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  • 151. N, Browaldh
    et al.
    A, Markström
    Friberg, Danielle
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Elective tracheostomy is an alternative treatment in patients with severe obstructive sleep apnoea syndrome and CPAP failure.2009Inngår i: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, s. 1121-1126Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Conclusions.Elective tracheostomy with custom-made tubes was tolerated in a majority of patients with severe obstructivesleep apnoea syndrome (OSAS), as it reduced daytime symptoms and served as a link to other treatments.Objectives.Toevaluate the tolerability of elective tracheostomy and changes in excessive daytime sleepiness and nocturnal oxygendesaturations (ODI) in patients with severe OSAS and obesity.Patients and methods.The medical records of 10 patients,median age 53.5 years (range 3177), BMI 36 kg/m2(3150), ODI 81 (55126) during a 5-year period were reviewed.Inclusion criteria were failure of continuous positive airway pressure (CPAP), acceptance of tracheostomy, excessivedaytime sleepiness and ODI50. All patients received a custom-made tube. Sleep apnoea recordings and questionnaireswith Epworth sleepiness scale (ESS) were performed before and after tracheostomy.Results.Eight of 10 patients toleratedthe tube for more than 6 months. The ESS score was reduced from median 18 (range 823) to 5 (07) and the ODI valuesfrom 81 (55126) to 13 (187). Two patients insisted on decannulation because they had nocturnal breathing problems,two underwent palatal surgery and were decannulated, and five still have their tubes. Severe cough, sputum infections andstoma granuloma were seen in all patients.

  • 152. N, Browaldh
    et al.
    Friberg, Danielle
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    E, Svanborg
    P, Nerfeldt
    15-year efficacy of uvulopalatopharyngoplasty based on objective and subjective data2011Inngår i: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251Artikkel i tidsskrift (Fagfellevurdert)
  • 153. N, Browaldh
    et al.
    J, Bring
    Friberg, Danielle
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    SKUP3: 6 and 24 months follow-up of changes in respiration and sleepiness after modified UPPP.2018Inngår i: The LaryngoscopeArtikkel i tidsskrift (Fagfellevurdert)
    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.

  • 154. N, Browaldh
    et al.
    P, Nerfeldt
    M, Lysdahl
    J, Bring
    Friberg, Danielle
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    SKUP3 randomised controlled trial: polysomnographic results after uvulopalatopharyngoplasty in selected patients with obstructive sleep apnoea.2013Inngår i: ThoraxArtikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective To assess the 6-month efficacy of uvulopalatopharyngoplasty (UPPP) compared with expectancy in selected patients with obstructive sleep apnoea syndrome (OSAS).

    Design A prospective single-centre randomised controlled trial with two parallel arms stratified by Friedman stage and body mass index (BMI).

    Participants 65 consecutive patients with moderate to severe OSAS (apnoea-hypopnoea index (AHI) ≥15 events/h sleep), BMI <36 kg/m2, Epworth sleepiness scale ≥8, Friedman stage I or II.

    Intervention Surgical treatment with UPPP. The control group underwent UPPP after a delay of 6 months.

    Outcomes Changes in AHI and other polysomnography parameters at baseline compared with the 6-month follow-up.

    Results All patients (32 in the intervention group and 33 in the control group) completed the trial. The mean (SD) AHI in the intervention group decreased significantly (p<0.001) by 60% from 53.3 (19.7) events/h to 21.1 (16.7) events/h . In the control group the mean AHI decreased by 11% from 52.6 (21.7) events/h to 46.8 (22.8) events/h, with a significant difference between the groups (p<0.001). The mean time in the supine position and the BMI were unchanged in both groups. Subgroup analyses for Friedman stage, BMI group and tonsil size all showed significant reductions in AHI in the intervention group compared with controls. There were no severe complications after surgery.

    Conclusions This trial demonstrates the efficacy of UPPP in treating selected patients with OSAS with a mean reduction in AHI of 60% compared with 11% in controls, a highly significant and clinically relevant difference between the groups.

    Trial registration number NCT01659671.

  • 155.
    Niklasson, Anders
    et al.
    Umea Univ, Dept Clin Sci, Otorhinolaryngol, Umea, Sweden.
    Gladine, Kilian
    Univ Antwerp, Dept Phys, Antwerp, Belgium.
    Ronnblom, Anton
    Umea Univ, Dept Clin Sci, Otorhinolaryngol, Umea, Sweden.
    von Unge, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Akershus Univ Hosp, Dept Otorhinolaryngol, Lorenskog, Norway;Univ Oslo, Oslo, Norway.
    Dirckx, Joris
    Univ Antwerp, Dept Phys, Antwerp, Belgium.
    Tano, Krister
    Umea Univ, Dept Clin Sci, Otorhinolaryngol, Umea, Sweden.
    An Optimal Partial Ossicular Prosthesis Should Connect Both to the Tympanic Membrane and Malleus: A Temporal Bone Study Using Laser Doppler Vibrometry2018Inngår i: Otology and Neurotology, ISSN 1531-7129, E-ISSN 1537-4505, Vol. 39, nr 3, s. 333-339Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective:To compare stapes vibrations in different partial ossicular replacement prosthesis (PORP) applications.

    Methods: Stapedial vibrations were measured on fresh frozen human temporal bones with laser Doppler vibrometry. Eight different types of common ossiculoplasty methods were compared regarding recovery of stapes vibrations in relation with the normal ossicular chain. The PORPs were divided into three groups: 1) PORPs with the lateral contact only with the tympanic membrane, 2) PORPs with lateral contact only to the malleus handle, and 3) PORPs with lateral contact with both the malleus handle and the tympanic membrane.

    Results: The PORPs with lateral contact only to the malleus handle performed better than the PORPs with lateral contact to the tympanic membrane only at 2 kHZ, but the best recovery was found in the group with contact both to the malleus handle and the tympanic membrane.

    Conclusion: The best sound transmission might be achieved by placing a PORP in contact with both the tympanic membrane and the handle of the malleus.

  • 156.
    Niklasson, Anders
    et al.
    Umea Univ, Dept Clin Sci, Otorhinolaryngol, Umea, Sweden..
    Ronnblom, Anton
    Umea Univ, Dept Clin Sci, Otorhinolaryngol, Umea, Sweden..
    Muyshondt, Pieter
    Univ Antwerp, Dept Phys, Antwerp, Belgium..
    Dirckx, Joris
    Univ Antwerp, Dept Phys, Antwerp, Belgium..
    von Unge, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Akershus Univ Hosp, Dept Otorhinolaryngol, Oslo, Norway.;Univ Oslo, Oslo, Norway..
    Tano, Krister
    Umea Univ, Dept Clin Sci, Otorhinolaryngol, Umea, Sweden..
    Ossiculoplasty on Isolated Malleus Fractures: A Human Temporal Bone Study Using Laser Doppler Vibrometry2016Inngår i: Otology and Neurotology, ISSN 1531-7129, E-ISSN 1537-4505, Vol. 37, nr 7, s. 895-901Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Hypothesis: In the literature several surgical methods have been reported that aim to improve hearing in patients with isolated malleus fractures; however, it is still not clear which method gives the best results.

    Background: In this study, laser Doppler vibrometry (LDV) was used to compare the outcome of different surgical methods on malleus fractures in fresh frozen human temporal bones.

    Methods: Fractured malleus shafts of defrosted human temporal bones were repaired with bone cement, with a malleus prosthesis from cortical bone, or with a partial ossicular replacement prosthesis (PORP) from cortical bone, and LDV measurements were obtained for analysis.

    Results: The best result was achieved with the bone cement only, applied directly at the site of the fracture. The malleus prosthesis and the PORP gave similar results.

    Conclusion: All three surgical methods gave good results, but when the distal end of the fractured malleus can be attached close to the proximal end, the technique using only cement tends to be the best option. If the parts are too far apart, a malleus prosthesis or a PORP would be good options.

  • 157.
    Nilsson, Elin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Logopedi.
    Pettersson, Kajsa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Logopedi.
    Utveckling och normering av ett stavningstest för vuxna (STAVUX)2009Independent thesis Advanced level (degree of Master (One Year)), 20 poäng / 30 hpOppgave
    Abstract [sv]

    Syftet med denna studie var att utveckla och normera ett logopediskt stavningstest för vuxna., då det idag saknas ett sådant test. Det framtagna testet bestod till en början av en orddel som innehöll 80 ord i varierande svårighetsgrad, utvalda för att representera svenskans olika stavningskombinationer. Vidare fanns en del med 80 nonord, konstruerade för att följa svenskans ljudmässiga uppbyggnad. 146 deltagare från 18 – 94 år deltog i normeringen av testet. Urvalet stratifierades efter kön, ålder och utbildningsnivå så att inverkan av dessa olika faktorer på stavningsförmågan kunde undersökas. Resultaten visade att utbildningsnivå påverkade stavningsförmågan på så sätt att personer med eftergymnasial utbildning klarade stavning av både ord och nonord bättre än personer med förgymnasial/gymnasial utbildning. Vidare uppvisade kvinnor bättre resultat på stavning av ord jämfört med män, men ingen signifikant skillnad i stavningsförmåga av nonord uppmättes. Vid stavning av ord framkom ingen skillnad i förhållande till ålder, men vid stavning av nonord uppvisade äldre personer ett sämre resultat, troligen p.g.a. nedsatt hörsel. De vanligaste typerna av stavfel bland deltagarna var på orddelen enkel-/dubbelteckning och på nonorddelen utbyte av bokstav. Stavfelens placering förekom främst medialt i orden, medan de i nonorden fanns både initialt och medialt. Studien utmynnade i STAVUX, ett test med 45 ord och 45 nonord, utvalda från det ursprungliga testet. STAVUX deltest har en hög intern reliabilitet. Testet har normerats och är tänkt att användas vid utredning av vuxna med stavningssvårigheter.

  • 158.
    Nilsson, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Logopedi.
    PECS som samtalsstöd vid autism: En interventionsstudie med införande av en kommunikationskarta anpassad för pratstunder.2010Independent thesis Advanced level (degree of Master (One Year)), 20 poäng / 30 hpOppgave
    Abstract [sv]

    Syftet med denna studie var att undersöka hur en för situationen anpassad kommunikationskarta, en pratkarta, kan möjliggöra samtal mellan en 11-årig pojke med autism och utvecklingsstörning och hans mamma när de samtalar om en händelse som inte händer nu. Erik har inget fungerande tal och är beroende av Alternativ och Kompletterande Kommunikation (AKK). Han har sedan förskoletiden en pärm med löstagbara bilder (PECS), som han använder för att uttrycka sina behov och intentioner. I studien undersöktes hur interaktionen mellan Erik och hans mamma Maria organiserades sekventiellt. Analysen visade att en kommunikationskarta, en pratkarta med bilder anpassade för samtalet, var en viktig gemensam resurs för både Maria och Erik för att initiera, utveckla och avsluta pratstunden. Analysen baserades på videoinspelat material i hemmet, inspelat av Maria, där deltagarna pratade om den förestående julhelgen. Samtalsanalys (Conversation Analysis) användes som analysmetod. Det visade sig att deltagarna orienterar mot tre huvudsakliga faser i det kommunikativa projektet att etablera samtal om julen:prefas, huvudfas och postfas. Pratkartan var en viktig kommunikativ resurs för både Maria och Erik, vilken de orienterade mot i alla delar av samtalet. Prefasen bestod av de handlingar som leder fram till att Erik använder PECS-bilder för att involvera sig i samtalet. I prefasen var pratkartan helt avgörande för att Erik skulle komma igång och pecsa. I huvudfasen, den fas där Erik använder PECS-bilder för att samtala om julen, utvecklade Maria och Erik gemensamt olika ämnesaspekter av samtalet. Maria upprepade och utvidgade utifrån Eriks pecsyttranden. Hon gav också värderande bidrag och föreslog nya perspektiv på det pågående ämnet. Erik upprepade, byggde ut och överlappade Marias bidrag, men han kunde också aktivt bibehålla koherens i episoden och följde inte alltid Marias utvidgning eller förslag på nya ämnesaspekter. I postfasen avslutade deltagarna pratstunden och talet om julen. Erik bidrog aktivt till avslutandet genom att plocka ihop pratkartorna. Maria bekräftade både verbalt och genom att använda SLUTA-PRATA-bilden att pratstunden är avslutad. Förslag ges på framtida praktikbaserade studier som kan bidra till evidensbaserad praktik.

  • 159.
    Nordang, Leif
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    The Round Window Membrane - Gateway to the Cochlea: A Morphological and Electrophysiological study2002Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Topical treatment of several inner ear diseases through the round window membrane (RWM) might be feasible in the near future. Bacteria toxins, ototoxic drugs and noise trauma seem to harm the inner ear by a common pathway which involves, excessive outflow of the afferent neurotransmitter glutamate and formation of nitric oxide (NO), which can severely damage cells/nerve endings and lead to cell death.

    In this study we used 98 Sprague-Dawley rats and seven human temporal bones. Various substances were instilled into the middle ear of the rat, such as Pseudomonas Aeruginosa Exotoxin (PaExoA), gentamicin, NO-inhibitor N-Omega-Nitro-L-Arginine Methyl Ester (L-NAME), and glucocorticoids. The effects of the substances were studied by morphological analysis of RWM and the endolymphatic sac (ES) by light and electron microscopic. Hearing level was measured in the rats by ABR technique. The human temporal bones were studied immunomorphologically to search for glutamate.

    In the human inner ear, glutamate receptors and glutamine synthetase, were identified. In the rat, we found, following PaExoA exposure, reversible and permanent hearing loss and morphological changes in the RWM. The ES showed increased numbers of macrophages and thickening of the epithelia. When L-NAME was used as an otoprotector from gentamicin ototoxicity a therapeutic effect in the high frequency area was found. Hydrocortisone (but not dexamethasone) exposure of the RWM resulted in membrane thickening, and adjacent to the membrane, inflammatory cells.

    The importance of the RWM as a portal for toxic substances and topical treatment of inner ear diseases was highlighted in this study. The difficulties of applying drugs in the round window niche were exposed. The results of this study add important knowledge concerning certain mechanisms of inner ear injury and help us to understand possibilities and problems of local treatment of inner ear diseases in patients.

    Delarbeid
    1. Hearing loss in relation to round window membrane morphology in experimental chronic otitis media
    Åpne denne publikasjonen i ny fane eller vindu >>Hearing loss in relation to round window membrane morphology in experimental chronic otitis media
    2001 (engelsk)Inngår i: Journal for Oto-Rhino-Laryngology, ISSN 0301-1569, E-ISSN 1423-0275, Vol. 63, nr 6, s. 333-340Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    The present study was performed to test the effect of single and repeated Pseudomonas aeruginosa exotoxin A (PaExoA) instillations in the middle ear of the rat. The hearing level was examined by the ABR technique, round window membrane (RWM) thickness was measured and morphology was studied by light microscopy. The results showed both reversible and permanent hearing loss (HL). In animals that received a single dose of PaExoA, the RWM thickness doubled initially and remained thickened during the observation period. When PaExoA was instilled on several occasions, RWM thickness doubled, before decreasing to near-control levels. This study confirms the toxicity of PaExoA and the partially reversible HL occurring after a single application of the toxin. The diminished effect of repeated toxin instillations--despite the decreasing thickness of the RWM--is discussed.

    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-89796 (URN)10.1159/000055770 (DOI)11713421 (PubMedID)
    Tilgjengelig fra: 2002-04-10 Laget: 2002-04-10 Sist oppdatert: 2017-12-14bibliografisk kontrollert
    2. Middle ear exotoxin and endolymphatic sac response: an immune reaction?
    Åpne denne publikasjonen i ny fane eller vindu >>Middle ear exotoxin and endolymphatic sac response: an immune reaction?
    2001 Inngår i: Oto-Rhino-Laryngologia Nova, Vol. 10, s. 269-276Artikkel i tidsskrift (Fagfellevurdert) Published
    Identifikatorer
    urn:nbn:se:uu:diva-89797 (URN)
    Tilgjengelig fra: 2002-04-10 Laget: 2002-04-10bibliografisk kontrollert
    3. Glutamate is the afferent neurotransmitter in the human cochlea
    Åpne denne publikasjonen i ny fane eller vindu >>Glutamate is the afferent neurotransmitter in the human cochlea
    2000 (engelsk)Inngår i: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 120, nr 3, s. 359-362Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Glutamate, the most important afferent neurotransmitter in the auditory system, is thought to be the afferent transmitter between the cochlear inner hair cells and afferent neurons, hitherto visualized only in the cochlea of animal species. It has been identified for the first time in sections from the human inner ear. L-glutamate, NMDAR2B and the enzyme glutamine synthetase were identified by using monoclonal antibodies. The distribution pattern of the transmitter L-glutamate in the human cochlea is similar to that observed in other mammals. L-glutamate was identified adjacent to outer and inner hair cells and in the spiral ganglion. Similar distributions were found for glutamine synthetase and the ionotropic NMDA receptor subunit NMDAR2. The identification of neurotransmitters and their receptors in the human cochlea has implications for the pharmacotherapy of inner ear diseases.

    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-89798 (URN)10894409 (PubMedID)
    Tilgjengelig fra: 2002-04-10 Laget: 2002-04-10 Sist oppdatert: 2017-12-14bibliografisk kontrollert
    4. Nitro-L-arginine methyl ester: a potential protector against gentamicin ototoxicity
    Åpne denne publikasjonen i ny fane eller vindu >>Nitro-L-arginine methyl ester: a potential protector against gentamicin ototoxicity
    2005 (engelsk)Inngår i: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 125, nr 10, s. 1033-8Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    The nitric oxide (NO) inhibitor nitro-L-arginine methyl ester (L-NAME) may act as an otoprotectant against high-frequency hearing loss caused by gentamicin, but further studies are needed to confirm this.Aminoglycoside antibiotics are still widely used by virtue of their efficacy and low cost. Their ototoxicity is a serious health problem and, as their ototoxic mechanism involves the production of NO, we need to assess the use of NO inhibitors for the prevention of aminoglycoside-induced sensorineural hearing loss. In this experimental study we used 30 Sprague-Dawley rats, 27 of which had gentamicin instilled into the middle ear. The otoprotectant L-NAME was administered topically to 12/27 animals. Its effect was determined in terms of attenuation of hearing loss, measured by shifts in the auditory brainstem response threshold. L-NAME reduced gentamicin-induced hearing loss in the high-frequency range, but gave no protection in the middle or low frequencies.

    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-89799 (URN)10.1080/00016480510038022 (DOI)16298782 (PubMedID)
    Tilgjengelig fra: 2002-04-10 Laget: 2002-04-10 Sist oppdatert: 2017-12-14bibliografisk kontrollert
    5. Morphological changes in round window membrane following topical hydrocortisone and dexamethasone treatment
    Åpne denne publikasjonen i ny fane eller vindu >>Morphological changes in round window membrane following topical hydrocortisone and dexamethasone treatment
    2003 (engelsk)Inngår i: Otology and Neurotology, ISSN 1531-7129, E-ISSN 1537-4505, Vol. 24, nr 2, s. 339-43Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    HYPOTHESIS: Are all glucocorticoids supposed to have the same effect on the round window membrane? BACKGROUND: Interest in glucocorticoids for topical treatment of inner ear diseases is increasing. The safety of such treatment should therefore be an important consideration before clinical use. METHODS: In this study the authors investigated the morphology of the round window membrane after topical instillation of dexamethasone or hydrocortisone into the middle ear. Twenty Sprague-Dawley rats were used. Five rats received 5 doses, and five rats 10 doses, of 1 microg (20 microl) dexamethasone in the right ear, and five others were given 5 doses, and five rats 10 doses, of 2% (20 microl) hydrocortisone solution, also in the right ear. Membrane morphology was studied in both light microscopy and transmission electron microscopy. The thickness of exposed membranes was measured and compared with that of control membranes. RESULTS: Thickening and microscopically signs of inflammation were observed in hydrocortisone-exposed membranes but not in dexamethasone-exposed membranes, which did not differ morphologically from those in control ears. CONCLUSION: Although hydrocortisone has anti-inflammatory properties, it seems to provoke inflammation in the round window membrane after topical instillation. Dexamethasone had no such effects, however.

    Emneord
    Administration; Topical, Animals, Anti-Inflammatory Agents/*pharmacology/*therapeutic use, Basilar Membrane/*drug effects/*pathology/ultrastructure, Dexamethasone/administration & dosage/*pharmacology/*therapeutic use, Epithelium/drug effects/ultrastructure, Hydrocortisone/administration & dosage/*pharmacology, Male, Microscopy; Electron, Rats, Rats; Sprague-Dawley, Round Window/*drug effects/*pathology/ultrastructure
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-89800 (URN)12621354 (PubMedID)
    Tilgjengelig fra: 2002-04-10 Laget: 2002-04-10 Sist oppdatert: 2017-12-14bibliografisk kontrollert
  • 160.
    Nordang, Leif
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Lindholm, Carl-Eric
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Larsson, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Linder, Arne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Early laryngeal outcome of prolonged intubation using an anatomical tube: a double blind, randomised study2016Inngår i: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 273, nr 3, s. 703-708Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 161.
    Nordang, Leif
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Morén, Staffan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Johansson, Henrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Wenngren, Ewa
    Nordvall, Lennart
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Exercise-induced asthma could be laryngeal obstruction. Not uncommon among young sportsmen--avoiding the wrong treatment is important2009Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518Artikkel i tidsskrift (Fagfellevurdert)
    Abstract
  • 162.
    Norlander, Katarina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Exercise-induced laryngeal obstruction: Prevalence, laryngeal findings and evaluation of treatment2017Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Exercise-induced laryngeal obstruction (EILO) is one of many different causes for adolescents to experience dyspnoea during exercise. Objective exercise-testing with continuous video laryngoscopy is crucial for a correct diagnosis since it is difficult to differentiate EILO from other exercise related conditions in the airways only on the symptomatology. The main symptom in EILO is inspiratory stridor arising from an obstruction at the laryngeal level during ongoing exercise which quickly resolves after the exercise has stopped. EILO is often misdiagnosed as exercise-induced bronchoconstriction (EIB), which is obstruction in the peripheral airways that typically arises after cessation of exercise.

    From a previous survey investigating self-reported exercise-induced dyspnoea in all 12-13-year-old adolescents in Uppsala (n=3,838, response rate 60.2%) a subset of 150 randomly selected adolescents (103 with dyspnoea and 47 controls) performed standardized treadmill exercise-tests for EIB and EILO.

    During the exercise-test for EIB the subjects breathed dry air according to the current recommended guidelines. EIB was defined as a decrease in FEV1 ≥10% from baseline. EILO was diagnosed during a continuous laryngoscopy exercise (CLE) test by use of the CLE-score method and was defined as an obstruction of grade 2 at either glottic or/and supraglottic laryngeal level. The estimated prevalence of EIB in the general population was 19.2% and the estimated prevalence of EILO was 5.7%. No gender differences were detected.

    A diagnostic software program for EILO, EILOMEA, was compared with the CLE-score and the methods were found to be compatible. EILOMEA was used to map and compare laryngeal response patterns in adolescents with exercise-induced dyspnoea (EIB and/or EILO), in adolescents with dyspnoea but without a diagnosis of EIB or EILO, and in healthy controls, all of whom had performed the CLE-test. No differences were seen between the healthy controls and the adolescents with dyspnoea without a diagnosis. Only adolescents diagnosed with EILO showed a significant different laryngeal response pattern which strongly suggests that the diagnostic procedure is reliable.

    In a follow-up study of patients referred for investigation of exercise-induced dyspnoea, we investigated the outcome of surgical vs. conservative treatment of EILO-positive subjects and subjects tested negative for the diagnosis, regarding the level of exercise-induced dyspnoea and physical activity. Surgically treated patients had less breathing problems and were more physically active than both conservatively treated patients and patients who were tested negative.

    Delarbeid
    1. Comparison between two assessment methods for exercise-induced laryngeal obstructions
    Åpne denne publikasjonen i ny fane eller vindu >>Comparison between two assessment methods for exercise-induced laryngeal obstructions
    Vise andre…
    2016 (engelsk)Inngår i: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 273, nr 2, s. 425-430Artikkel i tidsskrift (Fagfellevurdert) Published
    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.

    Emneord
    E-ILO; Continuous laryngoscopy exercise test; CLE score; EILOMEA; Exercise-induced respiratory difficulties
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-266447 (URN)10.1007/s00405-015-3758-7 (DOI)000368990700022 ()26351037 (PubMedID)
    Eksternt samarbeid:
    Tilgjengelig fra: 2015-11-10 Laget: 2015-11-10 Sist oppdatert: 2017-12-01bibliografisk kontrollert
    2. Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population
    Åpne denne publikasjonen i ny fane eller vindu >>Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population
    Vise andre…
    2015 (engelsk)Inngår i: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 70, nr 1, s. 57-63Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Background Exercise-induced respiratory symptoms are common among adolescents. Exercise is a known stimulus for transient narrowing of the airways, such as exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (EILO). Our aim was to investigate the prevalence of EIB and EILO in a general population of adolescents. Methods In this cross-sectional study, a questionnaire on exercise-induced dyspnoea was sent to all adolescents born in 1997 and 1998 in Uppsala, Sweden (n=3838). A random subsample of 146 adolescents (99 with self-reported exercise-induced dyspnoea and 47 without this condition) underwent standardised treadmill exercise tests for EIB and EILO. The exercise test for EIB was performed while breathing dry air; a positive test was defined as a decrease of >= 10% in FEV1 from baseline. EILO was investigated using continuous laryngoscopy during exercise. Results The estimated prevalence of EIB and EILO in the total population was 19.2% and 5.7%, respectively. No gender differences were found. In adolescents with exercise-induced dyspnoea, 39.8% had EIB, 6% had EILO and 4.8% had both conditions. In this group, significantly more boys than girls had neither EIB nor EILO (64.7% vs 38.8%; p=0.026). There were no significant differences in body mass index, lung function, diagnosed asthma or medication between the participants with exercise-induced dyspnoea who had or did not have a positive EIB or EILO test result. Conclusions Both EIB and EILO are common causes of exercise-induced dyspnoea in adolescents. EILO is equally common among girls and boys and can coexist with EIB.

    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-241953 (URN)10.1136/thoraxjnl-2014-205738 (DOI)000346338300012 ()
    Merknad

    Henrik Johansson and Katarina Norlander have shared first authorship on this paper.

    Tilgjengelig fra: 2015-01-20 Laget: 2015-01-19 Sist oppdatert: 2017-12-05bibliografisk kontrollert
    3. Laryngeal findings during exercise in healthy and dyspneic adolescents
    Åpne denne publikasjonen i ny fane eller vindu >>Laryngeal findings during exercise in healthy and dyspneic adolescents
    (engelsk)Manuskript (preprint) (Annet vitenskapelig)
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-315122 (URN)
    Tilgjengelig fra: 2017-02-09 Laget: 2017-02-09 Sist oppdatert: 2017-02-09
    4. Surgical treatment is effective in severe cases of exercise-induced laryngeal obstruction: A follow-up study
    Åpne denne publikasjonen i ny fane eller vindu >>Surgical treatment is effective in severe cases of exercise-induced laryngeal obstruction: A follow-up study
    Vise andre…
    2015 (engelsk)Inngår i: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 135, nr 11, s. 1152-1159Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Conclusions: Surgery is an effective treatment in severe cases of supraglottic exercise-induced laryngeal obstruction (E-ILO). Conservatively treated subjects and subjects tested negative for E-ILO, who still experience breathing problems 1–3 years after diagnosis, tend to adjust their physical activity to a greater extent than surgically treated subjects. Objective: To investigate how symptoms and level of physical activity change over time in patients with E-ILO who have undergone surgery, patients with E-ILO treated conservatively and patients who tested negative for laryngeal obstruction at continuous laryngoscopy exercise-test (CLE-test). Methods: Patients referred for exercise-induced breathing difficulties answered questionnaires at diagnostic CLE-test and at follow-up. Questions regarded exercise-induced breathing problems, current physical activity level, and medical history of asthma and perennial allergy. Results: Out of 84 invited subjects, 59 (70%) answered both questionnaires. Surgically treated subjects had less breathing problems at follow-up compared with conservatively treated subjects and subjects who tested negative (p < 0.001). None of the surgically treated subjects were less physically active or had changed sport due to exercise-induced dyspnoea, whereas 41.7% of the conservatively treated subjects had made such adjustments (p < 0.001).

    Emneord
    Laryngoplasty; exercice-induced dyspnoea; vocal cord dysfunction; physical activity; E-ILO
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-264379 (URN)10.3109/00016489.2015.1062548 (DOI)000369936800010 ()26200564 (PubMedID)
    Tilgjengelig fra: 2015-10-10 Laget: 2015-10-10 Sist oppdatert: 2017-12-01bibliografisk kontrollert
  • 163.
    Norlander, Katarina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Laryngeal findings during exercise in healthy and dyspneic adolescentsManuskript (preprint) (Annet vitenskapelig)
  • 164.
    Norlander, Katarina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Christensen, Pernille M
    Maat, Robert C
    Halvorsen, Thomas
    Heimdal, John Helge
    Morén, Staffan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Rasmussen, Niels
    Nordang, Leif
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Comparison between two assessment methods for exercise-induced laryngeal obstructions2016Inngår i: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 273, nr 2, s. 425-430Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 165.
    Norlander, Katarina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Johansson, Henrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Nordvall, Lennart
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Nordang, Leif
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Surgical treatment is effective in severe cases of exercise-induced laryngeal obstruction: A follow-up study2015Inngår i: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 135, nr 11, s. 1152-1159Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Conclusions: Surgery is an effective treatment in severe cases of supraglottic exercise-induced laryngeal obstruction (E-ILO). Conservatively treated subjects and subjects tested negative for E-ILO, who still experience breathing problems 1–3 years after diagnosis, tend to adjust their physical activity to a greater extent than surgically treated subjects. Objective: To investigate how symptoms and level of physical activity change over time in patients with E-ILO who have undergone surgery, patients with E-ILO treated conservatively and patients who tested negative for laryngeal obstruction at continuous laryngoscopy exercise-test (CLE-test). Methods: Patients referred for exercise-induced breathing difficulties answered questionnaires at diagnostic CLE-test and at follow-up. Questions regarded exercise-induced breathing problems, current physical activity level, and medical history of asthma and perennial allergy. Results: Out of 84 invited subjects, 59 (70%) answered both questionnaires. Surgically treated subjects had less breathing problems at follow-up compared with conservatively treated subjects and subjects who tested negative (p < 0.001). None of the surgically treated subjects were less physically active or had changed sport due to exercise-induced dyspnoea, whereas 41.7% of the conservatively treated subjects had made such adjustments (p < 0.001).

  • 166. Oberg, Marie
    et al.
    Bohn, Therese
    Larsson, Ulrika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Short- and Long-Term Effects of the Modified Swedish Version of the Active Communication Education (ACE) Program for Adults with Hearing Loss2014Inngår i: JOURNAL OF THE AMERICAN ACADEMY OF AUDIOLOGY, ISSN 1050-0545, Vol. 25, nr 9, s. 848-858Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: In Sweden, there is a lack of evidence-based rehabilitation programs for hearing loss. The Active Communication Education program (ACE) has successfully been used in Australia and was translated and evaluated in a Swedish pilot study. The pilot study included 23 participants (age 87 yr). No statistically significant effects were found, but the qualitative assessments indicated that this population found the program to be beneficial. The participants requested more focus on the psychosocial consequences of hearing loss, and the modules in the original ACE program were modified. Purpose: The aim of this study was to explore the effects of a modified Swedish version of the ACE program in a population aged 39-82 yr old. Research Design: Design was a between-group and within-group intervention study. Study Sample: The participants were recruited from the hearing health clinic in Linkoping during 2010 and 2012. A total of 73 participante agreed to undergo the ACE, and 67 (92%) completed three or more sessions. Intervention: The ACE program consists of five weekly 2 hr group sessions with 6 to 10 participants per group. Data Collection and Analysis: The outcomes were measured before initiation of the program, 3 wk after program completion, and 6 mo after program completion and included communication strategy use, activity and participation, health-related quality of life, and anxiety and depression. In addition, outcomes were measured after program completion using the International Outcome Inventory Alternative Interventions, a modified version of the Client Oriented Scale of Improvement, and qualitative feedback was obtained about the response to the program and actions taken as a result of participation. The treatment effects were examined using repeated-measures analyses of variance. Results: Statistically significant effects were found for communication strategy use, activity and participation, and psychosocial well-being. Statistically significant effects were found for gender and degree of hearing loss, indicating that women and those with mild hearing loss significantly improved communication strategies. Conclusions: It is suggested that the program be implemented as part of regular audiological rehabilitation and offered in an early stage of rehabilitation.

  • 167. P, Nerfeldt
    et al.
    BY, Nilsson
    J, Uddén
    S, Rössner
    Friberg, Danielle
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Weight reduction improves nocturnal respiration in obese sleep apnoea patients-: A randomized controlled pilot study2008Inngår i: Obesity Research and Clinical Practice, ISSN 1871-403X, E-ISSN 1878-0318Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives

    Randomized controlled pilot study of the effect of weight reduction on nocturnal respiratory parameters in obese patients with obstructive sleep apnoea syndrome (OSAS).

    Methods

    Twenty consecutive obese male patients fulfilling OSAS criteria at Karolinska University Hospital were randomized into two groups. Intervention with an 8-week weight reduction programme consisting of a low-calorie diet, together with group meetings, was evaluated compared to expectancy alone for the control group, followed by a crossover. Follow-up at 3 months included anthropometrics and ambulant sleep apnoea recordings.

    Results

    Eleven of twenty men completed the protocol. There were significant differences between the intervention group (n = 6) and the control group (n = 5) in changes of weight (p < 0.01) and oxygen desaturation index (ODI4) (p < 0.05). We also found a significant positive correlation in these 11 males after the crossover between their reduction in weight and their reduction in ODI4 (p < 0.05).

    Conclusions

    This pilot study indicates that weight reduction improves nocturnal respiration in obese OSAS patients after 3 months’ dietary treatment compared to expectancy.

  • 168. P, Nerfeldt
    et al.
    BY, Nilsson
    L, Mayor
    J, Uddén
    Friberg, Danielle
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    A two-year weight reduction program in obese sleep apnea patients2010Inngår i: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 6, nr 5, s. 479-486Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Study Objectives:

    To evaluate the effects of a 2-year weight reduction program on respiratory disturbances, arousal index, daytime sleepiness, metabolic status, and quality of life in obese patients with obstructive sleep apnea syndrome (OSAS).

    Methods:

    Prospective intervention study of 33 consecutive obese OSAS patients (24 men, 9 women); 19 subjects used continuous positive airway pressure and 4 used mandibular retaining device, except during nights with sleep recording. The program consisted of 8 weeks of low calorie diet followed by group meetings with behavioral change support.

    Results:

    Seventy percent of the patients completed the program; 67% completed the sleep recordings. The success rate for the apnea-hypopnea index (AHI) (< 20 and reduction ≥ 50%) was 15% in the intention to treat (ITT) analysis. The AHI showed a nonsignificant decrease in mean values, from 43 to 28. The oxygen desaturation index (ODI) decreased from 42 to 23 (p = 0.010), arousal index from 24 to 11 (p = 0.019), body mass index from 40 to 35 (p = 0.003) and the Epworth Sleepiness Scale (ESS) from 9 to 5 (p = 0.026), all ITT. Metabolic status, physical functioning, and vitality evaluations improved only in the per protocol analysis. Reduction in weight correlated significantly to reductions in ESS (p = 0.038) and insulin levels (p = 0.002), respectively. There were no differences based on gender or use/non-use of OSAS treatment device.

    Conclusions:

    Our weight reduction program showed a limited success in reducing AHI. However, there were significant improvements in weight, ODI, arousal index, and subjective symptoms. We recommend the program as an adjunct treatment for well-motivated obese OSAS patients.

    Citation:

    Nerfeldt P; Nilsson BY; Mayor L; Uddén J; Friberg D. A two-year weight reduction program in obese sleep apnea patients. J Clin Sleep Med 2010;6(5):479-486.

    Keywords: Sleep apnea, obesity, weight reduction, diet, quality of life, sleepiness, behavioral therapy

  • 169. P, Nerfeldt
    et al.
    BY, Nilsson
    L, Mayor
    J, Uddén
    S, Rössner
    Friberg, Danielle
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Weight reduction improves sleep, sleepiness and metabolic status in obese sleep apnoea patients.2008Inngår i: Obesity Research and Clinical Practice, ISSN 1871-403X, E-ISSN 1878-0318, Vol. 2, nr 4, s. 251-262Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Method

    In this prospective intervention study, 33 obese patients with obstructive sleep apnoea syndrome (OSAS) (24 men, 9 women) were consecutively enrolled for a weight reduction program at the Obesity Unit, Karolinska University Hospital. 23 of 33 patients used OSAS-device, 19 with Continuous Positive Airway Pressure and 4 with Mandibular Retaining Device. The patients were investigated with questionnaires, blood tests and ambulant nocturnal polysomnography before and after a 6-month program. Patients with OSAS-device slept without it during the sleep studies. The intervention consisted of 8 weeks low calorie diet and group meetings, followed by a day-care program of behaviour change support.

    Results

    27 of 33 patients (82%, 21 men and 6 women) completed the study. After the intervention there were highly significant decreases (p < 0.001) in Body Mass Index from mean(S.D.) 40(5) to 34(3), apnoea–hypopnoea index from 43(24) to 26(20) and Epworth Sleepiness Scale (ESS)-score from 9(4) to 6(4). Sleep quality (arousal index, sleep efficiency, percentage deep sleep) and metabolic status (blood pressure, blood glucose levels, lipidemia) were also significantly improved. There was a significant correlation between increased percentage deep sleep and reduced ESS-score. There were no differences due to gender or use/no use of OSAS-device.

    Conclusion

    The results suggest that weight loss, induced by low calorie diet and behaviour change support, significantly improves nocturnal respiratory parameters, sleep quality, daytime sleepiness and metabolic status in obese OSAS patients after 6 months.

  • 170. P, Nerfeldt
    et al.
    F, Aoki
    Friberg, Danielle
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Polygraphy vs. polysomnography: missing osas in symptomatic snorers–a reminder for clinicians2014Inngår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709Artikkel i tidsskrift (Fagfellevurdert)
  • 171. P, Nerfeldt
    et al.
    Friberg, Danielle
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Effectiveness of Oral Appliances in Obstructive Sleep Apnea with Respiratory Arousals2016Inngår i: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 15, nr 2Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Study Objectives

    To compare adherence and treatment effects with an oral appliance (OA) in patients with different types of obstructive sleep apnea (OSA): those with mainly respiratory arousals (“arousers”), and those with oxygen desaturations (“desaturaters”) at polysomnography (PSG).

    Methods

    A prospective intervention study on 72 “tired snorers” with “normal” home sleep study (HSS), but later diagnosed as OSA with PSG, who accepted OA treatment. They were offered evaluation with a follow-up PSG and questionnaires, including the Epworth Sleepiness Scale (ESS), general health (GH), satisfaction, and side effects.

    Results

    Sixty-six patients, 33 arousers and 33 desaturaters, were adapted to OA. The 1-year adherence rate was significantly higher among arousers (85%) than desaturaters (55%) (p = 0.034). Thirty-six of 66 patients underwent follow-up PSG; the apnea-hypopnea index was significantly reduced in 22 arousers from a median of 14 to 3 (p < 0.001), and in 14 desaturaters from 18 to 7 (p = 0.002; no significant group difference). ESS and GH showed no significant improvements in either group, although sleepy “arousers” (ESS ≥ 10) significantly improved their ESS. In total, 77% reported side effects, while 63% were still satisfied with the OA treatment. Gender analysis showed a significant dominance of females classified as “arousers” (p = 0.025).

    Conclusions

    OSA patients with mainly arousals at PSG showed higher adherence to OA treatment, compared to patients with desaturations. Both groups responded similarly to treatment: improved nocturnal respiration, but only a small reduction of symptoms. We suggest that “tired snorers” with “normal HSS” should be offered PSG, and if OSA, also OA treatment.

  • 172. P, Nerfeldt
    et al.
    P, Graf
    S, Borg
    Friberg, Danielle
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Prevalence of high alcohol and benzodiazepine consumption in sleep apnea patients studied with blood and urine tests.2004Inngår i: Acta oto-laryngologicaArtikkel i tidsskrift (Fagfellevurdert)
  • 173.
    Peacock, John
    et al.
    Univ Antwerp, Lab Biomed Phys, Groenenborgerlaan 171, B-2020 Antwerp, Belgium..
    Dirckx, Joris
    Univ Antwerp, Lab Biomed Phys, Groenenborgerlaan 171, B-2020 Antwerp, Belgium..
    von Unge, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Akershus Univ Hosp, Dept Otorhinolaryngol, Oslo, Norway.;Univ Oslo, Oslo, Norway..
    Intraoperative assessment of ossicular fixation2016Inngår i: Hearing Research, ISSN 0378-5955, E-ISSN 1878-5891, Vol. 340, s. 99-106Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Determining the degree of ossicular fixation is a difficult task, with the final assessment often being made with manual palpation during exploratory tympanotomy. A more objective method to evaluate ossicular fixation would be valuable. In this paper we describe a new method which makes use of a magnet and coil to measure ossicular motion through the ear canal with an elevated tympanic membrane. We report measurements of the vibration response at the umbo, the tip of the incus long process and the lateral posterior crus of the stapes before and after artificially fixing the stapes footplate and anterior mallear ligament with luting cement. Results were obtained on temporal bones, but the practicality of the method allows easy clinical implementation. Velocity ratios between different measurement points along the ossicular chain may provide a quantitative indication of the degree of stapes fixation. Isolated anterior mallear ligament fixation was not distinguishable from the unfixed condition.

  • 174.
    Peacock, John
    et al.
    Univ Antwerp, Lab Biomed Phys, B-2020 Antwerp, Belgium..
    Dirckx, Joris
    Univ Antwerp, Lab Biomed Phys, B-2020 Antwerp, Belgium..
    Von Unge, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Aker Univ Hosp, Dept Otorhinolaryngol, Oslo, Norway.;Univ Oslo, Oslo, Norway..
    Towards quantitative diagnosis of ossicular fixation: Measurement of stapes fixations using magnetically driven ossicles in human temporal bones2015Inngår i: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 135, nr 9, s. 880-885Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Conclusion: Information on the degree of stapes fixation can be found by measuring the ratio of stapes to umbo and stapes to incus velocity. Objectives: To evaluate a method of quantifying ossicular fixation in an ear with elevated tympanic membrane. Method: Measurements were made on four fresh-frozen human temporal bones. After elevating the tympanic membrane, a small magnet was attached to the manubrium and an electromagnetic excitation coil was used to vibrate the ossicles. The vibration response of the umbo, the tip of the incus long process, and the posterior crus of the stapes were measured before and after partially fixing the footplate with luting cement. Results: The velocities at the different measurement points were unequally affected by the fixation. The difference in the velocity ratio between different points provides an indication of the degree of footplate fixation.

  • 175.
    Pierre, Pernilla Videhult
    et al.
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Audiol, Stockholm, Sweden.
    Fransson, Anette
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Kisiel, Marta Alina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Damberg, Peter
    Karolinska Univ Hosp, Karolinska Expt Res & Imaging Ctr, Stockholm, Sweden.
    Aski, Sahar Nikkhou
    Karolinska Univ Hosp, Karolinska Expt Res & Imaging Ctr, Stockholm, Sweden.
    Andersson, Mats
    RISE Res Inst Sweden, Div Biosci & Mat, Sodertalje, Sweden.
    Hallgren, Lotta
    RISE Res Inst Sweden, Div Biosci & Mat, Sodertalje, Sweden.
    Laurell, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Middle Ear Administration of a Particulate Chitosan Gel in an in vivo Model of Cisplatin Ototoxicity2019Inngår i: Frontiers in Cellular Neuroscience, ISSN 1662-5102, E-ISSN 1662-5102, Vol. 13, artikkel-id 268Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Middle ear (intratympanic, IT) administration is a promising therapeutic method as it offers the possibility of achieving high inner ear drug concentrations with low systemic levels, thus minimizing the risk of systemic side effects and drug-drug interactions. Premature elimination through the Eustachian tube may be reduced by stabilizing drug solutions with a hydrogel, but this raises the secondary issue of conductive hearing loss. Aim: This study aimed to investigate the properties of a chitosan-based particulate hydrogel formulation when used as a drug carrier for IT administration in an in vivo model of ototoxicity. Materials and Methods: Two particulate chitosan-based IT delivery systems, Thio-25 and Thio-40, were investigated in albino guinea pigs (n = 94). Both contained the hearing protecting drug candidate sodium thiosulfate with different concentrations of chitosan gel particles (25% vs. 40%). The safety of the two systems was explored in vivo. The most promising system was then tested in guinea pigs subjected to a single intravenous injection with the anticancer drug cisplatin (8 mg/kg b.w.), which has ototoxic side effects. Hearing status was evaluated with acoustically evoked frequency-specific auditory brainstem response (ABR) and hair cell counting. Finally, in vivo magnetic resonance imaging was used to study the distribution and elimination of the chitosan-based system from the middle ear cavity in comparison to a hyaluronan-based system. Results: Both chitosan-based IT delivery systems caused ABR threshold elevations (p < 0.05) that remained after 10 days (p < 0.05) without evidence of hair cell loss, although the elevation induced by Thio-25 was significantly lower than for Thio-40 (p < 0.05). Thio-25 significantly reduced cisplatin-induced ABR threshold elevations (p < 0.05) and outer hair cell loss (p < 0.05). IT injection of the chitosan- and hyaluronan-based systems filled up most of the middle ear space. There were no significant differences between the systems in terms of distribution and elimination. Conclusion: Particulate chitosan is a promising drug carrier for IT administration. Future studies should assess whether the physical properties of this technique allow for a smaller injection volume that would reduce conductive hearing loss.

  • 176.
    Pierre, Pernilla Videhult
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Johnson, Ann-Christin
    Fridberger, Anders
    Subjective and Clinically Assessed Hearing Loss; A Cross-Sectional Register-Based Study on a Swedish Population Aged 18 through 50 Years2015Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, nr 4Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives Questionnaire studies suggest that hearing is declining among young adults. However, few studies have examined the reliability of hearing questionnaires among young adult subjects. This study examined the associations between pure tone audiometrically assessed (PTA) hearing loss and questionnaire responses in young to middle aged adults. Materials and Methods A cross-sectional study using questionnaire and screening PTA (500 through 6000 Hz) data from 15322 Swedish subjects (62% women) aged 18 through 50 years. PTA hearing loss was defined as a hearing threshold above 20 dB in both ears at one or more frequencies. Data were analysed with chi-square tests, nonlinear regression, binary logistic regression, and the generalized estimating equation (GEE) approach. Results The prevalence of PTA hearing loss was 6.0% in men and 2.9% in women (p < 0.001). Slight hearing impairment was reported by 18.5% of the men and 14.8% of the women (p < 0.001), whereas 0.5% of men and women reported very impaired hearing. Using multivariate GEE modelling, the odds ratio of PTA hearing loss was 30.4 (95% CI, 12.7-72.9) in men and 36.5 (17.2-77.3) in women reporting very impaired hearing. The corresponding figures in those reporting slightly impaired hearing were 7.06 (5.25-9.49) in men and 8.99 (6.38-12.7) in women. These values depended on the sound stimulus frequency (p = 0.001). The area under the ROC curve was 0.904 (0.892-0.915) in men and 0.886 (0.872-0.900) in women. Conclusions Subjective hearing impairment predicted clinically assessed hearing loss, suggesting that there is cause for concern as regards the future development of hearing in young to middle-aged people.

  • 177.
    Pirttilä, Kristian
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för läkemedelskemi, Analytisk farmaceutisk kemi.
    Pierre, Pernilla Videhult
    Karolinska Inst, Div Audiol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.
    Haglöf, Jakob
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för läkemedelskemi, Analytisk farmaceutisk kemi.
    Engskog, Mikael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för läkemedelskemi, Analytisk farmaceutisk kemi.
    Hedeland, Mikael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för läkemedelskemi, Analytisk farmaceutisk kemi.
    Laurell, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Arvidsson, Torbjörn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för läkemedelskemi, Analytisk farmaceutisk kemi.
    Pettersson, Curt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för läkemedelskemi, Analytisk farmaceutisk kemi.
    An LCMS-based untargeted metabolomics protocol for cochlear perilymph: highlighting metabolic effects of hydrogen gas on the inner ear of noise exposed Guinea pigs2019Inngår i: Metabolomics, ISSN 1573-3882, E-ISSN 1573-3890, Vol. 15, nr 10, artikkel-id 138Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction

    Noise-induced hearing loss (NIHL) is an increasing problem in society and accounts for a third of all cases of acquired hearing loss. NIHL is caused by formation of reactive oxygen species (ROS) in the cochlea causing oxidative stress. Hydrogen gas (H-2) can alleviate the damage caused by oxidative stress and can be easily administered through inhalation.

    Objectives

    To present a protocol for untargeted metabolomics of guinea pig perilymph and investigate the effect of H-2 administration on the perilymph metabolome of noise exposed guinea pigs.

    Methods

    The left ear of guinea pigs were exposed to hazardous impulse noise only (Noise, n = 10), noise and H-2 (Noise + H2, n = 10), only H-2 (H2, n = 4), or untreated (Control, n = 2). Scala tympani perilymph was sampled from the cochlea of both ears. The polar component of the perilymph metabolome was analyzed using a HILIC-UHPLC-Q-TOF-MS-based untargeted metabolomics protocol. Multivariate data analysis (MVDA) was performed separately for the exposed- and unexposed ear.

    Results

    MVDA allowed separation of groups Noise and Noise + H2 in both the exposed and unexposed ear and yielded 15 metabolites with differentiating relative abundances. Seven were found in both exposed and unexposed ear data and included two osmoprotectants. Eight metabolites were unique to the unexposed ear and included a number of short-chain acylcarnitines.

    Conclusions

    A HILIC-UHPLC-Q-TOF-MS-based protocol for untargeted metabolomics of perilymph is presented and shown to be fit-for-purpose. We found a clear difference in the perilymph metabolome of noise exposed guinea pigs with and without H-2 treatment.

  • 178.
    Popa, Raul
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Nitric Oxide in the Inner Ear with Particular Regard to Neurotansmission and Pharmacotherapy2002Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Research into nitric oxide (NO) in the inner ear has expanded explosively during recent years. There is evidence that NO is present in the various cochlear structures and its action is involved in physiological mechanisms, such as neurotransmission, and in pathological processes, e.g. ototoxicity. In order to obtain more data, sections of human cochlea were studied with immunostaining, using monoclonal antibodies to nitric oxide synthase (NOS) isoforms. Both constitutive NOS isoforms (I and III) were detected, but the predominant isoform was the neural type NOS I. Greatest affinity for NOS I was located in spiral ganglion (SG) cells and adjacent nerve fibres. The results imply that NO in the human cochlea could act as neurotransmitter. In the human inner ear, it has also been identified nicotinic acetylcholine receptors (n-ACh-r) by studying localization and distribution of α and β subunits. Both subunits were identified on SG cells, adjacent nerve fibres and in vestibular hair cells. It would appear that the subunits form an active complex at the level of these structures. Differences in the staining of β subunits at the level of the outer hair cells (OHC) suggest that different rows of OHCs could participate to different degrees in the function of n-ACh-r of the cochlea.

    The animal experiments were been designed to obtain information about NO involvement in the pathological mechanism of hearing impairment and to study the protection afforded by various drugs against damage to the inner ear associated with NO. The results of our investigations have demonstrated that NO produced by cNOS may mediate neurotoxicity in the inner ear early in the pathological process, whereas NO from inducible NOS may contribute by its cytotoxicity to the late phase of tissue damage in the inner ear. Analyses of the pharmacological effects of different drugs have shown that inhibitors of NO production and glutamate overproduction, as well as reactive oxygen species scavengers, could effectively protect the inner ear from injury caused by various pathological agents.

  • 179.
    Rask-Andersen, Helge
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Li, Hao
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Löwenheim, Hubert
    Med Univ Innsbruck, Dept Otolaryngol, Innsbruck, Austria.;Med Campus Univ Oldenburg Sch Med & Hlth Sci, European Med Sch, Oldenburg, Germany.;Carl von Ossietzky Univ Oldenburg, Res Ctr Neurosensory Sci, Oldenburg, Germany.;Eberhard Karls Univ Tubingen, Tubingen Hearing Res Ctr, Dept Otolaryngol Head & Neck Surg, DE-72076 Tubingen, Germany..
    Mueller, Marcus
    Med Univ Innsbruck, Dept Otolaryngol, Innsbruck, Austria.;Med Campus Univ Oldenburg Sch Med & Hlth Sci, European Med Sch, Oldenburg, Germany.;Carl von Ossietzky Univ Oldenburg, Res Ctr Neurosensory Sci, Oldenburg, Germany.;Eberhard Karls Univ Tubingen, Tubingen Hearing Res Ctr, Dept Otolaryngol Head & Neck Surg, DE-72076 Tubingen, Germany..
    Pfaller, Kristian
    Carl von Ossietzky Univ Oldenburg, Cluster Excellence Hearing4all, Oldenburg, Germany..
    Schrott-Fischer, Annelies
    Med Univ Innsbruck, Inst Anat & Histol, Dept Histol & Mol Cell Biol, Innsbruck, Austria..
    Glueckert, Rudolf
    Med Univ Innsbruck, Inst Anat & Histol, Dept Histol & Mol Cell Biol, Innsbruck, Austria..
    Supernumerary human hair cells-signs of regeneration or impaired development?: A field emission scanning electron microscopy study2017Inngår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, nr 1, s. 11-19Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Current attempts to regenerate cochlear sensorineural structures motivate further inspection of the human organ of hearing. Here, we analyzed the supernumerary inner hair cell (sIHC), a possible sign of regeneration and cell replacement. Methods: Human cochleae were studied using field emission scanning electron microscopy (FESEM; maximum resolution 2 nm) obtained from individuals aged 44, 48, and 58 years with normal sensorineural pure-tone average (PTA) thresholds (PTA < 20 dB). The wasted tissue was harvested during trans-cochlear approaches and immediately fixed for ultrastructural analysis. Results: All specimens exhibited sIHCs at all turns except at the extreme lower basal turn. In one specimen, it was possible to image and count the inner hair cells (IHCs) along the cochlea representing the 0.2 kHz-8 kHz region according to the Greenwood place/frequency scale. In a region with 2,321 IHCs, there were 120 scattered one-cell losses or 'gaps' (5%). Forty-two sIHCs were present facing the modiolus. Thirty-eight percent of the sIHCs were located near a 'gap' in the IHC row (+/- 6 IHCs). Conclusions: The prevalence of ectopic inner hair cells was higher than expected. The morphology and placement could reflect a certain ongoing regeneration. Further molecular studies are needed to verify if the regenerative capacity of the human auditory periphery might have been underestimated.

  • 180.
    Rask-Andersen, Helge
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Schart-Moren, Nadine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Strömbäck, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Linthicum, Fred
    Univ Calif Los Angeles, David Gefin Sch Med, Dept Head & Neck Surg, 1000 Vet Ave,Room 32-28, Los Angeles, CA 90024 USA.
    Li, Hao
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Special Anatomic Considerations in Otosclerosis Surgery2018Inngår i: Otolaryngologic clinics of North America, ISSN 0030-6665, E-ISSN 1557-8259, Vol. 51, nr 2, s. 357-+Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The anatomy of the vestibular organs together with considerations of the middle and inner ear anatomy relevant to stapes surgery is discussed. An archival collection of macerated and freshly frozen human temporal bones underwent micro computed tomography (CT) with subsequent volume rendering. Three-dimensional (3D) reconstructions and the topographic anatomy of the oval window were considered. Micro-CT and 3D rendering revealed the relationship between the otolith organs and the oval window. Anatomic variations were extensive and included the distance between the footplate and the reconstructed macula margins. A "no-go" zone is suggested for the surgeon to avoid injury during stapes surgery.

  • 181. Rasmussen, Eva Rye
    et al.
    von Buchwald, Christian
    Wadelius, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakogenomik och osteoporos. Uppsala universitet, Science for Life Laboratory, SciLifeLab.
    Prasad, Sumangali Chandra
    Kamaleswaran, Shailajah
    Ajgeiy, Kawa Khaled
    Authried, Georg
    Pallesen, Kristine Appel U
    Bygum, Anette
    Assessment of 105 Patients with Angiotensin Converting Enzyme-Inhibitor Induced Angioedema2017Inngår i: International Journal of Otolaryngology, ISSN 1687-9201, E-ISSN 1687-921X, Vol. 2017, artikkel-id 1476402Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To asses a cohort of 105 consecutive patients with angiotensin converting enzyme-inhibitor induced angioedema withregard to demographics, risk factors, family history of angioedema, hospitalization, airway management, outcome, and use ofdiagnostic codes used for the condition.

    Study Design. Cohort study.

    Methods.This was a retrospective cohort study of 105 patientswith angiotensin converting enzyme-inhibitor induced angioedema in the period 1995–2014.

    Results. The cohort consisted of 67females and 38 males (F :Mratio 1.8), with a mean age of 63 [range 26–86] years. Female gender was associated with a significantlyhigher risk of angiotensin converting enzyme-inhibitor induced angioedema. 6.7% had a positive family history of angioedema.Diabetes seemed to be a protective factor with regard to angioedema. 95% experienced angioedema of the head and neck. 4.7%needed intubation or tracheostomy. 74 admissions took place during the study period with a total of 143 days spent in the hospital.The diagnosis codes most often used for this condition were “DT783 Quincke’s oedema” and “DT78.4 Allergy unspecified”.Complement C1 inhibitor was normal in all tested patients.

    Conclusion. Female gender predisposes to angiotensin convertingenzyme-inhibitor induced angioedema, whereas diabetes seems to be a protective factor.

  • 182.
    Salander, Pär
    et al.
    Umea Univ, Dept Social Work, S-90187 Umea, Sweden..
    Isaksson, Joakim
    Umea Univ, Dept Social Work, S-90187 Umea, Sweden..
    Granström, Brith
    Umea Univ, Dept Clin Sci Otorhinolaryngol, Umea, Sweden..
    Laurell, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar. Uppsala Univ, Dept Surg Sci Otolaryngol & Head & Neck Surg, Uppsala, Sweden..
    Motives that head and neck cancer patients have for contacting a specialist nurse - an empirical study2016Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, nr 21-22, s. 3160-3166Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims and objectives. The purpose of this study is to systematically explore the motives for patients with head and neck cancer to contact a specialist nurse during two years postdiagnosis. Background. Research focusing on the role of specialist nurses in cancer care almost exclusively concern cancers other than head and neck cancer. Design. Qualitative, descriptive study based on the contacts between patients with head and neck cancer and a specialist nurse. Methods. Patients were invited to contact a specialist nurse by telephone. The specialist nurse took systematic field notes, that is, she registered who contacted her, the nature of the call and the outcome. Sixty patients were included. Results. In descending order, the motives for contact were questions about practical and uncomplicated matters, consultations about medical troubles/worries, presenting a report of the patient's situation, requests for additional information about the treatment plan and requests for medical information. The pattern of the patients' motivations for calling was not related to medical or social factors, suggesting that the initiative to make contact is very much a question of the complexity of individual life circumstances. Very few referrals were sent from the specialist nurse to other professionals. Conclusions. The specialist nurse turned out to be more than just a coordinator of health-care resources. The findings bring up questions about the potential of the nurse's function as a coordinator, but also as a potential attachment figure, and questions about the nurse's relationships to other professionals. Relevance to clinical practice. When implementing a specialist nurse function, it is important to decide whether the function should be inspired by a broader relational perspective. In addition to the indispensible competence and experience in the clinical field of head and neck cancer, training in counselling and acquaintance with object-relational psychology will then be desirable.

  • 183.
    Sandström, Karl
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Haylock, Anna-Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Spiegelberg, Diana
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för biomedicinsk strålningsvetenskap.
    Qvarnström, Fredrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för onkologi.
    Wester, Kenneth
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Molekylär och morfologisk patologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för biomedicinsk strålningsvetenskap.
    Nestor, Marika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för biomedicinsk strålningsvetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    A novel CD44v6 targeting antibody fragment with improved tumor-to-blood ratio2012Inngår i: International Journal of Oncology, ISSN 1019-6439, Vol. 40, nr 5, s. 1525-1532Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The chimeric monoclonal antibody U36 (cMAb U36) recognizes the CD44v6 antigen. Its potential as a radioimmunotargeting agent, as well as its safety, has been shown in previous studies in head and neck cancer patients. However, intact MAbs have long circulation time in the blood and tumor targeting may also be hampered due to the slow and incomplete diffusion into solid tumors. In comparison, smaller monovalent Fab' and divalent F(ab')2 fragments are expected to exhibit shorter circulating half-lives, better tumor penetration and are thus more likely to yield better imaging results. In this study, novel F(ab')2 and Fab' fragments from cMAb U36 were radiolabeled with 125I and the characteristics of the conjugates in vitro were examined. The biodistribution of the conjugates were then evaluated in nude mice bearing CD44v6-expressing xenograft tumors. Furthermore, the penetration depth and distribution in tumor tissue was assessed by autoradiography in selected tumor samples. The in vitro experiments showed that the conjugates were stable and had intact affinity to CD44v6. The biodistribution study demonstrated superior tumor-to-blood ratio for the novel cMAb U36 fragment 125I-F(ab')2 compared with both the intact MAb and the monovalent fragment form. Autoradiography also revealed better tumor penetration for 125I-F(ab')2. This study demonstrates that the use of antibody fragments may improve radioimmunotargeting and possibly improve the management of head and neck malignancies.

  • 184.
    Santi, Peter A.
    et al.
    Univ Minnesota, Dept Otolaryngol, Lions Res Bldg 2001 Sixth St,SE, Minneapolis, MN 55455 USA..
    Aldaya, Robair
    Univ Minnesota, Dept Otolaryngol, Lions Res Bldg 2001 Sixth St,SE, Minneapolis, MN 55455 USA..
    Brown, Alec
    Univ Minnesota, Dept Otolaryngol, Lions Res Bldg 2001 Sixth St,SE, Minneapolis, MN 55455 USA..
    Johnson, Shane
    Univ Minnesota, Dept Otolaryngol, Lions Res Bldg 2001 Sixth St,SE, Minneapolis, MN 55455 USA..
    Stromback, Tyler
    Univ Minnesota, Dept Otolaryngol, Lions Res Bldg 2001 Sixth St,SE, Minneapolis, MN 55455 USA..
    Cureoglu, Sebahattin
    Univ Minnesota, Dept Otolaryngol, Lions Res Bldg 2001 Sixth St,SE, Minneapolis, MN 55455 USA..
    Rask-Andersen, Helge
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Scanning Electron Microscopic Examination of the Extracellular Matrix in the Decellularized Mouse and Human Cochlea2016Inngår i: Journal of the Association for Research in Otolaryngology, ISSN 1525-3961, E-ISSN 1438-7573, Vol. 17, nr 3, s. 159-171Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Decellularized tissues have been used to investigate the extracellular matrix (ECM) in a number of different tissues and species. Santi and Johnson JARO 14: 3-15 (2013) first described the decellularized inner ear in the mouse, rat, and human using scanning thin-sheet laser imaging microscopy (sTSLIM). The purpose of the present investigation is to examine decellularized cochleas in the mouse and human at higher resolution using scanning electron microscopy (SEM). Fresh cochleas were harvested and decellularized using detergent extraction methods. Following decellularization, the ECM of the bone, basilar membrane, spiral limbus, and ligament remained, and all of the cells were removed from the cochlea. A number of similarities and differences in the ECM of the mouse and human were observed. A novel, spirally directed structure was present on the basilar membrane and is located at the border between Hensen and Boettcher cells. These septa-like structures formed a single row in the mouse and multiple rows in the human. The basal lamina of the stria vascularis capillaries was present and appeared thicker in the human compared with the mouse. In the mouse, numerous openings beneath the spiral prominence that previously housed the root processes of the external sulcus cells were observed but in the human there was only a single row of openings. These and other anatomical differences in the ECM between the mouse and human may reflect functional differences and/or be due to aging; however, decellularized cochleas provide a new way to examine the cochlear ECM and reveal new observations.

  • 185.
    Schart-Moren, Nadine
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Agrawal, Sumit K
    Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada.
    Ladak, Hanif M
    Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada.
    Li, Hao
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Rask-Andersen, Helge
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Effects of Various Trajectories on Tissue Preservation in Cochlear Implant Surgery: A Micro-Computed Tomography and Synchrotron Radiation Phase-Contrast Imaging Study2019Inngår i: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 40, nr 2, s. 393-400Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES:

    The purpose of this study was to evaluate the three-dimensional (3D) anatomy and potential damage to the hook region of the human cochlea following various trajectories at cochlear implantation (CI). The goal was to determine which of the approaches can avoid lesions to the soft tissues, including the basilar membrane and its suspension to the lateral wall. Currently, there is increased emphasis on conservation of inner ear structures, even in nonhearing preservation CI surgery.

    DESIGN:

    Micro-computed tomography and various CI approaches were made in an archival collection of macerated and freshly fixed human temporal bones. Furthermore, synchrotron radiation phase-contrast imaging was used to reproduce the soft tissues. The 3D anatomy was investigated using bony and soft tissue algorithms, and influences on inner ear structures were examined.

    RESULTS:

    Micro-computed tomography with 3D rendering demonstrated the topography of the round window (RW) and osseous spiral laminae, while synchrotron imaging allowed reproduction of soft tissues such as the basilar membrane and its suspension around the RW membrane. Anterior cochleostomies and anteroinferior cochleostomies invariably damaged the intracochlear soft tissues while inferior cochleostomies sporadically left inner ear structures unaffected.

    CONCLUSIONS:

    Results suggest that cochleostomy approaches often traumatize the soft tissues at the hook region at CI surgery. For optimal structural preservation, the RW approach is, therefore, recommended.

  • 186.
    Schart-Moren, Nadine
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Hallin, Karin
    Agrawal, Sumit K
    Ladak, Hanif M
    Eriksson, Per-Olof
    Li, Hao
    Rask-Andersen, Helge
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Peri-operative electrically evoked auditory brainstem response assessment of facial nerve/cochlea interaction at cochlear implantation2018Inngår i: Cochlear Implants International, ISSN 1467-0100, E-ISSN 1754-7628, Vol. 19, nr 6, s. 324-329Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: Dehiscence between the cochlear otic capsule and the facial nerve canal is a rare and relatively newly described pathology. In cochlear implantation (CI), this dehiscence may lead to adverse electric facial nerve stimulation (FNS) already at low levels, rendering its use impossible. Here, we describe an assessment technique to foresee this complication.

    METHODS: Pre- and postoperative computed tomography (CT) scans and intraoperative electrically evoked auditory brainstem response (e-ABR) measurements were analyzed in two patients with cochlear-facial dehiscence (CFD).

    RESULTS: Because of the relatively low resolution, the confirmation of CFD with a clinical CT was difficult. The e-ABR displayed a large potential with 6 and 7.5 ms latency, respectively, which did not occur otherwise.

    DISCUSSION: Potential strategies to resolve and manage FNS are described.

    CONCLUSION: Prediction of FNS by assessing the distance between the labyrinthine portion of the facial nerve and the cochlea is difficult using conventional CT scans. A large evoked late myogenic potential at low stimulation levels during intraoperative e-ABR measurement may foresee FNS at CI activation.

  • 187.
    Schart-Moren, Nadine
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar. Uppsala Univ, Uppsala Univ Hosp, Dept Head & Neck Surg, Uppsala, Sweden..
    Mannström, Paula
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Rask-Andersen, Helge
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar. Uppsala Univ, Uppsala Univ Hosp, Dept Head & Neck Surg, Uppsala, Sweden..
    von Unge, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Univ Oslo, Akershus Univ Hosp, Dept ENT, Oslo, Norway..
    Effects of mechanical trauma to the human tympanic membrane: an experimental study using transmission electron microscopy2017Inngår i: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 137, nr 9, s. 928-934Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Hypothesis: To examine the cellular events following induced superficial lesions of the human tympanic membrane (TM). Such information could lead to enhanced appreciation of repair mechanisms and novel strategies to restore TM perforations. Background: Persistent perforation of the TM in chronic otitis media is a major global health problem and frequently necessitates surgical intervention. Most TM perforations heal spontaneously and swiftly, but sometimes healing fails. The underlying mechanisms and the reason for incomplete repair are often elusive, although some mechanisms have been proposed. Methods: Here, five healthy adult human TMs were sampled during vestibular schwannoma surgery. Three days before harvesting, three TMs were superficially lesioned, including the epithelial and sub-epithelial layers, using a needle and two TMs served as controls. Light and transmission electron microscopy were performed. Results: Surrounding lesion showed distinct ultrastructural changes. This included a keratinocyte frontier with electron-dense cells with abundant ribosomes and nuclei metamorphosis. Beneath, were activated fibroblasts and invaded/transformed free cells and signs of increased transcellular activity of adjacent blood vessels. Conclusions: The study describes dynamic morphological events of a human lesioned TM. The human model may be used for further investigations and understanding of TM healing mechanisms.

  • 188.
    Schart-Morén, Nadine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    The Human Cochlea and Cochlear Implantation: Morphological Characteristics and Clinical Correlations2018Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The most common sensory deficit in the world is sensorineural hearing loss. Cochlear implantation (CI) can majorly contribute to restore hearing, not only in patients with severe to profound hearing loss, but also in hearing-impaired patients with residual low-frequency hearing. The overall aims of the present thesis were to study human cochlear anatomy in order to improve structural preservation during CI surgery. An archival collection of temporal bones underwent micro-computer tomography and synchrotron radiation phase-contrast imaging (SR-PCI) with 3D reconstructions, new techniques to digitally image and reproduce the human inner ear. Studying the anatomy of the facial nerve and its interaction with the cochlea revealed that a fusion of the two was found in 1.4 % of the specimens (cochlear-facial dehiscence). This may cause facial nerve excitation after CI. CT-scans and intraoperative electrically auditory brainstem response (e-ABR) measurements were analyzed in patients with cochlear-facial dehiscence. A large evoked late myogenic potential at low stimulation levels during intraoperative e-ABR measurements, can foresee excitation at CI activation. The 3D anatomy of the fundus of the inner acoustic canal was also studied, helping to interpret preoperative imaging of the VIIIth nerve before CI. In a subsequent study, SR-PCI reproduced the soft tissue anatomy at the round window region. Results indicated a high risk for trauma at cochleostomy. For optimal preservation, the round window approach was recommended. In a long-term follow-up the first 21 consecutively operated patients in Uppsala, that underwent hearing preservation CI-surgery, data could be retrieved in 15 patients. Pure tone audiometry was assessed preoperatively and at one, three and >5 years following surgery. Insertion angle, number of electrodes inside the cochlea, user-time of the processor, and stimulation strategies were documented. Results showed that long-term preservation of hearing is possible in most cases. There was a high correlation between insertion depth and preservation of residual hearing. Also, patients with complete hearing loss experienced good performance in speech discrimination and user time.

    Delarbeid
    1. Anatomical Characteristics of Facial Nerve and Cochlea Interaction
    Åpne denne publikasjonen i ny fane eller vindu >>Anatomical Characteristics of Facial Nerve and Cochlea Interaction
    2017 (engelsk)Inngår i: Audiology & neuro-otology, ISSN 1420-3030, E-ISSN 1421-9700, Vol. 22, nr 1, s. 41-49Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Objective: The aim was to study the relationship between the labyrinthine portion (LP) of the facial canal and the cochlea in human inner ear molds and temporal bones using micro-CT and 3D rendering. A reduced cochlea-facial distance may spread electric currents from the cochlear implant to the LP and cause facial nerve stimulation. Influencing factors may be the topographic anatomy and otic capsule properties.

    Methods: An archival collection of human temporal bones underwent micro-CT and 3D reconstruction. In addition, cochlea-facial distance was assessed in silicone and polyester resin molds, and the association between the LP and upper basal turn of the cochlea was analyzed.

    Results: Local thinning of the otic capsule and local anatomy may explain the development of cochlea-facial dehiscence, which was found in 1.4%. A reduced cochlea-facial distance was noted in 1 bone with a superior semicircular canal dehiscence but not in bones with superior semicircular canal "blue line." The otic capsule often impinged upon the LP and caused narrowing.

    Conclusion: Micro-CT with 3D rendering offers new possibilities to study the topographic anatomy of the human temporal bone. The varied shape of the cross-section of the LP could often be explained by an "intruding" cochlea.

    sted, utgiver, år, opplag, sider
    KARGER, 2017
    Emneord
    Human temporal bones, Cochlea, Facial canal, Micro-CT
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-333425 (URN)10.1159/000475876 (DOI)000406762600006 ()28628917 (PubMedID)
    Tilgjengelig fra: 2017-11-13 Laget: 2017-11-13 Sist oppdatert: 2019-01-27bibliografisk kontrollert
    2. Peri-operative electrically evoked auditory brainstem response assessment of facial nerve/cochlea interaction at cochlear implantation
    Åpne denne publikasjonen i ny fane eller vindu >>Peri-operative electrically evoked auditory brainstem response assessment of facial nerve/cochlea interaction at cochlear implantation
    Vise andre…
    2018 (engelsk)Inngår i: Cochlear Implants International, ISSN 1467-0100, E-ISSN 1754-7628, Vol. 19, nr 6, s. 324-329Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    OBJECTIVES: Dehiscence between the cochlear otic capsule and the facial nerve canal is a rare and relatively newly described pathology. In cochlear implantation (CI), this dehiscence may lead to adverse electric facial nerve stimulation (FNS) already at low levels, rendering its use impossible. Here, we describe an assessment technique to foresee this complication.

    METHODS: Pre- and postoperative computed tomography (CT) scans and intraoperative electrically evoked auditory brainstem response (e-ABR) measurements were analyzed in two patients with cochlear-facial dehiscence (CFD).

    RESULTS: Because of the relatively low resolution, the confirmation of CFD with a clinical CT was difficult. The e-ABR displayed a large potential with 6 and 7.5 ms latency, respectively, which did not occur otherwise.

    DISCUSSION: Potential strategies to resolve and manage FNS are described.

    CONCLUSION: Prediction of FNS by assessing the distance between the labyrinthine portion of the facial nerve and the cochlea is difficult using conventional CT scans. A large evoked late myogenic potential at low stimulation levels during intraoperative e-ABR measurement may foresee FNS at CI activation.

    Emneord
    Cochlea, Cochlear implantation, Dehiscence, Facial nerve stimulation
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-373491 (URN)10.1080/14670100.2018.1481179 (DOI)29877144 (PubMedID)
    Tilgjengelig fra: 2019-01-14 Laget: 2019-01-14 Sist oppdatert: 2019-05-27bibliografisk kontrollert
    3. Three-Dimensional Analysis of the Fundus of the Human Internal Acoustic Canal
    Åpne denne publikasjonen i ny fane eller vindu >>Three-Dimensional Analysis of the Fundus of the Human Internal Acoustic Canal
    2018 (engelsk)Inngår i: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 39, nr 3, s. 563-572Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Objectives: Documentation of the nerve components in the internal acoustic canal is essential before cochlea implantation surgery. Interpretations may be challenged by wide anatomical variations of the VIIIth nerve and their ramifications. Malformations may further defy proper nerve identification. Design: Using microcomputed tomography, we analyzed the fundus bone channels in an archival collection of 113 macerated human temporal bones and 325 plastic inner molds. Data were subsequently processed by volume-rendering software using a bony tissue algorithm. Three-dimensional reconstructions were made, and through orthogonal sections, the topographic anatomy was established. Results: The technique provided additional information regarding the anatomy of the nerve foramina/channels of the human fundus region, including variations and destinations. Channel anastomosis were found beyond the level of the fundus. A foramen of the transverse crest was identified. Conclusions: Three-dimensional reconstructions and cropping outlined the bone canals and demonstrated the highly variable VIIIth nerve anatomy at the fundus of the human inner acoustic canal. Myriad channel interconnections suggested an intricate system of neural interactive pathways in humans. Particularly striking was the variable anatomy of the saccule nerve channels. The results may assist in the preoperative interpretation of the VIIIth nerve anatomy.

    sted, utgiver, år, opplag, sider
    Lippincott Williams & Wilkins, 2018
    Emneord
    Human, Inner acoustic canal, Inner ear, Micro-CT
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-364017 (URN)10.1097/AUD.0000000000000510 (DOI)000442150400018 ()29117061 (PubMedID)
    Tilgjengelig fra: 2018-10-24 Laget: 2018-10-24 Sist oppdatert: 2019-01-27bibliografisk kontrollert
    4. Effects of Various Trajectories on Tissue Preservation in Cochlear Implant Surgery: A Micro-Computed Tomography and Synchrotron Radiation Phase-Contrast Imaging Study
    Åpne denne publikasjonen i ny fane eller vindu >>Effects of Various Trajectories on Tissue Preservation in Cochlear Implant Surgery: A Micro-Computed Tomography and Synchrotron Radiation Phase-Contrast Imaging Study
    Vise andre…
    2019 (engelsk)Inngår i: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 40, nr 2, s. 393-400Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    OBJECTIVES:

    The purpose of this study was to evaluate the three-dimensional (3D) anatomy and potential damage to the hook region of the human cochlea following various trajectories at cochlear implantation (CI). The goal was to determine which of the approaches can avoid lesions to the soft tissues, including the basilar membrane and its suspension to the lateral wall. Currently, there is increased emphasis on conservation of inner ear structures, even in nonhearing preservation CI surgery.

    DESIGN:

    Micro-computed tomography and various CI approaches were made in an archival collection of macerated and freshly fixed human temporal bones. Furthermore, synchrotron radiation phase-contrast imaging was used to reproduce the soft tissues. The 3D anatomy was investigated using bony and soft tissue algorithms, and influences on inner ear structures were examined.

    RESULTS:

    Micro-computed tomography with 3D rendering demonstrated the topography of the round window (RW) and osseous spiral laminae, while synchrotron imaging allowed reproduction of soft tissues such as the basilar membrane and its suspension around the RW membrane. Anterior cochleostomies and anteroinferior cochleostomies invariably damaged the intracochlear soft tissues while inferior cochleostomies sporadically left inner ear structures unaffected.

    CONCLUSIONS:

    Results suggest that cochleostomy approaches often traumatize the soft tissues at the hook region at CI surgery. For optimal structural preservation, the RW approach is, therefore, recommended.

    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-373492 (URN)10.1097/AUD.0000000000000624 (DOI)000459769700016 ()29952804 (PubMedID)
    Tilgjengelig fra: 2019-01-14 Laget: 2019-01-14 Sist oppdatert: 2019-06-19bibliografisk kontrollert
    5. Cochlear Implantation and Residual Hearing Preservation. Long-term Follow-up of the First Consecutively Operated Patients Using the Round Window Approach in Uppsala, Sweden.
    Åpne denne publikasjonen i ny fane eller vindu >>Cochlear Implantation and Residual Hearing Preservation. Long-term Follow-up of the First Consecutively Operated Patients Using the Round Window Approach in Uppsala, Sweden.
    (engelsk)Inngår i: Artikkel i tidsskrift (Fagfellevurdert) Submitted
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-373493 (URN)
    Tilgjengelig fra: 2019-01-14 Laget: 2019-01-14 Sist oppdatert: 2019-01-27
  • 189. Schart-Morén, Nadine
    et al.
    Erixon, Elsa
    Li, Hao
    Rask-Andersen, Helge
    Cochlear Implantation and Residual Hearing Preservation. Long-term Follow-up of the First Consecutively Operated Patients Using the Round Window Approach in Uppsala, Sweden.Inngår i: Artikkel i tidsskrift (Fagfellevurdert)
  • 190.
    Sedaghat Tellner, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Logopedi.
    Svensson, Ida
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Logopedi.
    Interaktion genom bildbaserad AKK vid autism.: En samtalsanalytisk fallstudie av hur kommunikativa projekt konstrueras genom samarbete mellan deltagarna.2009Independent thesis Advanced level (degree of Master (One Year)), 20 poäng / 30 hpOppgave
    Abstract [sv]

    I denna studie har vardaglig interaktion studerats utifrån ett dialogiskt perspektiv där en av samtalsdeltagarna är en ung man (M) med autism som använder alternativ ochkompletterande kommunikation (AKK). Studiens syfte var att undersöka hur kommunikativa projekt (t.ex. begäran av föremål eller aktiviteter) sekventiellt är konstruerade samt att synliggöra de sociala mönstren som bygger upp kommunikativa projekt vilka möjliggör för en person med autism att delta i en kommunikativ kontext genom bildanvändning och andra kommunikativa resurser. Analysen grundar sig på videoinspelat material av två kvällar då M filmades i sin hemmiljö. Conversation Analysis används som samtalsanalytiskt verktyg, vilket lämpar sig väl för att synliggöra kvalitativa samtalsfenomen. Den generella strukturen i de kommunikativa projekten har setts vara organiserade i tre faser. En prefas vilken består av handlingar där samtalspartnern guidar M till att uttrycka (oftast) en begäran explicit. Denna fas möjliggör för M att öppna upp ett kommunikativt projekt. I huvudfasen samkonstrueras en explicit begäran av deltagarna genom att den talande parten sätter ord på M´s icke verbala uttryck. Avslutningsvis består postfasen av bekräftande och avslutande handlingar. Denna studie visar att deltagarna bygger upp de kommunikativa projekten genom ömsesidiga och samarbetande handlingar som, förutom det kommunikativa projektets funktion, i sig är värdefulla för deltagarna.

  • 191. Selassie, G Rejnö-Habte
    et al.
    Viggedal, G
    Olsson, I
    Jennische, M
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Logopedi.
    Speech, language, and cognition in preschool children with epilepsy2008Inngår i: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 50, nr 6, s. 432-438Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We studied expressive and receptive language, oral motor ability, attention, memory, and intelligence in 20 6-year-old children with epilepsy (14 females, six males; mean age 6y 5mo, range 6y-6y 11mo) without learning disability, cerebral palsy (CP), and/or autism, and in 30 reference children without epilepsy (18 females, 12 males; mean age 6y 5mo, range 6y-6y 11mo). Ten children had partial, six primarily generalized, and four unclassified epilepsy. Fourteen were having monotherapy and six were taking two or more antiepileptic drugs; 13 children were free from seizures 3 months before the assessment. Results show no statistically significant difference between the groups concerning Verbal IQ, expressive and receptive grammar, and receptive vocabulary. The children with epilepsy had a significantly lower Performance IQ and lower scores in tests of oral motor ability, articulation, emerging literacy, auditory attention, short-term memory, and rapid word retrieval. Parent ratings revealed no significant difference in communicative ability. Polytherapy and early onset of epilepsy influenced some results. Preschool children with epilepsy without learning disability, CP, and/or autism may have receptive verbal ability within the normal range but visuoperceptual, auditory attentional, and speech-language difficulties that could affect school achievement. Careful testing of children with epilepsy who appear to be functioning within the normal range is needed because this may reveal specific impairments that require appropriate professional input.

  • 192.
    Senn, Pascal
    et al.
    Univ Bern, Inselspital, Univ Dept ORL Head & Neck Surg, Bern, Switzerland.;Univ Bern, Dept Clin Res, Bern, Switzerland.;Univ Hosp Geneva, Dept Clin Neurosci, Serv ORL & HNS, HUG, Geneva, Switzerland..
    Roccio, Marta
    Univ Bern, Inselspital, Univ Dept ORL Head & Neck Surg, Bern, Switzerland.;Univ Bern, Dept Clin Res, Bern, Switzerland..
    Hahnewald, Stefan
    Univ Bern, Inselspital, Univ Dept ORL Head & Neck Surg, Bern, Switzerland.;Univ Bern, Dept Clin Res, Bern, Switzerland..
    Frick, Claudia
    Univ Tubingen, Dept Otorhinolaryngol Head & Neck Surg, Tubingen, Germany..
    Kwiatkowska, Monika
    Univ Tubingen, Dept Otorhinolaryngol Head & Neck Surg, Tubingen, Germany..
    Ishikawa, Masaaki
    Univ Tubingen, Dept Otorhinolaryngol Head & Neck Surg, Tubingen, Germany..
    Bako, Peter
    Univ Tubingen, Dept Otorhinolaryngol Head & Neck Surg, Tubingen, Germany..
    Li, Hao
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Edin, Fredrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Liu, Wei
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Rask-Andersen, Helge
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Pyykko, Ilmari
    Univ Tampere, Hearing & Balance Res Unit, Dept Otorhinolaryngol, Tampere, Finland.;Univ Tampere, Finnish Ctr Alternat Methods, Tampere, Finland..
    Zou, Jing
    Univ Tampere, Hearing & Balance Res Unit, Dept Otorhinolaryngol, Tampere, Finland.;Univ Tampere, Finnish Ctr Alternat Methods, Tampere, Finland..
    Mannerstrom, Marika
    Univ Tampere, Hearing & Balance Res Unit, Dept Otorhinolaryngol, Tampere, Finland.;Univ Tampere, Finnish Ctr Alternat Methods, Tampere, Finland..
    Keppner, Herbert
    HES SO Univ Appl Sci Western Switzerland, Haute Ecole Arc Ingn, La Chaux De Fonds, Switzerland..
    Homsy, Alexandra
    HES SO Univ Appl Sci Western Switzerland, Haute Ecole Arc Ingn, La Chaux De Fonds, Switzerland..
    Laux, Edith
    HES SO Univ Appl Sci Western Switzerland, Haute Ecole Arc Ingn, La Chaux De Fonds, Switzerland..
    Llera, Miguel
    HES SO Univ Appl Sci Western Switzerland, Haute Ecole Arc Ingn, La Chaux De Fonds, Switzerland..
    Lellouche, Jean-Paul
    Bar Ilan Univ, Dept Chem, Ctr Adv Mat & Nanotechnol, Ramat Gan, Israel.;Bar Ilan Univ, Dept Chem, Mina & Everard Goodman Fac Life Sci, Ramat Gan, Israel..
    Ostrovsky, Stella
    Bar Ilan Univ, Dept Chem, Ctr Adv Mat & Nanotechnol, Ramat Gan, Israel.;Bar Ilan Univ, Dept Chem, Mina & Everard Goodman Fac Life Sci, Ramat Gan, Israel..
    Banin, Ehud
    Bar Ilan Univ, Dept Chem, Ctr Adv Mat & Nanotechnol, Ramat Gan, Israel.;Bar Ilan Univ, Dept Chem, Mina & Everard Goodman Fac Life Sci, Ramat Gan, Israel..
    Gedanken, Aharon
    Bar Ilan Univ, Dept Chem, Ctr Adv Mat & Nanotechnol, Ramat Gan, Israel.;Bar Ilan Univ, Dept Chem, Mina & Everard Goodman Fac Life Sci, Ramat Gan, Israel..
    Perkas, Nina
    Bar Ilan Univ, Dept Chem, Ctr Adv Mat & Nanotechnol, Ramat Gan, Israel.;Bar Ilan Univ, Dept Chem, Mina & Everard Goodman Fac Life Sci, Ramat Gan, Israel..
    Wank, Ute
    EMC Microcollect GmbH, Tubingen, Germany..
    Wiesmueller, Karl-Heinz
    EMC Microcollect GmbH, Tubingen, Germany..
    Mistrik, Pavel
    MED EL GmbH, Worldwide Headquarters, Innsbruck, Austria..
    Benav, Heval
    MED EL GmbH, Worldwide Headquarters, Innsbruck, Austria..
    Garnham, Carolyn
    MED EL GmbH, Worldwide Headquarters, Innsbruck, Austria..
    Jolly, Claude
    MED EL GmbH, Worldwide Headquarters, Innsbruck, Austria..
    Gander, Filippo
    SCIPROM Sarl, Rue Ctr 70, St Sulpice, Switzerland..
    Ulrich, Peter
    SCIPROM Sarl, Rue Ctr 70, St Sulpice, Switzerland..
    Mueller, Marcus
    Univ Tubingen, Dept Otorhinolaryngol Head & Neck Surg, Tubingen, Germany..
    Loewenheim, Hubert
    Univ Tubingen, Dept Otorhinolaryngol Head & Neck Surg, Tubingen, Germany..
    NANOCI-Nanotechnology Based Cochlear Implant With Gapless Interface to Auditory Neurons2017Inngår i: Otology and Neurotology, ISSN 1531-7129, E-ISSN 1537-4505, Vol. 38, nr 8, s. E224-E231Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Cochlear implants (CI) restore functional hearing in the majority of deaf patients. Despite the tremendous success of these devices, some limitations remain. The bottleneck for optimal electrical stimulation with CI is caused by the anatomical gap between the electrode array and the auditory neurons in the inner ear. As a consequence, current devices are limited through 1) low frequency resolution, hence suboptimal sound quality and 2), large stimulation currents, hence high energy consumption (responsible for significant battery costs and for impeding the development of fully implantable systems). A recently completed, multinational and interdisciplinary project called NANOCI aimed at overcoming current limitations by creating a gapless interface between auditory nerve fibers and the cochlear implant electrode array. This ambitious goal was achieved in vivo by neurotrophin-induced attraction of neurites through an intra-cochlear gel-nanomatrix onto a modified nanoCI electrode array located in the scala tympani of deafened guinea pigs. Functionally, the gapless interface led to lower stimulation thresholds and a larger dynamic range in vivo, and to reduced stimulation energy requirement (up to fivefold) in an in vitro model using auditory neurons cultured on multi-electrode arrays. In conclusion, the NANOCI project yielded proof of concept that a gapless interface between auditory neurons and cochlear implant electrode arrays is feasible. These findings may be of relevance for the development of future CI systems with better sound quality and performance and lower energy consumption. The present overview/review paper summarizes the NANOCI project history and highlights achievements of the individual work packages.

  • 193. Sgaramella, N.
    et al.
    Coates, P. J.
    Strindlund, K.
    Loljung, L.
    Colella, G.
    Laurell, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Rossiello, R.
    Muzio, L. L.
    Loizou, C.
    Tartaro, G.
    Olofsson, K.
    Danielsson, K.
    Fahraeus, R.
    Nylander, K.
    Expression of p16 in squamous cell carcinoma of the mobile tongue is independent of HPV infection despite presence of the HPV-receptor syndecan-12015Inngår i: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 113, nr 2, s. 321-326Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Tongue squamous cell carcinoma (TSCC) is increasing in incidence, especially among young patients and preferably females. Infection with human papilloma virus (HPV) has been suggested as a cause of SCC in the head and neck, and the proportion of oropharyngeal cancers caused by HPV has steadily increased. Methods: Samples from 109 patients with primary TSCC were analysed for the presence of HPV16 by in situ hybridisation and for expression of its surrogate marker p16 and the HPV receptor syndecan-1 by immunhistochemistry. Results: No evidence of HPV16 DNA was observed in the tumours, although one-third showed p16 staining. There was no difference in the expression of the primary HPV receptor, syndecan-1, between TSCC and a group of tonsil SCC. Conclusion: Whereas p16 is expressed in some TSCCs, HPV16 is undetectable, therefore, p16 cannot be used as a surrogate marker for high-risk HPV-infection in this tumour. Despite presence of the HPV-receptor syndecan-1 in TSCC, HPV prefers the tonsillar environment. Lack of p16 associates with worse prognosis primarily in patients aged <= 40 years with tongue SCC. The improved prognosis seen in p16-positive TSCC can be due to induction of a senescent phenotype or an inherent radiosensitivity due to the ability of p16 to inhibit homologous recombination repair.

  • 194.
    Sgaramella, Niccola
    et al.
    Univ Naples Federico II, Dept Neurosci Reprod & Dent Sci, Naples, Italy.
    Lindell Jonsson, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Boldrup, Linda
    Califano, Luigi
    Univ Naples Federico II, Dept Neurosci Reprod & Dent Sci, Naples, Italy.
    Coates, Philip
    Tartaro, Gianpaolo
    Lo Muzio, Lorenzio
    Fåhraeus, Robin
    Colella, Giuseppe
    Dell'Aversana Orabona, Giovanni
    Loljung, Lotta
    Santagata, Mario
    Rosiello, Riccardo
    Wilms, Torben
    Danielsson, Karin
    Laurell, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Nylander, Karin
    High expression of podoplanin in squamous cell carcinoma of the tongue occurs predominantly in patients≤ 40 years but does not correlate with tumour spread2016Inngår i: The journal of pathology. Clinical research, ISSN 2056-4538, nr 1, s. 3-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    More than 30% of patients with squamous cell carcinoma (SCC) of the mobile tongue have clinically undetectable lymph node metastasis. Tumour cells can spread as single cells or collectively. A protein known to play a role in both processes is podoplanin, which is expressed in endothelial cells not only in lymph vessels but also in some aggressive tumours with high invasive and metastatic potential. Here we studied samples from 129 patients with primary SCC of the tongue for expression of podoplanin using immunohistochemistry. mRNA levels were analysed in another 27 cases of tongue SCC with adjacent clinically tumour-free tongue tissue and 14 tongue samples from healthy donors. Higher levels of podoplanin were seen in tumours compared to both normal tongue and clinically normal tongue in the tumour vicinity. No association was found between levels of podoplanin, presence of lymph node metastases or other clinical factors. Patients aged 40 or less were more likely to express high levels of podoplanin protein compared to older patients (p = 0.027). We conclude that levels of podoplanin in primary tongue SCCs are not associated with lymph node metastases. However, tongue SCCs arising in young patients (< 40 years of age) are more likely to express high levels of podoplanin than tongue SCCs that arise in the more elderly. The data suggest that podoplanin has a distinctive role in young patients, who are known to have a poor prognosis: these patients may, therefore, benefit from podoplanin inhibitory therapies.

  • 195. Siegbahn, Malin
    et al.
    Lundin, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Olsson, Gun-Britt
    Stillesjö, Fredrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Kinnefors, Anders
    Rask-Andersen, Helge
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Nyberg, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Auditory Brainstem Implants (ABIs): 20 Years of Clinical Experience in Uppsala, Sweden2014Inngår i: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 134, nr 10, s. 1052-1061Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    CONCLUSIONS:

    Even though sound perception may be limited after treatment with an auditory brainstem implant (ABI), it provides benefits and should be selectively offered to patients. Importantly the patients must be motivated, given reasonable expectations of outcome and offered long-term rehabilitation with a considerable 'learn to listen' period with the implant device.

    OBJECTIVES:

    To describe the clinical experiences and results of 24 ABI surgeries performed in Uppsala University Hospital between 1993 and 2013.

    METHODS:

    Most patients (n = 20) suffered from neurofibromatosis type 2 (NF2); a few patients (n = 4) were paediatric non-NF2 patients. The files were searched for information on the presurgery size of the vestibular schwannoma, whether the patient had undergone gamma knife treatment, the surgical approach, the side effects of the surgery and of the use of the implant, the electrode activation pattern and implant use, and categories of auditory performance (CAP) score.

    RESULTS:

    Our results show that many patients greatly benefited from an ABI, and most of the patients used their implants even though the hearing improvements usually consisted of awareness of surrounding sounds and improved lip-reading. No severe side effects were observed from implant stimulation.

  • 196.
    Sivars, Lars
    et al.
    Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden..
    Landin, David
    Karolinska Inst, CLINTEC, Dept Otorhinolaryngol Head & Neck Surg, Stockholm, Sweden..
    Haeggblom, Linnea
    Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden..
    Tertipis, Nikolaos
    Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden..
    Grun, Nathalie
    Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden..
    Bersani, Cinzia
    Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden..
    Marklund, Linda
    Karolinska Inst, CLINTEC, Dept Otorhinolaryngol Head & Neck Surg, Stockholm, Sweden..
    Ghaderi, Mehran
    Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Clin Pathol, Stockholm, Sweden..
    Nasman, Anders
    Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Clin Pathol, Stockholm, Sweden..
    Ramqvist, Torbjorn
    Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden..
    Nordfors, Cecilia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk biokemi och mikrobiologi. Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden..
    Munck-Wikland, Eva
    Karolinska Inst, CLINTEC, Dept Otorhinolaryngol Head & Neck Surg, Stockholm, Sweden..
    Tani, Edneia
    Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Clin Pathol, Stockholm, Sweden..
    Dalianis, Tina
    Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden..
    Human papillomavirus DNA detection in fine-needle aspirates as indicator of human papillomavirus-positive oropharyngeal squamous cell carcinoma: A prospective study2017Inngår i: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 39, nr 3, s. 419-426Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background. Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (SCC) has a better outcome than most head neck squamous cell carcinomas (HNSCCs) and an HPV-positive lymph node metastasis likely has an HPV-positive oropharyngeal SCC origin. Determining HPV-status in cervical lymph nodes by fine-needle aspiration cytology (FNAC) may be useful for diagnosis. Methods. FNACs from 66 patients with neck masses were prospectively examined for HPV DNA and HPV16 mRNA by a polymerase chain reaction (PCR)-based assay, and the data correlated to diagnosis and HPV-status obtained from histopathological specimens. Results. Aspirates from 17 of 66 patients, later diagnosed with HPV-positive oropharyngeal SCC, were HPV16 DNA-positive. HPV16 mRNA was detected in all cases with extractable RNA. All remaining FNACs, including 18 branchial cleft cysts, were HPV DNA-negative. HPV DNA status in the aspirates showed perfect concordance with corresponding biopsies. Conclusion. HPV16 DNA detection in fine-needle aspirations from neck masses is reliable and HPV16 DNA in a metastasis is a strong indicator of an HPV-positive oropharyngeal SCC.

  • 197.
    Strömbäck, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    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 register2017Inngår i: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 274, nr 6, s. 2421-2427Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 198.
    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 universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Low inter-examiner agreement of the Friedman staging system indicating limited value in patient selection2018Inngår i: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 275, nr 6, s. 1541-1545Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 199.
    Svensson, Malin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Excessive Daytime Sleepiness in Women Without OSA Response2009Inngår i: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 136, nr 2, s. 649-649Artikkel i tidsskrift (Fagfellevurdert)
  • 200.
    Söderbäck, Emma
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Logopedi.
    Landfeldt, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Logopedi.
    Predicerar skriftliga bildbeskrivningar demens?: -En retrospektiv studie2009Independent thesis Advanced level (degree of Master (One Year)), 20 poäng / 30 hpOppgave
    Abstract [sv]

    Skrivning är en biomekaniskt invecklad process som kräver en viss nivå av såväl motorisksom kognitiv förmåga. Forskning om Alzheimers sjukdom tyder på att nedsättningar i flerakognitiva domäner förekommer innan den kliniska diagnosen ställs. Det finns även forskningsom tyder på att ett innehållsrikt skriftspråk i unga år minskar risken för demensutveckling påäldre dagar. För att studera om mått från texter kunde predicera demens på ett tidigt stadiumanalyserades 141 skriftliga bildbeskrivningar insamlade inom ramen för rutinmässigaminnesutredningar vid Karolinska universitetssjukhuset, Huddinge. Deltagarna delades in itre grupper utifrån diagnos (minnesutredning, lindrig kognitiv svikt och demens).Utgångspunkt för studien var de fyra textmåtten: idétäthet, verbtäthet, läsbarhetsindex (LIX)och T-enheter. Då texterna i de flesta fall var skrivna av personer med kognitiv nedsättninghar måtten varit tvungna att modifieras och särskilda instruktioner för bedömning av texternahar utformats. Resultaten tyder på att skriftliga bildbeskrivningar utförda av individer meddemens innehåller färre totalt antal ord än de skrivna av individer diagnostiserade medlindrig kognitiv svikt eller mindre svårigheter än så. De innehåller även färre propositioner,verb, långa ord, T-enheter, ord per T-enhet, har en kortare meningslängd samt har i snitt ettlägre LIX-värde. En logistisk regressionsanalys visade att demens (kontra minnesutredningarmed subjektiva besvär) predicerades signifikant (p < 0.01) av antalet verb samt av LIXvärdet.Totalt 85 % av fallen klassificerades korrekt.

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