains blood from the modiolus containing the spiral ganglion neurons. Surgical interference with this vein could cause neural damage influencing CI outcome. We analyzed the topographical relationship between the RW and ICV bony channel and cochlear aqueduct (CA) from a surgical standpoint. Archival human temporal bones were further microdissected to visualize the CA and its accessory canals (AC1 and AC2). This was combined with examinations of plastic and silicone molds of the human labyrinth. Metric analyses were made using photo stereomicroscopy documenting the proximal portion of the AC1, the internal aperture of the CA and the RW. The mean distance between the AC1 and the anterior rim of the RW was 0.81 mm in bone specimens and 0.67 mm assessed in corrosion casts. The AC1 runs from the floor of the scala tympani through the otic capsule passing parallel to the CA to the posterior cranial fossa. The mean distance between the CA and AC1 canal was 0.31 and 0.25 mm, respectively.

  • 6.
    Kakoi, Hiroyuki
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Anniko, Matti
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Erwall, C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Pettersson, C. Åke V.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Jansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Morphological changes in rat submandibular gland mucous cells during fixation with 10% formalin1996In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 253, no 4-5, p. 214-21Article in journal (Refereed)
    Abstract [en]

    The features of mucous cells in 10% formalin (FA)-fixed submandibular glands differ markedly from those fixed in glutaraldehyde (GA). We therefore studied morphological changes in mucous cells during 10% FA fixation. Mucous cells were fixed in either 10% FA, neutral sodium-phosphate-buffered (Na-PBed) 10% FA, ice-cold 10% FA or an ice-cold fixative mixture of 2.0% paraformaldehyde (PA) and 0.5% GA. Two different methods were used: immersion fixation and venous perfusion fixation. The 10% FA-fixed tissues had elliptical or flattened nuclei, a clear cytoplasm and no secretory granules. Tissues fixed with the fixative mixture displayed almost round nuclei, a broad endoplasmic reticulum and abundant secretory granules in the cytoplasm. Tissues immersion-fixed with neutral Na-PBed 10% FA or perfusion-fixed with ice-cold 10% FA had almost the same light microscopic appearance as that of the mixture-fixed tissues. To elucidate the process of morphological changes during 10% FA fixation at room temperature, samples immersed in 10% FA for varying periods of time were postfixed immediately in the fixative mixture and exposed to microwave irradiation. This method produced a variety of findings, even within the same section. There was a significant difference in the findings seen in the center of the section and at the periphery. The initial changes caused by 10% FA were rupture of the secretory granules located in the perinuclear region and destruction of the perinuclear organelles such as Golgi apparatus, mitochondria and endoplasmic reticulum. Absorption of the endoplasmic reticulum progressed so that the perinuclear region became translucent. To obtain a better structure in mucous cells from the fixed submandibular gland tissues, an appropriate fixative such as GA should be used and the fixative should infiltrate into the tissues as quickly as possible.

  • 7.
    Nordang, Leif
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Lindholm, Carl-Eric
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Larsson, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Linder, Arne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Early laryngeal outcome of prolonged intubation using an anatomical tube: a double blind, randomised study2016In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 273, no 3, p. 703-708Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to study the short-term impact on larynx by a newly designed anatomical tube. A prospective randomised trial of a newly designed anatomical tube versus a standard endotracheal tube in patients operated under general anaesthesia for at least 12 h. Seventy adults were included and randomised to either type of tube. The patients were evaluated by means of fibre-optic laryngoscopy and VAS-rating of symptoms on two occasions in the first post-operative week. The evaluating investigators and the patients were blinded to the type of tube used. 27 cases and 23 controls had complete data for evaluation. Age, gender and intubation times were comparable. Symptoms such as hoarseness, coughing, and pain were rated above 30 % of maximum during at least one of the first post-operative days by 21 and 19 patients, respectively. At the first examination (within 24 h), 38 % of patients in the anatomical tube group stated no hoarseness; compared to 13 % of the controls (p = 0.057). Fibre-optic laryngoscopy showed some kind of pathology in all the patients examined within 24 h of extubation. After 3-6 days, seven patients with the anatomical tube and four patients in the control group showed complete resolution of the lesions, and the changes were limited to redness in the vocal process area in another seven and four, respectively. The differences between the groups did not attain statistical significance. The study shows considerable short-term laryngeal morbidity after prolonged intubation, and the anatomical tube only showed an advantage concerning hoarseness. Further improvement of the endotracheal tubes and intubation routines are still needed.

  • 8.
    Norlander, Katarina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Christensen, Pernille M
    Maat, Robert C
    Halvorsen, Thomas
    Heimdal, John Helge
    Morén, Staffan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Rasmussen, Niels
    Nordang, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Comparison between two assessment methods for exercise-induced laryngeal obstructions2016In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 273, no 2, p. 425-430Article in journal (Refereed)
    Abstract [en]

    Exercise-induced laryngeal obstructions (E-ILOs) are important differential diagnoses to exercise-induced asthma and are diagnosed by the continuous laryngoscopy exercise (CLE) test. There are two different methods for evaluating the severity of E-ILOs using recordings from the CLE test; the CLE score and EILOMEA. The aim of this study was to investigate the consistency between these methods. Using their respective method, the developers of each method evaluated 60 laryngoscopic recordings from patients with different subtypes and various levels of severity of E-ILOs. The CLE score evaluates glottic and supraglottic obstructions on a 4-grade scale. EILOMEA uses software to calculate the obstruction severity on continuous scales from a still frame of the larynx during maximal obstruction giving three parameters reflecting glottic and supraglottic obstruction. The means of the EILOMEA measures differed significantly for CLE score 1 vs. 2 and 2 vs. 3, but not for 0 vs. 1 for glottic as well as supraglottic obstructions. The EILOMEA method does not distinguish between CLE score 0 and 1, but otherwise the methods correlate. Since previous studies have suggested that only CLE scores of 2 and 3 reflect a severity of E-ILOs of clinical importance, this lack of the EILOMEA method is not crucial for a correct medical evaluation.

  • 9.
    Stenqvist, Monika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Anniko, Matti
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Rask-Andersen, Helge
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Middle ear mucosa changes following exposure to Pseudomonas aeruginosa exotoxin A1999In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 256, no 10, p. 484-90Article in journal (Refereed)
    Abstract [en]

    Pseudomonas aeruginosa exotoxin A (1 microgram/20 microliters) was instilled into the middle ear cavity in the rat. Morphological changes of the mucosa were analyzed after various intervals using light (LM) and transmission electron microscopy (TEM). An inflammatory cell reaction was seen in which there was a predominance of polymorphonuclear leukocytes (PMNs) and mononuclear cells that were mostly lymphocytes and monocytes/macrophages. Epithelial cells often showed signs of metaplasia and hyperplasia, followed by degradation through necrosis and/or apoptosis, resulting in denudation of the submucosal layer. A characteristic feature was the physical interaction between intraepithelial lymphocytes and epithelial cells. Lymphocytes adhering to the cell coat of epithelial cells showed signs of directed secretion that seemed to end in necrosis or apoptosis of the target cell. These changes occurred simultaneously with phagocytosis of cells and cell debris by PMNs and macrophages. Ultrastructural analysis suggested that intraepithelial, lymphocyte-mediated cytolysis and apoptosis may be important events in degradation of the epithelium following exposure to Pseudomonas sp. exotoxin. These findings indicate that denuding of the lamina propria may facilitate the penetration of toxin into the labyrinth, thus explaining subsequent inner ear damage.

  • 10.
    Strömbäck, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Lundman, Lars
    Karlstad Hosp, Karlstad, Sweden..
    Bjorsne, Andreas
    Sahlgrenska Tech Audiologist Univ Hosp, Gothenburg, Sweden..
    Grendin, Joakim
    Ostersund Hosp, Ostersund, Sweden..
    Stjernquist-Desatnik, Anna
    Lund Univ Hosp, Lund, Sweden..
    Dahlin-Redfors, Ylva
    Sahlgrens Univ Hosp, Gothenburg, Sweden..
    Stapes surgery in Sweden: evaluation of a national-based register2017In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 274, no 6, p. 2421-2427Article in journal (Refereed)
    Abstract [en]

    The aim of the National Quality Registries is to monitor the outcome of healthcare given to patients. The Swedish Quality register for otosclerosis surgery is one of the nine official national registers for ear, nose and throat diseases in Sweden. Since 2004, surgical and audiological results and patient satisfaction scores have been systematically collected from a majority of the ear, nose and throat clinics performing stapes surgery in Sweden. The results of 1688 patients who underwent primary operations for otosclerosis were evaluated for 24 out of totally 26 clinics performing stapes surgery, between 2004 and 2010. The most common surgical technique reported was stapedotomy accomplished in an overnight stay. A majority of patients experienced improved hearing, and were satisfied with the preoperative counselling. Successful surgery, defined as an ABG closure ae<currency>10 dB HL, was achieved in 69%, improvement in AC by ae<yen>20 dB in 63% and BC not worsened by more than ae<yen>5 dB in 93% of the patients. An overall low incidence of postoperative complications was reported. The outcome for ABG and BC was demonstrated to be independent of the number of operations performed by each clinic. An evaluation of the register and the results from the SQOS revealed that stapes surgery is a safe procedure with good hearing outcomes, low complication rates and a high rate of patient's satisfaction on a national level.

  • 11.
    Sundman, Joar
    et al.
    Karolinska Inst, Dept Clin Sci Intervent & Technol, S-17177 Stockholm, Sweden;Karolinska Univ Hosp, Dept Otorhinolaryngol, S-14186 Stockholm, Sweden.
    Fehrm, Johan
    Karolinska Inst, Dept Clin Sci Intervent & Technol, S-17177 Stockholm, Sweden;Karolinska Univ Hosp, Dept Otorhinolaryngol, S-14186 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.
    Low inter-examiner agreement of the Friedman staging system indicating limited value in patient selection2018In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 275, no 6, p. 1541-1545Article in journal (Refereed)
    Abstract [en]

    The Friedman staging system is a clinical method for selecting patients with obstructive sleep apnoea who are likely to benefit from uvulopalatopharyngoplasty. The objective of this study was to evaluate the system by determining its inter-examiner agreement. Twelve patients with obstructive sleep apnoea were examined by 14 doctors. The Friedman stage was derived from tonsil size and tongue position, and a Cohen's kappa analysis was performed to assess inter-examiner agreement. One hundred and sixty-eight ratings were performed. The median kappa for tongue position was 0.32 (first and third quartiles: 0.21 and 0.44) and was 0.62 (0.50 and 0.63) for tonsil size. The median kappa for the Friedman stage was 0.38 (0.24 and 0.55), which corresponds to only a slight or fair agreement. The Friedman staging system demonstrated a low inter-examiner agreement, indicating that the system is an uncertain method for selecting patients for uvulopalatopharyngoplasty. Level of evidence: 2B.

  • 12. Söderfeldt, Ylva
    The galvanic treatment of deafness and the trials at the Berlin Royal Deaf-Mute Asylum in 1802.2013In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 270, no 6, p. 1953-8Article in journal (Refereed)
    Abstract [en]

    In 1802, the director of the Berlin Royal Deaf-Mute Asylum, Ernst Adolph Eschke, performed an experiment to investigate the possibility of curing deafness by means of galvanism. This article explores the hope for a cure for deafness that was connected to the voltaic pile, and concludes that the treatment was based on insufficient knowledge of the aetiology of deafness. Furthermore, it uncovers the competition between the medical and the pedagogic approach to deafness that resulted from the purported cure. Comparing the approaches of different directors of galvanic experiments, divergences in attitudes between the medical and pedagogic realms are revealed. This is explained with reference to the contrasting motives and experiences of educational and medical professionals: the former had reasons to resist a cure to protect their profession, whereas the latter hoped for a medical breakthrough. Since the former had personal and long-lasting relationships to deaf people, while the latter only had brief encounters with deaf patients, the physicians were also more prone to objectify their trial subjects. The report from Eschke's trials is presented as an early document of deaf reactions to attempts to restore their hearing, showing that resistance to medical interventions were prevalent among the deaf already in the early nineteenth century.

  • 13. Takumida, Masaya
    et al.
    Anniko, Matti
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Lipopolysaccharide-induced expression of nitric oxide synthase II in the guinea pig vestibular end organ1998In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 255, no 4, p. 184-8Article in journal (Refereed)
    Abstract [en]

    The purpose of the investigation was to ascertain whether inoculation of bacterial lipopolysaccharide (LPS) into the vestibular organ of the guinea pig might induce formation of nitric oxide synthase (NOS) II. Forty-eight hours after the animals were injected with 1 mg transtympanic LPS, varying degrees of impaired caloric responses were observed with similar degeneration of vestibular hair cells. These effects could be blocked with N-nitro-L-arginine methylester, a competitive inhibitor of NOS. Findings suggested that NOS II, which was not normally detectable in the guinea pig vestibular organ but was present following inoculation of LPS, produced the nitric oxide as the toxic factor causing cell damage. If true, LPS may represent a reproducible method for studying the vestibular pathogenesis of inner ear disease.

  • 14.
    von Unge, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Dircks, Joris J
    Functional effects of repeated pressure loads upon the tympanic membrane: mechanical stiffness measurements after simulated habitual sniffing.2009In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 266, no 8, p. 1219-24Article in journal (Refereed)
    Abstract [en]

    In experimental studies it was found that otitis media causes stiffness loss in the tympanic membrane, possible precursors to retraction pockets and cholesteatoma. Besides otitis media habitual sniffing behaviour is associated with the development of retractions. The present study aims to test the hypothesis that repeated sniffing manoeuvre may cause not only structural, epithelial tympanic membrane changes presumed to be possible precursors to retractions, but also tympanic membrane stiffness loss, another possible mediator for the development of retractions. An experimental model with a pressure chamber was used to mimic the pressure conditions for the tympanic membrane in habitual sniffers' ears. The stiffness properties of twelve Mongolian gerbil tympanic membranes were measured with moiré interferometry after varying time up to 12 days with repeated pressure loading. Three days later, lower overall displacement were obtained in two ears; after 7-12 days the displacement readings were normal. This study with maximum of 12 days of pressure loading did not verify the hypothesis that habitual "sniffing" impairs the stiffness of the tympanic membrane.

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  • rtf