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  • 1.
    Alm, Fredrik
    et al.
    Örebro University, School of Health Sciences. Department of Anaesthesia and Intensive Care, School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Lundeberg, Stefan
    Pain Treatment Service, Astrid Lindgren Children's Hospital, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.
    Ericsson, Elisabeth
    Örebro University, School of Health Sciences.
    Adherence to Swedish guidelines for pain treatment in relation to pediatric tonsil surgery: A survey of the multidisciplinary team2017In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 101, p. 123-131Article in journal (Refereed)
    Abstract [en]

    Background: Pain management in children after tonsil surgery is essential, and optimal pain treatment has been discussed for many years. Data from the National Tonsil Register in Sweden (NTRS) and a national mapping system have demonstrated the need for national pain treatment guidelines for pediatric tonsil surgery. As a result, Swedish national guidelines, together with updated patient information on the website tonsilloperation.se, were developed and implemented in 2013.

    Objectives The objective of this study was to evaluate the professionals’ opinions of and adherence to pain treatment guidelines for pediatric tonsil surgery patients in a two-year follow-up.

    Method: This descriptive cross-sectional study was based on data from an inter-professional questionnaire, which was validated by an expert group using a content validity index (S-CVI 0.93). The questionnaire was sent to all Swedish ear, nose and throat (ENT) departments (n=49) that the NTRS identified as performing tonsil surgery on children younger than 18 years of age. In each clinic, we asked for responses from staff in each of the following professions: ENT physicians, anesthesia physicians, registered nurse anesthetists, and registered nurses in the ENT departments.

    Results: Respondents from 48 ENT departments participated, and 139/163 (85%) completed questionnaires were returned. The guidelines were reported as being clear, ensuring patient safety and providing optimal pharmacological treatment. Treatment was given according to the guidelines: Half of the departments gave pre- or intraoperative treatment with clonidine, betamethasone and high-dose paracetamol (acetaminophen). A multimodal pain approach (paracetamol and COX inhibitors) after hospital discharge was prescribed by all departments after tonsillectomy and, more extensively, after tonsillotomy. One-third of the departments prescribed paracetamol with a higher normal dose for the first three postoperative days. Half of the departments prescribed rescue analgesics, clonidine or opioids after tonsillectomy. None of the departments prescribed codeine or tramadol, drugs that are discouraged in the guidelines. The majority of the departments used the website tonsilloperation.se to provide information to the patients and their caregivers.

    Conclusion: The respondents' opinions of and the ENT departments adherence to the Swedish national guidelines were considered to be good. The national implementation process in Sweden has impacted the manner in which ENT departments treat pain after tonsil surgery.

  • 2.
    Alm, Fredrik
    et al.
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Lundeberg, Stefan
    Astrid Lindgrens Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Hemlin, Claes
    Sollentuna Specialist Clinic, Stockholm, Sweden.
    Hessén-Söderman, Anne-Charlotte
    Department of Otorhinolaryngology, Aleris Sabbatsberg, Stockholm, Sweden; Division of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Nerfeldt, Pia
    Karolinska University Hospital, Huddinge, Sweden.
    Odhagen, Erik
    Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sunnergren, Ola
    Department of Otorhinolaryngology, Ryhov County Hospital, Jönköping, Sweden; Futurum-The Academy for health and care, County Council, Jönköping, Sweden.
    Stalfors, Joacim
    Sahlgrenska Universitety Hospital, Göteborg, Sweden.
    Ericsson, Elisabeth
    Örebro University, School of Health Sciences.
    Adherence to Swedish Guidelines for Pain Treatment in Tonsil Surgery in Pediatric Patients2016Conference paper (Refereed)
    Abstract [en]

    Objective: As shown by data from the National Tonsil Surgery Register in Sweden, tonsil surgery often causes severe pain that lasts for many days. The register data demonstrate the necessity for better evidence-based pain treatment guidelines for tonsil surgery. The guidelines, introduced in 2013, consist of both pharmacological and non-pharmacological recommendations. In the guidelines, a multimodal analgesic approach and combination of analgesics are recommended to provide effective pain treatment with limited side effects. Two national multi-professional education days on pain, pharmacology and the guidelines were offered. Web-based information about pharmacological treatment (www.tonsililloperation.se) was designed for patients and next-of-kin. The current aims were to describe adherence to the Swedish guidelines for pain treatment in tonsil surgery in pediatric patients < 18 years

    Method: An inter-professional questionnaire was developed, including questions linked to the relevant guidelines. The questions came from a national mapping before the guidelines were designed. The items were discussed by an expert group, and content validity was evaluated using the content validity index.ENT-and anesthesia physicians and nurses from all 50 ENT clinics in Sweden were enrolled.

    Results: Most clinics had received the guidelines, but there was a discrepancy between the professions. More than half had perused the literature review performed before the guidelines were designed, and attended themulti-professional education day. Pre- and perioperative treatment usually included paracetamol, clonidine and betamethasone. A multimodal pain approach after discharge from hospital (tonsillectomy and tonsillotomy) was used, combining paracetamol with cox-inhibitors. Most clinics used paracetamol, with a higher dose for the first 3 days (healthy children and acceptable nutrition), and a reduced dose from day 4.In case of inadequate analgesia after tonsillectomy, oral clonidine or opioids were used. Several clinics followed the recommendation to use clonidine as first choice and secondly an opioid. No respondents prescribed codeine compared to 80% at the mapping before the guidelines were designed. The guidelines were experienced as clear, safe and sufficient. The web-based information was used by most of the clinics to improve quality of care and provide facilitating tools for patients, relatives and caregivers.

    Conclusion: Swedish guidelines for tonsil surgery provide practical evidence-based pain treatment recommendations. To achieve a change, multi-professional education is necessary. This needs to be repeated for a wider spread.

    Future research should include evaluation through pain diaries and questionnaires to next-of-kin and children. There should be matching of data from the quality registers at each clinic, with pain variables such as unplanned health care contacts due to pain, number of days with analgesics, and return to normal diet

  • 3.
    Alm, Fredrik
    et al.
    Örebro University, School of Health Sciences.
    Stalfors, Joacim
    Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Sheikh Khalifa Medical City, Ajman, United Arab Emirates.
    Nerfeldt, Pia
    Karolinska University Hospital, Huddinge, Sweden.
    Ericsson, Elisabeth
    Örebro University, School of Health Sciences.
    Patient reported outcome of pain after tonsil surgery: An analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009-20162017Conference paper (Refereed)
    Abstract [en]

    Tonsil surgery is common surgical procedure in children and cause significant pain under postoperative recovery. The objective of this register study was to explore factors affecting pain after pediatric tonsil surgery, using patient-reported outcomes from questionnaires in the National Tonsil Surgery Registry in Sweden, 30 days after surgery. A total of 32,225 tonsil surgeries on children (aged 1-18 years) during January 2009- November 2016 were included; 13,904 tonsillectomies with or without adenoidectomy (TE±A) and 18,321 tonsillotomies with or without adenoidectomy (TT±A). In surgery cases of indication obstruction, the TT±A stopped taking painkillers and returned to normal eating habits sooner, and had less contact with health care services due to pain, compared to TE±A. After TE±A, the indication infection group had more days on analgesics and more contacts with health care services due to pain, compared to the indication obstruction group. TE±A with cold-dissection technique resulted in fewer days on painkillers compared to warm-technique, and reduced the number of contacts with health care services due to pain. Older children were affected by more days of morbidity than the younger ones, but there was no gender difference after adjustment for age, dissection technique and hemostasis technique. Implementation of national guidelines for pain treatment (2013) and patient information on the website tonsilloperation.se seems to have increased the days on analgesics after surgery. Pain after tonsil surgery depends on the surgical procedure and technique, as well as factors such as the patient’s age and surgical indication. More studies including pain interventions are needed to improve the care of tonsillectomy patients.

  • 4.
    Alm, Fredrik
    et al.
    Örebro University, School of Health Sciences. Department of Anaesthesia and Intensive Care.
    Stalfors, Joacim
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sheikh Khalifa Medical City, Ajman, United Arab Emirates.
    Nerfeldt, Pia
    Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden; Division of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
    Ericsson, Elisabeth
    Örebro University, School of Health Sciences.
    Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009–20162017In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 274, no 10, p. 3711-3722Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to describe factors affecting pain after pediatric tonsil surgery, using patient reported pain-related outcome measures (pain-PROMs) from the National Tonsil Surgery Register in Sweden. In total, 32,225 tonsil surgeries on children (1 to\18 years) during 2009–2016 were included; 13,904 tonsillectomies with or without adenoidectomy (TE ± A), and 18,321 tonsillotomies with or without adenoidectomy (TT ± A). Adjustments were made for variables included in the register to compensate for contributable factors in the analysis. When compared to TE ± A for surgical indication obstruction, TT ± A resulted in lower pain-PROMs, shorter use of postoperative analgesics, earlier return to regular food intake, and lower risk for contact with health care services due to pain. Children who underwent TE ± A because of obstruction problems stopped taking painkillers and returned to normal eating habits sooner, compared to children who underwent TE ± A for infectious indications. In both indication groups, TE ± A performed with hot rather than cold technique (dissection and haemostasis) generally resulted in higher pain-PROMs. Older children reported more days on analgesics and a later return to regular food intake after TE ± A than younger ones. No clinically relevant difference between sexes was found. Between 2012 and 2016 (pre-and post-implementation of Swedish national guidelines for pain treatment), the mean duration of postoperative analgesic use had increased. In conclusion, TE ± A caused considerably higher ratings of pain-related outcome measures, compared to TT ± A. For TE ± A, cold surgical techniques (dissection and haemostasis) were superior to hot techniques in terms of pain-PROMs. Older children reported higher pain-PROMs after TE ± A than younger ones.

  • 5.
    Andersson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Fredriksson, Valeria
    Svenska audionomers inställning gentemot kompetensutvecklingsprogram2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Sammanfattning:

    Audionomyrket har utvecklats från ett assisterande till ett självständigt yrke. Framsteg inom forskning berörande audiologi ställer höga krav på audionomens kompetensutveckling. Internationellt har det undersökts hur kompetensutveckling kan förbättras, genom bildandet av frivilliga eller obligatoriska kompetensutvecklingsprogram, för att ge en säker patientvård och en tillfredsställande yrkesutveckling. I Sverige ansvarar varje audionom enskilt för sin kompetensutveckling. Det finns i dagsläget inga studier som undersöker svenska audionomers inställning till att införa liknande kompetensutvecklingsprogram som finns internationellt, vilket är motivet bakom studien. Syftet är att undersöka svenska audionomers inställning kring frivilliga samt obligatoriska kompetensutvecklingsprogram med tillhörande gransknings-process för att vidareutveckla audionomprofessionen och hålla samtliga yrkesverksamma ajour med ny vetenskap. En kvantitativ metod i form av en webbenkät tillämpades för att nå ut till ett stort omfång yrkesverksamma audionomer över hela Sverige. Studiens resultat visar att ett stort antal yrkesverksamma audionomer är positivt inställda till det frivilliga samt obligatoriska kompetensutvecklingsprogrammet med tillhörande granskningsprocess. En förändrad form av kompetensutvecklingssystem än den nuvarande är därmed eftersträvad av majoriteten. Studiens resultat har tagit fasta på att kompetensutvecklingsprogram bör inriktas mot både de tvärvetenskapliga områden som professionen bygger på och audionomens specialiseringsområden. Audionomerna anser att tiden motsvarande en till åtta timmar per månad är tillräcklig för kompetensutvecklande aktiviteter. Audionomerna har en stor medvetenhet om vikten av att utveckla den professionella kompetensen. Hindrande faktorer som ekonomi, hög patientgenomströmning, tidsbrist, etc. minskar audionomernas möjlighet till deltagande av kompetensutvecklande aktiviteter. De yttre omständigheterna bidrar till att yrkesverksamma audionomer i hög grad önskar en förändrad form av kompetensutvecklings-system än den nuvarande.

  • 6.
    Andersson, Susanne
    et al.
    Örebro University, School of Health and Medical Sciences.
    Eriksson, Angelica
    Ljudmiljön på två särboenden för äldre: En pilotstudie2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 7.
    Arancibia, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Eriksson, Emma
    ”Det klickar i mitt öra…” Objektiv tinnitus orsakad av palatal myoklonus: En forskningsöversikt2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Tinnitus är idag vanligt förekommande och kan klassificeras som antingen subjektiv eller objektiv. Subjektiv tinnitus hörs endast av den drabbade individen, medan objektiv tinnitus kommer från verkliga ljud som kan mätas eller höras av andra. Palatal myoklonus innebär muskelryckningar i palatala muskler och räknas bland muskulära orsaker till objektiv tinnitus.

    Syfte: Syftet med denna studie är att belysa objektiv tinnitus orsakad av essentiell palatal myoklonus med avseende på symptombild, diagnostik samt behandling och utfall.

    Metod: En forskningsöversikt har genomförts för att besvara studiens syfte.

    Resultat: Resultatet visar att symptombilden vid essentiell palatal myoklonus främst är objektiv klickande tinnitus, vilken i vissa fall varit mycket svår för individen att hantera och i majoriteten av fallen haft en negativ inverkan på de drabbade individernas livskvalitet. De diagnostiska metoder som används är i många fall mätningar som görs i syfte att utesluta påverkan från andra organ, i synnerhet någon form av neurologisk patologi. Nasal endoskopi, audiologiska utredningar och magnetkameraröntgen är några av de mätmetoder som använts för att ställa korrekt diagnos. Bland behandlingsmetoder nämns främst injektion av botulinumtoxin A i muskler kring mjuka gommen samt farmakologiska behandlingsmetoder, men även ett par mer sällsynta behandlingsmetoder beskrivs såsom radiofrekvensablation av palatala muskler och kirurgisk blockering av örontrumpeten.

    Slutsats: En tidig, korrekt diagnos för den drabbade individen är angelägen då denna objektiva tinnitus kan vara enormt påfrestande. Det föreligger ett behov av kontrollerade studier på ett större antal individer för att fastställa reproducerbarheten i de behandlingsmetoder som idag finns att tillgå.

  • 8.
    Asp, Filip
    et al.
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Cochlear Implants M43, Karolinska University Hospital, Stockholm, Sweden.
    Mäki-Torkko, Elina
    Örebro University, School of Medical Sciences. Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of ENT-Head Neck Surgery, County Council of Östergötland, Linköping, Sweden; Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Karltorp, Eva
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Cochlear Implants M43, Karolinska University Hospital, Stockholm, Sweden.
    Harder, Henrik
    Örebro University, School of Medical Sciences. Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of ENT-Head Neck Surgery, County Council of Östergötland, Linköping, Sweden.
    Hergils, Leif
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of ENT-Head Neck Surgery, County Council of Östergötland, Linköping, Sweden.
    Eskilsson, Gunnar
    Department of Cochlear Implants, M43, Karolinska University Hospital, Stockholm, Sweden.
    Stenfelt, Stefan
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    A longitudinal study of the bilateral benefit in children with bilateral cochlear implants2015In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 54, no 2, p. 77-88Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the development of the bilateral benefit in children using bilateral cochlear implants by measurements of speech recognition and sound localization.

    DESIGN: Bilateral and unilateral speech recognition in quiet, in multi-source noise, and horizontal sound localization was measured at three occasions during a two-year period, without controlling for age or implant experience. Longitudinal and cross-sectional analyses were performed. Results were compared to cross-sectional data from children with normal hearing.

    STUDY SAMPLE: Seventy-eight children aged 5.1-11.9 years, with a mean bilateral cochlear implant experience of 3.3 years and a mean age of 7.8 years, at inclusion in the study. Thirty children with normal hearing aged 4.8-9.0 years provided normative data.

    RESULTS: For children with cochlear implants, bilateral and unilateral speech recognition in quiet was comparable whereas a bilateral benefit for speech recognition in noise and sound localization was found at all three test occasions. Absolute performance was lower than in children with normal hearing. Early bilateral implantation facilitated sound localization.

    CONCLUSIONS: A bilateral benefit for speech recognition in noise and sound localization continues to exist over time for children with bilateral cochlear implants, but no relative improvement is found after three years of bilateral cochlear implant experience.

  • 9.
    Axelsson, Arvid
    et al.
    Örebro University, School of Health and Medical Sciences.
    Hammar, Magnus
    Örebro University, School of Health and Medical Sciences.
    Träning av frekvensdiskriminering - är det meningsfullt?2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Denna experimentella studie syftar till att undersöka huruvida en eventuell träningseffekt i 

    frekvensdiskrimination kvarstår efter en tids träningsuppehåll. Tidigare forskning har visat 

    tydliga samband mellan frekvensdiskriminering och talutveckling, kortikal signalbehandling 

    och dyslexi. Det har klargjorts genom tidigare studier att förmågan att diskriminera frekvenser 

    är möjligt att träna upp. Därmed är träning i frekvensdiskrimination en lämplig del i en 

    behandlingsmetod med syfte att utveckla den auditiva perceptionen. Denna studie undersöker 

    de praktiska förutsättningarna till denna behandlingsmetod genom att utreda varaktigheten av 

    den eventuella träningseffekten 14 dagar efter träningen. 24 normalhörande personer deltog i 

    studien där försökspersonernas förmåga att frekvensdiskriminera undersöktes med hjälp av ett 

    egenutvecklat mjukvaruprogram. Först uppmättes försökspersonernas förmåga när de var 

    otränade (mätning 1). Sedan genomfördes ett träningspass som följdes av en mätning 

    (mätning 2). Efter 14 dagar genomfördes ytterligare en mätning för att undersöka den 

    bestående effekten (mätning 3). 

    Resultatet visade (när tre outliers exkluderats) en signifikant skillnad mellan mätning 1 och 2 

    (p=0,034) vilket innebär att en omedelbar träningseffekt erhölls. Ingen signifikant skillnad 

    kunde påvisas mellan mätning 2 och 3 (p=0,952) men en signifikant skillnad erhölls mellan 

    mätning 1 och 3 (p=0,031) vilket påvisar att den omedelbara träningseffekten kvarstod efter 

    de gångna 14 dagarna. 

  • 10.
    Backlund, Ann-Christin
    Örebro University, School of Health and Medical Sciences.
    Grad av nöjdhet och ökad livskvalitet hos uni- respektive bilaterala hörapparatanvändare2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 11.
    Balisani, Safia
    Örebro University, School of Health and Medical Sciences.
    Audionomens möjligheter till kompetens- och kunskapsutveckling2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 12.
    Basic, Vladimir T.
    et al.
    Department of Clinical Medicine, Örebro University, Örebro, Sweden.
    Tadele, Elsa
    Department of Clinical Medicine, Örebro University, Örebro, Sweden; Medical University of Giessen, Molecular Biology and Medicine of the Lung program, Giessen, Germany.
    Jacobsen, Annette
    Department of Clinical Medicine, Örebro University, Örebro, Sweden; School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, Australia.
    Sirsjö, Allan
    Department of Clinical Medicine, Örebro University, Örebro, Sweden.
    Abdel-Halim, Samy M.
    Division of Respiratory Medicine and Allergology, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.
    Chronic cigarette smoke exposureimpairs skeletal muscle regenerative capacity in murineCOPD/emphysema model.Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: Cigarette smoke (CS) is a well established risk factor in the development of COPD and irreversible airflow limitation. In contrast, the extent to which CS exposure contributes to development of peripheral skeletal muscle dysfunction and wasting remains largely unknown. Decline in skeletal muscle regenerative capacity has been previously reported in COPD patients.

    Methods: To investigate effects of chronic CS exposure on skeletal muscle regenerative capacity, 129/SvJ mice were exposed to CS for 6 months. The expression levels of myogenin, Jarid2, Znf496, Notch1, Pax7, Fgf1 and Myh3, which are known to regulate skeletal muscle myogenesis, were studied. Additionally, number of fibers with central nuclei, myonuclei number and mean fiber cross-sectional area were assessed.

    Results: Compared to controls, skeletal muscles from CS-exposed mice exhibited significantly decreased expression of Jarid2, coupled with enhanced expression of Znf496, Notch1, Pax7, Fgf1 and Myh3. Expression of myogenin, a marker of terminally differentiated myofibers, was reduced. Furthermore, reduced muscle fiber crosssectional area, increased number of fibers with central nuclei and reduced myonuclei number were also observed in CS-exposed animals.

    Conclusions: Taken together, current results provide evidence linking chronic CS exposure and an ongoing damage/repair process as well as impaired regenerative capacity in skeletal muscles of CS-exposed mice.

  • 13.
    Bergemalm, Per-Olof
    Örebro University, Department of Nursing and Caring Sciences.
    Progress of sensorineural hearing loss after closed head injury: presence of autoantibodies2004In: Audiological Medicine, ISSN 1651-386X, E-ISSN 1651-3835, Vol. 2, no 2, p. 92-99Article in journal (Refereed)
    Abstract [en]

    Sensorineural hearing impairment is a common sequel to closed head injury (CHI). In most cases, the impairment subsides within the first post‐traumatic year; in some cases the impairment is permanent and in other cases there will be progress. In most cases the reason for progress is unknown. Substantial research has been carried out to ascertain the aetiology of sudden sensorineural hearing loss (SNHL) and Menière's disease. A number of studies have demonstrated the presence of antibodies against HSP 70 antigen in patients' sera. In accordance with this finding, autoimmunity as an aetiological factor for progressive SNHL has been proposed. There are reports indicating that trauma is a possible mechanism for eliciting an autoimmune response, and the aim of the present study is to study this mechanism. The question of sympathetic cochleolabyrinthitis is highlighted. Sera from 35 subjects with a history of closed head injury three to 13 years prior to the investigation were obtained for Western blot immunoassay in an attempt to identify HSP 70 antibodies. Twenty‐seven of the subjects demonstrated progress of a sensorineural hearing impairment after CHI. Two of 35, both with progress of a SNHL, demonstrated presence of anti‐HSP 70 antibodies. Therefore, a significant role of an HSP 70 related autoimmune mechanism for SNHL progress post CHI could not be confirmed in the present study. Nevertheless, the possible role of autoantibodies in individual cases cannot be ruled out, neither can the presence of other transitory autoimmune reactions after CHI. No conclusive evidence of sympathetic cochleolabyrinthitis was found.

  • 14.
    Bergemalm, Per-Olof
    Örebro University, Department of Nursing and Caring Sciences.
    Progressive hearing loss after closed head injury: a predictable outcome?2003In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 123, no 7, p. 836-845Article in journal (Refereed)
    Abstract [en]

    Objectives-To evaluate the prevalence of progression of closed head injury (CHI)-induced hearing impairment, defined as greater than or equal to 15 dB HL deterioration at 1 or more frequencies, and to identify risk factors in patient history and initial status that could predict progression.

    Material and Methods-A total of 600 patients with major CHI were admitted to 2 Swedish medical centres during a 14-year period. The type of injury was established by means of CT and the severity of head injury was measured using the Swedish Reaction Level Scale (RLS). In 62 of these patients, pure-tone audiometry was performed soon after the injury. Forty-three patients agreed to participate in the present investigation, which was carried out 2-13 years after the injury. Each participant was evaluated using pure-tone audiometry and an itemized anamnesis was obtained.

    Results-There was a higher prevalence of hearing impairments in the study group compared to a control group. Thirty-two subjects (74%) showed a progression of greater than or equal to 15 dB, which was significantly greater than the spontaneous progression in the control group. Age and temporal bone fracture were risk factors for progression but not brain contusion only or RLS. There was an association between early pure-tone average (PTA) and progression as well as regression, i.e. the poorer the initial PTA the greater the progression as well as regression, indicating increased instability in the auditory system. Examination of patient histories did not reveal any single risk factors for progression. A serendipitous finding was a higher prevalence of reported memory shortcomings among those with post-traumatic tinnitus.

    Conclusion-Especially for those with fracture of the temporal bone the present results stress the importance of audiometric evaluation and follow-up, from both rehabilitation and medicolegal perspectives

  • 15.
    Bergemalm, Per-Olof
    et al.
    Örebro University, Department of Nursing and Caring Sciences.
    Lyxell, Björn
    Appearances are deceptive?: Long-term cognitive and central auditory sequelae from closed head injury2005In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 44, no 1, p. 39-49Article in journal (Refereed)
    Abstract [en]

    The purpose of the present study was to examine possible signs of long-term cognitive and/or central auditory sequelae seven to eleven years after a closed head injury (CHI) of sufficient severity to cause scull fracture and/or brain contusion. Another purpose was that this investigation should be carried out in a group of recovered trauma victims with, to the individual, no known or minimal sequelae. A computer-based set of five cognitive tests and three central auditory tests were used in a group of formerly brain-injured patients who considered themselves as well recovered. Most of the participants did not report any signs of cognitive or auditory impairment. Tests of working memory capacity, verbal information processing speed, phonological processing and verbal inference-making ability were used. Auditory brain response (ABR), distorted speech audiometry (interrupted speech), and phase audiometry were used to test central auditory function. The initial severity of brain damage, i.e. status when the patient arrived at the emergency ward, was estimated with Swedish Reaction Level Scale (RLS). Cognitive shortcomings after CHI were demonstrated in a high percentage (59%, 13/22) of the cases seven to eleven years after the injury. Central auditory processing disorders (APD) were also demonstrated in a fairly high percentage (58%, 11/19) of the subjects. None of the correlations between RLS and the results on cognitive and central auditory tests reached statistical significance. However, there was a correlation between cognitive performance and the results on the central auditory tests used in this investigation. Eighty percent (8/10) of those participants with pathologies on ABR and/or phase audiometry and/or IS also failed on one or more of the cognitive tasks, compared to 44% (4/9) among those with no signs of APD. It is possible, many years after CHI, to observe cognitive shortcomings and APD in a relatively high percentage of CHI cases that are subjectively considered to be fairly well recovered. The cognitive tasks used in the study have proved to be a sensitive method to discover cognitive impairments. Long-term cognitive sequelae and APD could not be predicted from RLS scores.

  • 16.
    Bergemalm, P-O
    Örebro University Hospital.
    Interrupted speech and MRI findings after traumatic head injury: A long-term follow-up2013In: Hearing, Balance and Communication, ISSN 2169-5725, Vol. 11, no 2, p. 80-86Article in journal (Refereed)
  • 17.
    Bjessbo, Sofia
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lindström Stolt, Jessica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    BAHA versus CROS: En sammanställning av en experimentell studie om hörhjälpmedel för personer med ensidig dövhet2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 18.
    Bogren, Sandra
    et al.
    Örebro University, School of Health and Medical Sciences.
    Nilsson, Kristine
    Dikotiska lyssningstester:  En mätmetod i testbatteriet för utredning av centrala auditiva störningar2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 19.
    Boisvert, Isabelle
    et al.
    Centre for Language Sciences, Macquarie University, Sydney NSW, Australia; HEARing Cooperative Research Centre, Melbourne VIC, Australia; Linnaeus Centre HEAD, Swedish Institute for Disability Research, Linnaeus University, Växjö, Sweden.
    Lyxell, Björn
    Linnaeus Centre HEAD, Swedish Institute for Disability Research, Linnaeus University, Växjö, Sweden; Department of Behavioural Sciences and Learning, Division of Technical Audiology, Linköping University, Linköping, Sweden.
    Mäki-Torkko, Elina
    Örebro University, School of Medical Sciences. Linnaeus Centre HEAD, Swedish Institute for Disability Research, Linnaeus University, Växjö, Sweden; Department of Clinical and Experimental Medicine, Division of Technical Audiology, Linkoping University, Linkoping, Sweden; Department of ENT-Head Neck Surgery UHL, County Council of Östergötland, Linköping, Sweden.
    McMahon, Catherine M.
    Centre for Language Sciences, Macquarie University, Sydney NSW, Australia; HEARing Cooperative Research Centre, Melbourne VIC, Australia.
    Dowell, Richard C.
    HEARing Cooperative Research Centre, Melbourne VIC, Australia; Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, Australia; Department of Audiology, Royal Victorian Eye and Ear Hospital, Melbourne VIC, Australia.
    Choice of ear for cochlear implantation in adults with monaural sound-deprivation and unilateral hearing aid2012In: Otology and Neurotology, ISSN 1531-7129, E-ISSN 1537-4505, Vol. 33, no 4, p. 572-579Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To identify whether speech recognition outcomes are influenced by the choice of ear for cochlear implantation in adults with bilateral hearing loss who use a hearing aid in 1 ear but have long-term auditory deprivation in the other.

    STUDY DESIGN: Retrospective matched cohort study. Speech recognition results were examined in 30 adults with monaural sound deprivation. Fifteen received the implant in the sound-deprived ear and 15 in the aided ear.

    SETTING: Tertiary referral centers with active cochlear implant programs.

    PATIENTS: Adults with bilateral hearing loss and a minimum of 15 years of monaural sound deprivation who received a cochlear implant after meeting the traditional implantation criteria of the referral centers.

    INTERVENTION: Cochlear implantation with devices approved by the U.S. Food and Drug Administration.

    MAIN OUTCOME MEASURE(S): Paired comparisons of postoperative monosyllabic word recognition scores obtained with the implant alone and in the usual listening condition (CI alone or bimodal).

    RESULTS: With the cochlear implant alone, individuals who received the implant in a sound-deprived ear obtained poorer scores than individuals who received the implant in the aided ear. There was no significant difference, however, in speech recognition results for the 2 groups when tested in their usual listening condition. In particular, poorer speech recognition scores were obtained with the cochlear implant alone by individuals using bimodal hearing.

    CONCLUSION: Similar clinical outcomes of cochlear implantation can be achieved by adults with a long-term monaural sound deprivation when comparing the usual listening condition, irrespective of whether the implant is in the sound-deprived or in the aided ear.

  • 20.
    Borg, Erik
    et al.
    Audiol Res Ctr, Örebro University Hospital, Örebro, Sweden.
    Borg, Birgitta
    Audiol Res Ctr, Örebro University Hospital, Örebro, Sweden.
    New perspectives on counselling in audiological habilitation/rehabilitation2015In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 54, no 1, p. 11-19Article in journal (Refereed)
    Abstract [en]

    Objective: To develop and apply a pedagogical method focusing on Empowerment, Empathy, Competence, and Counselling: the EC programme, and to present an initial evaluation. Design: The EC programme was gradually developed within a study circle framework and in dialogue with study circle leaders and participants (clients) with hearing impairment (HI). An evaluation was carried out with the study circle leaders. Study sample : Seventeen upper secondary school students with HI took part in the development of the programme. Eighteen study circle leaders responded to a questionnaire. Results: The EC programme developed consisted of films, CD, and DVD productions to increase insight into one's own hearing ability, to demonstrate for others what HI means, strategies to evaluate situations, and help to act constructively in social situations. The study circle leaders found most of the course material appropriate and easy to use, as a whole or in parts. The leaders' evaluations indicated that the clients had increased their knowledge about how the HI affected themselves and others. The clients had improved their self-confidence and their empathic view of others. Conclusion: The EC programme can be used in its entirety or in part. Participation may lead to increased empowerment, empathy, competence and counselling ability.

  • 21.
    Bäckström, Matilda
    et al.
    Örebro University, School of Health and Medical Sciences.
    Eriksson, Birgitta
    Örebro University, School of Health and Medical Sciences.
    Auditiv deprivering: i ett audionom perspektiv2008Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Studien riktar sig främst till audionomer, och andra med intresse av hörselrehabilitering.

    Auditiv deprivering kan visa sig som en med tiden försämrad taluppfattning i örat som inte fått adekvat stimulering. Vad som karaktäriserar dem som drabbas är inte klarlagt. Inte heller vet man exakt orsak eller tidsförlopp. Genom att hörapparatanpassa det drabbade örat har effekten kunnat reduceras och i vissa fall har fullständig återhämtning konstaterats.

    Litteraturstudiens syfte var att belysa fenomenet och aspekter som bör beaktas i audionomens arbete med insatser av både förebyggande och rehabiliterande karaktär. Metoden var att granska artiklar framtagna genom systematisk och manuell sökning, i databaser tillgängliga genom Örebro universi¬tet.

    Resultatet visar att personer med hörselnedsättning av såväl sensorineural som konduktiv art drabbas. Hörselnedsättningens grad kan troligen påverka, liksom symmetrin mellan öronen. Den initiala taluppfattningen i örat som drabbas kan variera. Detta arbete visar också att en sensitiv metod för att konstatera effekten är den som i Sverige heter maximal taluppfattning, men objektiva mätmetoder välkomnas. Audionomens ställningstagande i val av en eller två hörapparater berörs, med utgångspunkt av auditiv deprivering och binaural interference. Resultat och diskussion lyfter viktiga aspekter att beakta för audionomen i det rehabiliterande arbetet.

  • 22.
    Båsjö, Sara
    et al.
    Örebro University, School of Health Sciences. Swedish Institute for Disability Research, Örebro University Hospital, Örebro, Sweden; HEAD Graduate School, Linköping University, Linköping, Sweden.
    Möller, Claes
    Örebro University, School of Health Sciences. Swedish Institute for Disability Research, Örebro University Hospital, Örebro, Sweden.
    Widén, Stephen
    Örebro University, School of Health Sciences. Swedish Institute for Disability Research, Örebro University Hospital, Örebro, Sweden.
    Jutengran, Göran
    School of Health Sciences, University of Borås, Borås, Sweden.
    Kähäri, Kim
    Division of Audiology, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Hearing thresholds, tinnitus, and headphone listening habits in nine-year-old children2016In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 55, no 10, p. 587-596Article in journal (Refereed)
    Abstract [en]

    Objective: Investigate hearing function and headphone listening habits in nine-year-old Swedish children. Design: A cross-sectional study was conducted and included otoscopy, tympanometry, pure-tone audiometry, and spontaneous otoacoustic emissions (SOAE). A questionnaire was used to evaluate headphone listening habits, tinnitus, and hyperacusis. Study sample: A total of 415 children aged nine years.

    Results: The prevalence of a hearing threshold 20 dB HL at one or several frequencies was 53%, and the hearing thresholds at 6 and 8 kHz were higher than those at the low and mid frequencies. SOAEs were observed in 35% of the children, and the prevalence of tinnitus was 5.3%. No significant relationship between SOAE and tinnitus was found. Pure-tone audiometry showed poorer hearing thresholds in children with tinnitus and in children who regularly listened with headphones.

    Conclusion: The present study of hearing, listening habits, and tinnitus in nine-year old children is, to our knowledge, the largest study so far. The main findings were that hearing thresholds in the right ear were poorer in children who used headphones than in children not using them, which could be interpreted as headphone listening may have negative consequences to children’s hearing. Children with tinnitus showed poorer hearing thresholds compared to children without tinnitus.

  • 23.
    Carlsson, Ellinor
    et al.
    Örebro University, School of Health and Medical Sciences.
    Norén, Linda
    Örebro University, School of Health and Medical Sciences.
    Finns det samband mellan psykologiska symptom och sömnsvårigheter hos personer med hörselnedsättning?2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 24.
    Carlsson, Per-Inge
    et al.
    Örebro University, Department of Nursing and Caring Sciences.
    Borg, Erik
    Grip, Lars
    Dahl, Niklas
    Bondeson, Marie-Louise
    Variabillity in noise susceptibility in a Swedish population: the role of 35delG mutation in the Connexin 26 (GJB2) gene2004In: Audiological Medicine, ISSN 1651-386X, E-ISSN 1651-3835, Vol. 2, no 2, p. 123-130Article in journal (Refereed)
    Abstract [en]

    Although it seems that genetic factors can influence individual susceptibility to noise, still very little is known about the genes or the mechanisms involved. The connexin 26 (Cx26) (GJB2) gene is of particular interest to study in relation to noise, since the gene encodes the gap junction protein Cx26. Noise has a metabolic and mechanical effect on the inner ear and may, therefore, interfere with gap junction channels. In order to investigate whether abnormally high susceptibility to noise induced hearing loss (NIHL) in humans is associated with the common 35delG mutation in the Cx26 gene, 1200 noise‐exposed workers were investigated in Sweden. Using a selection procedure based on audiometric analysis, noise exposure data and questionnaires, noise‐exposed workers were divided into two categories: noise susceptible and noise resistant. There was a correspondence in noise susceptibility between this noise‐exposed population and the international reference ISO Standard 1999. Blood samples were drawn from 245 highly selected male subjects (103 noise susceptible, 112 noise resistant and 30 randomized cases), and genomic DNA was analysed with respect to the Cx26 35delG mutation. The incidence of 35delG carriers among this cohort was determined by multiplex, allele‐specific PCR. Two of the 245 subjects (0.8% ‐ [95% confidence interval 0.1–2.9]) were found to be heterozygous carriers of the 35delG mutation, while the remaining 243 subjects were all non‐carriers. Both the heterozygous carriers were found in the noise susceptible group. Statistical evaluation of the results demonstrated no significant difference in carrier incidence between the noise susceptible and noise resistant individuals in our Swedish noise‐exposed population. In conclusion, there was no support for a major role of Cx26 35delG mutation in explaining the variability in noise susceptibility in this Swedish population.

  • 25.
    Carlsson, Per-Inge
    et al.
    Department of Otorhinolaryngology, Central Hospital, Karlstad, Sweden; Audiological Research Centre, Örebro University Hospital, Örebro, Sweden.
    Karltorp, Eva
    Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.
    Carlsson-Hansén, Eva
    Department of Audiology, Örebro University Hospital, Örebro, Sweden.
    Åhlman, Henrik
    Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Möller, Claes
    Audiological Research Centre, Örebro University Hospital, Örebro, Sweden; Department of Otorhinolaryngology Karolinska University Hospital, Stockholm.
    von Döbeln, Ulrika
    Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden.
    GJB2 (Connexin 26) gene mutations among hearing-impaired persons in a Swedish cohort2012In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 132, no 12, p. 1301-1305Article in journal (Refereed)
    Abstract [en]

    Conclusion: The most common mutation in the Swedish population was Connexin 26 (C×26) 35delG, which indicates that the percentage of Swedish persons with C×26 mutations and polymorphisms in the GJB2 gene among non-syndromic hearing-impaired (HI) persons is comparable to the rest of Europe. The results strongly support a Swedish policy to offer all children with diagnosed hearing impairment genetic tests for the C×26 35delG mutation.

    Objectives: The aim of the present study was to search for mutations in the GBJ2 gene among Swedish persons with non-syndromic hearing impairment to further clarify how common these mutations are in Sweden, one of the northernmost countries in Europe.

    Methods: Seventy-nine patients with non-syndromic hearing impairment participated in the study. For 87% of the participants, a pure tone audiogram showed a severe or profound hearing impairment. Dried blood spots on filter paper, taken at 3-5 days of age in the Swedish nationwide neonatal screening programme for congenital disorders and saved in a biobank, were used for the molecular genetic analyses.

    Results: The total number of subjects with one or two pathologic mutations or a mutation of unknown consequence found in the GJB2 gene was 28 of 79 (35%). Nineteen (19) persons (24%) were homozygotes for the 35delG mutation.

  • 26.
    Dahlberg, Anna Maj
    et al.
    Örebro University, School of Health and Medical Sciences.
    Hjärpe, Maja
    Monaurala lågredundanta taltester: En litteraturstudie2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Monaurala lågredundanta taltester används, tillsammans med andra tester i testbatterier, för att undersöka centrala auditiva funktioner. Testgrupper som ingår i monaurala lågredundanta taltester är: lågpassfiltrerade taltester, tal-i-brus tester och tidskomprimerade taltester.

    Syfte: Syftet var att ta reda på vilka monaurala lågredundanta taltester som finns och vilka resultat man kan få på dessa.

    Metod: Litteraturstudie där experimentella studier har använts.

    Resultat: De monaurala lågredundanta taltester som har använts i de studerade artiklarna är filtrerat tal, meningar-i-brus, ord-i-brus, taluppfattning-i-brus, tal-i-brus, SPIN, R-SPIN, SSI/MCI, SSI/ICM, SIN, tidskomprimerade ord med olika kompressionsgrader, hackat tal, The Compressed Sentence Test och SCAN-A, SCAN-C med undertesterna Auditory Figure Ground och filtrerade ord. Försökspersoner med hörselnedsättning får signifikant sämre resultat än normalhörande på många av testerna. Barn får sämre resultat på flera av testerna jämfört med vuxna.

    Slutsatser: Det finns många olika monaurala lågredundanta taltester. De valda artiklarna tar upp fler monaurala lågredundanta taltester än vad som nämns i använd referenslitteratur.

  • 27.
    Dahlin Redfors, Ylva
    et al.
    Department of Otorhinolaryngology Head & Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Science, Sahl grenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Olaison, Sara
    Audiological Research Center, Örebro University Hospital, Örebro, Sweden; School of Medicine and Health Science, Örebro University, Örebro, Sweden; Swedish Institute of Disability Research, Örebro University, Örebro, Sweden.
    Karlsson, Jan
    Örebro University Hospital. Centre for Health Care Sciences Örebro University Hospital, Örebro, Sweden; School of Medicine and Health Science, Örebro University, Örebro, Sweden .
    Hellgren, Johan
    Department of Otorhinolaryngology Head & Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Möller, Claes
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Audiological Research Center, Region Örebro County, Örebro, Sweden.
    Hearing-related, health-related quality of life in patients who have undergone otosclerosis surgery: a long-term follow-up study2015In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 54, no 2, p. 63-69Article in journal (Refereed)
    Abstract [en]

    Objectives: The aims of the study were to assess health-related quality of life and hearing-related disability in subjects with otosclerosis 30 years after surgery.

    Design: An observational study was performed. Medical records were reviewed, a clinical examination as well as audiometric assessments were performed. Generic health-related quality of life was assessed by the SF-36v2 and hearing disability by a shortened version of SSQ (speech spatial and qualities of hearing scale).

    Study sample: Sixty-fi ve individuals, who had undergone stapedectomy in 1977-79 at a tertiary referral center.

    Results: Generic health-related quality of life according to SF-36 subscale scores was comparable to that of an age- and sex-matched reference population. The SF-36 mental component summary score (MCS) was, however, significantly better than that of the reference population. The mental and physical summary component scores correlated significantly to hearing disability measured by the SSQ but not to hearing impairment. Hearing disability was displayed in all SSQ sub-scores, especially in more complex listening situations and in the localization of sounds.

    Conclusions: This study shows that individuals with otosclerosis, 30 years after surgery, have a good generic health-related quality of life, despite moderate to severe hearing loss and significant hearing disabilities.

  • 28.
    Dahlin-Redfors, Ylva
    et al.
    Departments of Otolaryngology, Institute of Clinical Sciences, Jönköping, Sweden; Sahlgrenska Academy, University of Gotheburg, Gothenburg, Sweden.
    Gröndahl, H. G.
    Department of Maxillofacial Radiology, Institute for Postgraduate Dental Education, Jönköping, Sweden; Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hellgren, Johan
    Departments of Otolaryngology, Institute of Clinical Sciences, Jönköping, Sweden; Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lindfors, N.
    Department of Maxillofacial Radiology, Institute for Postgraduate Dental Education, Jönköping, Sweden; Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Nilsson, I.
    Department of Neuroradiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Möller, Claes
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Audiology, Örebro University Hospital, Örebro, Sweden.
    Otosclerosis: anatomy and pathology in the temporal bone assessed by multi-slice and cone-beam CT2012In: Otology and Neurotology, ISSN 1531-7129, E-ISSN 1537-4505, Vol. 33, no 6, p. 922-927Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the use of cone beam computed tomography (CBCT) compared with multi-slice computed tomography (MSCT) in otosclerosis, with special emphasis on middle-and inner-ear anatomy.

    Study Design: Prospective study.

    Patients: Twenty patients who underwent a stapedectomy 30 years ago were selected on the basis of bone conduction threshold values. Their mean age was 65 years (range, 48-76 yr).

    Intervention: All patients underwent CBCT and MSCT with a slice thickness of 0.5 to 0.6 mm.

    Main Outcome Measures: Sixteen middle-and inner-ear anatomic structures and stapedial prostheses were analyzed by visual grading analysis. To assess critical reproduction and thereby the clinical applicability of CBCT, a dichotomization was made. Assessment of otosclerotic foci was performed using a grading system dividing the lesions in; 1) sole fenestral lesions, 2) retrofenestral lesions with or without fenestral lesions and 3) severe retrofenestral lesions.

    Results: The 16 anatomic structures were clearly reproduced by both imaging techniques. However, there was an interobserver variation in judging the superiority of 1 method in favor of the other. Otosclerotic lesions were diagnosed in 80/95% using MSCT and 50/85% using CBCT (evaluators 1 and 2, respectively). Retrofenestral lesions were diagnosed in 5 of 10 of ears with severe-to-profound hearing loss, whereas no retrofenestral lesions were diagnosed in the 10 ears with mild-to-moderate hearing loss. The stapedial prostheses were adequately or very well reproduced by both methods.

    Conclusion: CBCT is a new imaging technique with a considerably lower radiation dose than conventional MSCT. Our study indicates that CBCT is suitable and, in many ways, equivalent to MSCT, for temporal bone imaging in otosclerosis.

  • 29.
    Danermark, Berth
    et al.
    Örebro University, School of Health and Medical Sciences.
    Cieza, Alarcos
    Inst Hlth & Rehabil Sci, ICF Res Branch, WHO CC FIC, Univ Munich, Munich, Germany.
    Gangé, Jean-Pierre
    Inst Univ Geriatrie Montreal, Ecole Orthophonie & Audiol, Univ Montreal, Montreal PQ, Canada.
    Gimigliano, Francesca
    Dept Audiol & Speech Sci, Univ Naples 2, Naples, Italy.
    Granberg, Sarah
    Örebro University, School of Health and Medical Sciences.
    Hickson, Louise
    Sch Hlth & Rehabil Sci, Commun Disabil Ctr, Univ Queensland, Brisbane Qld, Australia.
    Kramer, Sophia
    Med Ctr, Dept ENT Audiol, EMGO Inst Hlth & Care Res, Vrije, Univ Amsterdam, Amsterdam, Netherlands.
    McPherson, Bradley
    Ctr Commun Disorders, Univ Hong Kong, Hong Kong, Peoples R China.
    Möller, Claes
    Centre for Audiological Research, The University Hospital, Örebro, Sweden.
    Russo, Ieda
    Programa Estudos Posgrad Fonoaudiol, Pontificia Univ Catolica Sao Paulo, Sao Paulo, Brazil.
    Strömgren, Jan Peter
    Nottwil & Seminar Hlth Sci & Hlth Policy, Univ Lucerne, Luzern, Switzerland.
    Stucki, Gerold
    Nottwil & Seminar Hlth Sci & Hlth Policy, Univ Lucerne, Luzern, Switzerland.
    Swanepoel, DeWet
    Dept Commun Pathol, Univ Pretoria, Pretoria, South Africa; Callier Ctr Commun Disorders, Univ Texas Dallas, Dallas TX, USA.
    International classification of functioning, disability, and health core sets for hearing loss: A discussion paper and invitation2010In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 49, no 4, p. 256-262Article in journal (Refereed)
    Abstract [en]

    The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) has adopted a multifactorial understanding of functioning and disability, merging a biomedical paradigm with a social paradigm into a wider understanding of human functioning. Altogether there are more than 1400 ICF-categories describing different aspects of human functioning and there is a need to developing short lists of ICF categories to facilitate use of the classification scheme in clinical practice. To our knowledge, there is currently no such standard measuring instrument to facilitate a common validated way of assessing the effects of hearing loss on the lives of adults. The aim of the project is the development of an internationally accepted, evidence-based, reliable, comprehensive and valid ICF Core Sets for Hearing Loss. The processes involved in this project are described in detail and the authors invite stakeholders, clinical experts and persons with hearing loss to actively participate in the development process.

  • 30.
    Danermark, Berth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Audiological Research Centre, Örebro University Hospital, Örebro, Sweden; Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.
    Granberg, Sarah
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Swedish Institute for Disability Research, Örebro University, Örebro, Sweden; Audiological Research Centre, Örebro University Hospital, Örebro, Sweden; HEAD (Hearing and Deafness) Research School, Linköping University, Linköping, Sweden.
    Kramer, Sophia E.
    Vrije University Medical Center, Amsterdam, Netherlands.
    Selb, Melissa
    WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI), Nottwil, Switzerland; Swiss Paraplegic Research, Nottwil, Switzerland.
    Möller, Claes
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Audiological Research Centre, Örebro University Hospital, Örebro, Sweden; Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.
    The Creation of a Comprehensive and a Brief Core Set for Hearing Loss Using the International Classification of Functioning, Disability and Health2013In: American Journal of Audiology, ISSN 1059-0889, E-ISSN 1558-9137, Vol. 22, no 2, p. 323-328Article in journal (Refereed)
    Abstract [en]

    Purpose: In May 2001, to integrate biological, psychological, and social aspects of human functioning, the World Health Assembly endorsed the International Classification of Functioning, Disability and Health (ICF). The aim of this article is to describe the creation of Comprehensive and Brief ICF Core Sets for Hearing Loss. The core sets consist of the most relevant ICF categories for hearing loss. Method and Results: Four preparatory studies were carried out and presented at a consensus conference, resulting in a Comprehensive ICF Core Set for Hearing Loss, consisting of 117 ICF categories, and a Brief ICF Core Set for Hearing Loss, consisting of 27 categories (of the 117). Conclusion: The Comprehensive ICF Core Set for Hearing Loss can be a user-friendly tool for conducting comprehensive, multidisciplinary assessments. The Brief ICF Core Set can be used for many purposes, such as research and population studies. However, its most common use is by individuals seeking to provide a brief description and assessment of functioning of a person with hearing loss.

  • 31.
    Dort, Joseph C.
    et al.
    Section of Otolaryngology, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Cancer Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada.
    Farwell, D. Gregory
    Department of Otolaryngology, Division of Head and Neck Surgery, University of California Davis, Sacramento, USA.
    Findlay, Merran
    Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Camperdown NSW, Australia.
    Huber, Gerhard F.
    ENT Clinic, University Hospital Zürich, Zürich, Switzerland .
    Kerr, Paul
    Department of Otolaryngology, Winnipeg, Manitoba, Canada.
    Shea-Budgell, Melissa A.
    Cancer Strategic Clinical Network, Alberta Health Services, Calgary Alberta, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary Alberta, Canada.
    Simon, Christian
    Department of Otolaryngology, Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland.
    Uppington, Jeffrey
    University of California, Davis Health System, Sacramento, USA.
    Zygun, David
    Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Alberta, Canada.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Harris, Jeffrey
    Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton Alberta, Canada.
    Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction: A Consensus Review and Recommendations From the Enhanced Recovery After Surgery Society2017In: JAMA Otolaryngology - Head and Neck Surgery, ISSN 2168-6181, E-ISSN 2168-619X, Vol. 143, no 3, p. 292-303Article, review/survey (Refereed)
    Abstract [en]

    Importance: Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking.

    Objective: To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction.

    Evidence Review: Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic. The PubMed and Cochrane databases were initially searched to identify relevant publications on head and neck cancer surgery from 1965 through April 2015. Consistent key words for each topic included "head and neck surgery," "pharyngectomy," "laryngectomy," "laryngopharyngectomy," "neck dissection," "parotid lymphadenectomy," "thyroidectomy," "oral cavity resection," "glossectomy," and "head and neck." The final selection of literature included meta-analyses and systematic reviews as well as randomized controlled trials where available. In the absence of high-level data, case series and nonrandomized studies in head and neck cancer surgery patients or randomized controlled trials and systematic reviews in non-head and neck cancer surgery patients, were considered. An international panel of experts in major head and neck cancer surgery and enhanced recovery after surgery reviewed and assessed the literature for quality and developed recommendations for each topic based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations were graded following a consensus discussion among the expert panel.

    Findings: The literature search, including a hand search of reference lists, identified 215 relevant publications that were considered to be the best evidence for the topic areas. A total of 17 topic areas were identified for inclusion in the protocol for the perioperative care of patients undergoing major head and neck cancer surgery with free flap reconstruction. Best practice includes several elements of perioperative care. Among these elements are the provision of preoperative carbohydrate treatment, pharmacologic thromboprophylaxis, perioperative antibiotics in clean-contaminated procedures, corticosteroid and antiemetic medications, short acting anxiolytics, goal-directed fluid management, opioid-sparing multimodal analgesia, frequent flap monitoring, early mobilization, and the avoidance of preoperative fasting.

    Conclusions and Relevance: The evidence base for specific perioperative care elements in head and neck cancer surgery is variable and in many cases information from different surgerical procedures form the basis for these recommendations. Clinical evaluation of these recommendations is a logical next step and further research in this patient population is warranted.

  • 32.
    Drwesh, Bakhan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Professionellt bemötande är mer än att vara snäll: En integrerad litteraturstudie om bemötande inom hälso- och sjukvård2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 33.
    Durisala, Naresh
    et al.
    Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Republic of Singapore.
    Manchaiah, Vinaya
    Department of Speech and Hearing Sciences, Lamar University, Beaumont TX, USA; The Swedish Institute for Disability Research, Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden; Audiology India, Mysore IN-KA, India.
    Granberg, Sarah
    Örebro University, School of Health Sciences. Örebro University Hospital. The Swedish Institute for Disability Research (SIDR), Örebro University, Örebro, Sweden; Audiological Research Center, Örebro University Hospital, Örebro, Sweden.
    Möller, Kerstin
    Örebro University, School of Health Sciences. Örebro University Hospital. The Swedish Institute for Disability Research (SIDR),Örebro University, Örebro, Sweden; Audiological Research Center, Örebro University Hospital, Örebro, Sweden.
    Determination and classification of the problems experienced by adults with single-sided deafness using ICF classification: an exploratory study using 26 participants2017In: Clinical Otolaryngology, ISSN 1749-4478, E-ISSN 1365-2273, Vol. 42, no 3, p. 748-752Article in journal (Refereed)
    Abstract [en]

     1. Previous studies have shown the application of ICF in classifying hearing problems using open ended questionnaire.

    2. The present study leveraged on that concept and used ICF in classifying hearing related problems and their effects on life style in adults with single-sided deafness.

    3. We have used "problem and life effects" questionnaire to which patients were asked to list the problems and effects of hearing loss on their lives.

    4. Apart from hearing and emotional related problems, use of an open ended questionnaire allowed tapping onto some of the non-auditory problems that these individuals may experience. 5.ICF classification provided basic information on the complex character of single sided deafness and can serve as a key element for rehabilitation.

  • 34.
    Ekman, Johannes
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Utredning av asymmetrisk sensorineural hörselnedsättning: En litteraturstudie2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 35.
    Elawad, Mireille
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Karlsson, Emelie
    En studie om betydelsen av en hörselinformation:  - Ur ett patient- och anhörigperspektiv2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Att få ta del av gruppinformation inom vården har visat sig vara en betydelsefull del av rehabiliteringen för både patienter och deras anhöriga. Hörselinformation i grupp inför patienters hörselrehabilitering är en del av informationsrutinen på flera hörcentraler i Sverige. Dock finns det endast ett fåtal undersökningar som utvärderar hörselinformationstillfället utifrån ett patient- och anhörigperspektiv. Genom att utvärdera om hörselinformationstillfällena är meningsfulla för deltagarna undersöktes även om den tid som läggs ner av audionomerna är effektiv.

    Syfte: Syftet med undersökningen är att kartlägga patienters och anhörigas åsikter om den hörselinformation som ges i grupp inför en hörselrehabilitering. Kartläggningen avser områdena: Information och informationsmängd, Hörselinformationstillfällets upplägg, Utbyte av erfarenheter, Orsaker till anhörigas närvaro samt Förståelse motivation och delaktighet.

    Metod: Två enkäter konstruerades, en för patienter och en för anhöriga, därefter genomfördes en enkätundersökning i samband med nio hörselinformationstillfällen. Urvalet baserades på patienter och anhöriga, oavsett ålder och kön, som deltagit vid dessa hörselinformationstillfällen, inom en svensk hörsel- och dövverksamhet.

     

    Resultat: Överlag ansåg informanterna, att de fått lagom mängd information om hörsel, hörselnedsättning och hörselrehabilitering. Flertalet informanter upplevde att de fått chansen att vara delaktiga, fått tillfälle att utbyta erfarenheter samt fått en större förståelse för hur hörselnedsättningar kan påverka vardagslivet. De anhöriga följde med av olika anledningar, bland annat som stöd, transporthjälp eller av eget intresse. Efter hörselinformationstillfället upplevde majoriteten av patienterna att de blivit mer motiverade till att påbörja hörselrehabiliteringen. Det framkom även att flertalet av informanterna skulle rekommendera andra med hörselnedsättning och deras anhöriga att delta i hörselinformation. 

  • 36.
    Engelbrektsson, Jenny
    et al.
    Örebro University, School of Health and Medical Sciences.
    Reilin, Anu
    Örebro University, School of Health and Medical Sciences.
    Auditory Steady State Response: En jämförelse mellan två kliniska instrument: En experimentell studie2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

     

    I denna studie har jämförelse gjorts mellan Interacoustics Eclipse och GSI Audera i samband med Auditory Steady-State Respons (ASSR) mätningar.

    Syftet med studien var att undersöka ASSR som metod, att utvärdera dess tillförlitlighet i jämfö­relse med tonaudiometri för personer med normal hörsel och personer med hörsel­nedsätt­ning. Avsikten var dessutom att undersöka om elektrod­placering­ på örsnibb eller på mastoid påverkade mät­resultatet, försökspersonens upplevelse av instrumen­­t­ens ljudstimuli, om de estimerade ASSR-värdena påverkades av att mättillfället påbörjades eller avslutades med Interacoustics Eclipse samt undersöka tiden för mätningarna.

    En experimentell studie genomfördes. Mätningarna som utfördes var tonaudiometri och ASSR, den senare uppmättes med Interacoustics Eclipse och GSI Audera på (n=20) vuxna med normal hörsel och (n=4) vuxna med hörselnedsättning.

    För personer med normal hörsel påvisades en god överensstämmelse mellan estimerade ASSR-värden och tonaudiometri för Interacoustics Eclipse, något sämre överensstämmelse för GSI Audera. Genomsnittlig mättid för båda instrumenten var ca 40 min. Resultaten visade att elektrodplaceringen inte har någon påverkan på ASSR-värden för Interacoustics Eclipse. Hälften av försökspersonerna upplevde att Interacoustics Eclipse hade ett behagligare ljudstimuli att slappna av till och den andra hälften upplevde GSI Audera som behagligast. De estimerade ASSR-värdena påverkades minimalt beroende på om mättillfället påbörjades eller avslutades med Interacoustics Eclipse.

     

  • 37.
    Ericsson, Elisabeth
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Farmakologisk smärtbehandling (& illamående) i samband med tonsilloperation2012Conference paper (Refereed)
  • 38.
    Ericsson, Elisabeth
    Linköping University, Linköping, Sweden.
    Health and well-being of children and young adults in relation to surgery of the tonsils2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Tonsillectomy is one of the most frequently performed surgical procedures in children and youths. The aim of this thesis was to study children and youths in relation to tonsil surgery with the goal of improving the care, and to describe partial tonsillectomy/tonsillotomy (TT) using radiofrequency technique (RF) (Ellman International) in comparison with the more commonly used total tonsillectomy (TE).

    The thesis covers studies of wo age-groups with obstructive problems, with or without recurrent tonsillitis. Randomization to surgery was done from the existing waiting list; 92 children, 5-15 years old to 49/TT and 43/TE, (I-III) and 76 youths, 16-25 years old to 32/TT and 44/TE (IV-V).

    The first purpose (I, IV) was to compare the two surgical techniques with respect to pain and postoperative morbidity. Pain measures were for the children the Face Pain Scale and for the youths and parents and staff a verbal-pain-rating-scale. From the first day, the TT-groups scored significantly less pain than the TE-groups. The doses of pain-killing drugs (paracetamol and diclofenac) taken were significantly less for the children and youths receiving the TT-surgery, they could stop taking pain-killers sooner, and were back to normal activity three (5-15yrs) or four (16-25yrs) days earlier compared with TE-groups.

    Paper II focused on the child’s behavior (Child Behavior Checklist/CBCL), experience of pain, anxiety (State-Trait-Anxiety Inventory for Children /STAIC), previous experiences of surgery/tonsillitis, and the management of pain. The children scored higher on CBCL than a normative group before surgery, but no connection was observed between CBCL rating and experience of pain reported post surgically. There was no relation between preoperative anxiety and reported pain, but the postoperative anxiety level correlated with pain. The Egroup scored higher anxiety after surgery. Previous experience of surgery or tonsillitis did not influence the postoperative pain. The nurses scored pain lower than the parents/children and under-medicated.

    The second purpose was to compare the long-term effects of TT and TE-surgery after one and three years (5-15yrs) and one year (16-25yrs) (III, IV). The effect on snoring was the same for both TT and TE-groups and the rate of recurrence of throat infections was low after both surgical techniques.

    After one year, all children (TT/TE) showed improvements on CBCL to the same degree and there was no longer a difference between total behavior and normative values. They also scored improvements in health-related quality of life (HRQL) with Glasgow-Children-Benefit-Inventory.

    For both TT and TE, the older group reported lower HRQL preoperatively on all dimensions of Study-Short-Form (SF-36) compared with a normal population. After one year, a large improvement was found in HRQL in both groups and there were no differences compared with a normal population.

    Conclusion: Preoperative obstructive problems, in combination with recurrent tonsillitis have a negative impact on HRQL. Both after TE and TT there are large improvements in HRQL, infections, obstructive, and behavior problems one to three years after surgery, indicating that both surgical methods are equally effective. With fewer postoperative complications, less pain, shorter recovery time, and lower cost, TT with RF should be considered as method of choice.

    List of papers
    1. Pediatric Tonsillotomy with Radiofrequency Technique: Less Morbidity and Pain
    Open this publication in new window or tab >>Pediatric Tonsillotomy with Radiofrequency Technique: Less Morbidity and Pain
    2004 (English)In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 114, no 5, p. 871-877Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To compare two techniques for pediatric tonsil surgery with respect to pain and postoperative morbidity. The two methods were the partial tonsil resection using radiofrequency (RF) technique (tonsillotomy [TT]) versus traditional tonsillectomy (TE).

    STUDY DESIGN: Prospective clinical randomized study in one tertiary care ENT clinic and two secondary care clinics.

    METHOD: One hundred fifty children, between 5 and 15 years of age, were randomized to either TT with RF using the Surgitron Ellman, 1.7 MHz, or regular TE. Randomization was performed from the waiting list, including children with both a history of obstructive problems and recurrent tonsillitis. The TT was performed with a specially made sling electrode using a cut/coagulation mode.

    RESULTS: Forty-nine children were operated on with TT and 43 with TE. There was significantly less bleeding in the TT group, although two cases of primary postoperative bleeding occurred among the TT children and one in the TE group. The pain recordings showed significantly less pain for the TT children from the second hour postoperatively onward, and the TT children were pain free and in school 3 days earlier than the TE group. The TT group had less need of the prescribed drugs (diclofenac and paracetamol). After 9 days, 73% of the TT children were completely healed, but only 31% of the TE children. By that time, the TE children had lost a mean of 660 g, and the TT children had gained 127 g. The effect on snoring was the same for both groups.

    CONCLUSION: RF appears to be a safe and reliable method for tonsil surgery with much less postoperative morbidity than regular TE.

    Keywords
    Tonsils, tonsil surgery, RF surgery, snoring, sleep apnea
    National Category
    Otorhinolaryngology
    Identifiers
    urn:nbn:se:oru:diva-40826 (URN)10.1097/00005537-200405000-00016 (DOI)000221537900016 ()15126747 (PubMedID)2-s2.0-2442423346 (Scopus ID)
    Available from: 2007-05-21 Created: 2015-01-11 Last updated: 2017-12-05Bibliographically approved
    2. Pre-surgical Child Behavior Ratings and Pain Management after Two Different Techniques of Tonsil Surgery
    Open this publication in new window or tab >>Pre-surgical Child Behavior Ratings and Pain Management after Two Different Techniques of Tonsil Surgery
    2006 (English)In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 70, no 10, p. 1749-1758Article in journal (Refereed) Published
    Abstract [en]

    Objective

    The purpose of this investigation was to compare child behavior before surgery with experience of pain and anxiety in relation to two techniques of tonsil surgery, to relate previous experiences of surgery/tonsillitis with anxiety and pain, and to compare the children's, parent's and nurse's rating of pain.

    Method

    Ninety-two children (5–15 years) with sleep-disordered breathing (SDB) and with or without recurrent tonsillitis were randomized to partial tonsil resection/tonsillotomy (TT) or full tonsillectomy (TE). Measures: Parents: Child Behavior Checklist (CBCL). Children: State-Trait-Anxiety Inventory for Children (STAIC) and seven-point Faces Pain Scale (FPS). Parents/staff: seven-point Verbal Pain Rating Scale (VPRS). Pain relievers were opoids, paracetamol and diclophenac.

    Results

    These children with SDB scored significantly higher on CBCL than did normative groups, but no connection was observed between CBCL rating and experience of pain. There was no relation between pre-operative anxiety and pain. The post-operative anxiety level (STAIC) correlated with pain. The TE-group scored higher on STAIC after surgery. Previous experience of surgery or tonsillitis did not influence post-operative pain. The TE-group rated higher experience of pain despite more medication. The nurses scored pain lower than the parents/children and under-medicated.

    Conclusion

    SDB may influence children's behavior, but with no relation to post-operative pain. The surgical method predicts pain better than does the child's behavior rating. The nurses underestimated the pain experienced by the child.

    Keywords
    Children; Post-operative pain; Anxiety; Behavior; Tonsil surgery; Anesthesia
    National Category
    Otorhinolaryngology
    Identifiers
    urn:nbn:se:oru:diva-40832 (URN)10.1016/j.ijporl.2006.05.017 (DOI)000240782400010 ()16814402 (PubMedID)2-s2.0-33747891695 (Scopus ID)
    Available from: 2007-05-21 Created: 2015-01-11 Last updated: 2017-12-05Bibliographically approved
    3. Pediatric Tonsillotomy with the Radiofrequency Technique – Long-term Follow-up
    Open this publication in new window or tab >>Pediatric Tonsillotomy with the Radiofrequency Technique – Long-term Follow-up
    2006 (English)In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 116, no 10, p. 1851-1857Article in journal (Refereed) Published
    Abstract [en]

    Objectives: Compare the effects of partial tonsil resection using a radiofrequency technique, tonsillotomy (TT), with total tonsillectomy (TE, blunt dissection) after 1 and 3 years. Compare frequency of relapse in snoring or infections and possible long-term changes in behavior among TT children with those in TE children.

    Method: Ninety-two children (5-15 yr) randomized to TT (n = 49) or TE (n = 43) groups because of obstructive problems with or without recurrent tonsillitis. One year after surgery, general health, degree of obstruction, history of infections, and behavior were investigated using two questionnaires, the Qu1 and Child Behavior Checklist, as well as an ENT visit. After 3 years, two questionnaires, Qu2 and the Glasgow Children's Benefit Inventory, were answered by mail.

    Results: After 1 year, both groups were in good health. The effect on snoring and total behavior was the same for both groups, and the rate of recurrence of infections was not higher in the TT group. After 3 years, two children in the TT group were tonsillectomized (4%, 2/49), one because of peritonsillitis and another because of increased snoring. Otherwise, no differences existed between the groups in general health, snoring, or number of infections.

    Conclusion: Removing only the protruding parts of the tonsils has the same beneficial long-term effect on obstructive symptoms and recurrent throat infections as complete TE in the majority of cases. The need for re-operation is low; therefore, it appears inadvisable to follow the current common practice of routinely removing the whole tonsil given its higher morbidity and risk for serious complications.

    Keywords
    Tonsil surgery, tonsillotomy, snoring, behavior, reduced morbidity, immunology, long-term follow-up
    National Category
    Otorhinolaryngology
    Identifiers
    urn:nbn:se:oru:diva-40827 (URN)10.1097/01.mlg.0000234941.95636.e6 (DOI)000221537900016 ()17003713 (PubMedID)2-s2.0-33749437091 (Scopus ID)
    Available from: 2007-05-21 Created: 2015-01-11 Last updated: 2017-12-05Bibliographically approved
    4. Tonsil Surgery in Youths – Good Results with Less Invasive Method
    Open this publication in new window or tab >>Tonsil Surgery in Youths – Good Results with Less Invasive Method
    2007 (English)In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 117, no 4, p. 654-661Article in journal (Refereed) Published
    Abstract [en]

    Objective: Comparison of two types of tonsil surgery for 16- to 25-year-old patients, with respect to primary morbidity, snoring, and recurrent infections after 1 year. Teenagers and young adults are a significant proportion (26%) of the population that receive tonsil surgery each year and appear to suffer more pain than younger children. Recurrent tonsillitis, in combination with obstructive problems, is the main indication for surgery.

    Method: One hundred fourteen patients 16 to 25 years of age were randomized to tonsillotomy (TT) with radiosurgery (RF) (Ellman International) or to cold tonsillectomy (TE). Pain and analgesics were logged until patients were pain free.

    Results: Thirty-two patients were operated on with TT and 44 with TE. The TT group had less blood loss during surgery and no postoperative bleedings, compared with the TE group (2 primary and 4 late hemorrhages). The TT group recorded significantly less pain from the first day, had less need of analgesics (diclofenac and paracetamol), and were pain free and in school/at work 4 days earlier than the TE group. After 7 days, the TE patients had lost a mean of 1.8 kg compared with TT, with no significant weight loss. After 1 year, both groups were satisfied. The positive effect on snoring was the same for both groups. There were few throat infections in both groups.

    Conclusion: TT with RF is an effective method for tonsil surgery for many teenagers and young adults, with much less postoperative morbidity than regular TE. Long-term follow-up is necessary.

    Keywords
    Tonsillotomy, tonsillectomy, radiofrequency surgery, postoperative pain, snoring, recurrent tonsillitis
    National Category
    Otorhinolaryngology
    Identifiers
    urn:nbn:se:oru:diva-40838 (URN)10.1097/mlg.0b013e318030ca69 (DOI)000245377400018 ()17415136 (PubMedID)2-s2.0-34147128609 (Scopus ID)
    Available from: 2007-05-21 Created: 2015-01-11 Last updated: 2017-12-05Bibliographically approved
    5. Long-Term Improvement of Quality of Life as a Result of Tonsillotomy (With Radiofrequency Technique) and Tonsillectomy in Youths
    Open this publication in new window or tab >>Long-Term Improvement of Quality of Life as a Result of Tonsillotomy (With Radiofrequency Technique) and Tonsillectomy in Youths
    2007 (English)In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 117, no 7, p. 1272-1279Article in journal (Refereed) Published
    Abstract [en]

    Objective: This is a 1 year follow-up to compare the effects of partial tonsil resection using the radiofrequency technique (RF) tonsillotomy (TT) with total tonsillectomy (TE) (blunt dissection). Obstructive symptoms, tendency for infections, and health-related quality of life (HRQL) were studied and compared with the HRQL data from a normal population.

    Method: The study group consisted of 74 patients (16-25 yr old) randomized to TT (n = 31) or TE (n = 43) with obstructive throat problems with or without recurrent tonsillitis. The Short Form 36 (SF-36) and EuroQul Visual Analogue Scale were used to evaluate HRQL. A questionnaire investigated the degree of obstruction and history of infections.

    Results: Preoperatively, both groups reported significantly lower HRQL in all dimensions of the SF-36 compared with the normal population (P < .05-P < .001). After 1 year, a large improvement (P < .01-P < .001) in both groups in HRQL was found. No differences were found when these groups were compared with the normal population or between the study groups. The effect on snoring was the same for both groups, and the rate of recurrence of infections was low and not any higher in the TT group.

    Conclusion: Preoperative obstructive problems in combination with recurrent tonsillitis have a negative impact on HRQL. Both the TT and TE groups demonstrated large improvements on HRQL, infections, and obstructive problems 1 year after surgery, indicating that the surgical methods are equally effective. With its reduced postoperative complications, less pain, shorter recovery time, and cost reduction, TT with RF should be considered the method of choice.

    Keywords
    tonsillotomy, tonsillectomy, health-related quality of life, Short Form 36, snoring, recurrent tonsillitis
    National Category
    Otorhinolaryngology
    Identifiers
    urn:nbn:se:oru:diva-40810 (URN)10.1097/MLG.0b013e31805559e1 (DOI)000247763700027 ()17603326 (PubMedID)2-s2.0-34347347298 (Scopus ID)
    Available from: 2007-05-21 Created: 2015-01-11 Last updated: 2017-12-05Bibliographically approved
  • 39.
    Ericsson, Elisabeth
    School of Health Science, Jönköping University, Jönköping, Sweden.
    Improvement of Quality of Life by Tonsillotomy & Tonsillectomy in Children and Youths2009In: 1st Meeting of the European Academy of ORL - HNS, Mannheim, Tyskland  27-30 juni, 2009, 2009Conference paper (Refereed)
    Abstract [en]

    Background: There has been increasing evidence over the last few years that paediatric sleep-disordered breathing is associated with behavioural and neurocognitive problems as well as with poor school performance, failure to thrive and poor health related quality of life (HRQL). Several studies indicate that both behaviour and quality of life improve after tonsillectomy (TE) in children with sleep-disordered breathing (SDB). However, TE causes considerable pain and morbidity which often lasts more than seven days. Postoperative pain is poorly managed and under-treatment of pain leads to increased morbidity and postoperative behavioural changes. Tonsillotomy (TT) for obstructive symptoms has re-appeared with focus on reduction of postoperative morbidity. Removing only the protruding parts of the tonsils seems to have the same beneficial long-term effect on obstructive symptoms due to hypertrophic tonsils.

    Material and Method: Children and youths have been studied in relation to tonsil surgery with the goal of improving care and comparisons have been made between TT and TE.

    The first part of this presentation will cover three randomized trials of children and youth  4 to 25 years old with respect to pain and morbidity and with six months to three years follow-up including assessment of HRQL.

    The second part presents preliminary results from a Swedish national study of a sample of 550 children (4-15 yrs) to determine the impact on HRQL before and six months after TT or TE.

    In the studies, the impact on HRQL was evaluated in the younger age group using the Obstructive Sleep Apnea-18 (OSA-18), Glasgow Children´s Benefit Inventory (GCBI); their behavioural and emotional problems were assessed using the Child Behaviour Checklist (CBCL). In the age group 16-25 yrs, the HRQL was measured using the SF-36.

    Results: In the TT groups, the children recorded less pain from the first day after surgery onwards, used fewer doses of painkillers, and were pain-free 3 days (5-15yrs)/4 days (16-25 yrs) earlier than the children/youths in the TE group. For most TT patients, the combination of Paracetamol and Diclophenac was sufficient for analgesia. However, most of the TE patients with that medication had considerable pain and 50% still experienced substantial pain after one week. Before surgery, HRQL was registered as much lower among patients with obstruction problems when compared to the reference sample. Surgery with either tonsillotomy or tonsillectomy was associated with a marked improvement of the quality of life both for children with severe obstructive sleep related distress or with milder sleep disordered breathing.

     

    Conclusion: TT is a safe method, which causes less pain and postoperative morbidity than regular TE. Children and young adults with tonsillar hypertrophy and different degrees of obstructive sleep related distress all show a negative impact on HRQL and behaviour. All improve dramatically after a tonsillar operation—equally after TT as compared to TE.

  • 40.
    Ericsson, Elisabeth
    HHJ. CHILD, Högskolan i Jönköping, Jönköping.
    Validering av OSA-18 på en svensk barnpopulation2009In: Svensk ÖNH-tidskrift, ISSN 1400-0121, Vol. 16, no 4, p. 16-19Article in journal (Other academic)
  • 41.
    Ericsson, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Brattwall, Metha
    Anesthesia and Intensive Care, Sahlgrenska University Hospital, Mölndal, Sweden.
    Lundeberg, Stefan
    Pain treatment service, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden .
    Swedish guidelines for the treatment of pain in tonsil surgery in pediatric patients up to 18 years2015In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 79, no 4, p. 443-450Article in journal (Refereed)
    Abstract [en]

    Background: Surgery of the tonsils often causes severe pain lasting for many days as been shown by data from the National Tonsil Surgery Register in Sweden. Tonsillotomy is associated with fewer readmissions due to bleeding, number of days requiring analgesics and health care contacts due to pain compared to tonsillectomy. The register data demonstrate the necessity of better-evidenced based pain treatment guidelines for tonsil-surgery.

    Objectives: To develop evidenced based pain treatment guidelines for tonsil-surgery in Sweden.

    Methods: The evidence based guidelines were designed by an updated literature review and from the clinical expertise in the pediatric pain field, which thereafter were reviewed by ENT-doctors and anesthetists from each ENT-clinic in Sweden.

    Results: A multimodal pain treatment approach is advocated, including premedication and administration during anesthesia, with paracetamol (acetaminophen), clonidine and betamethasone. If not given as a premedication the combination can be administered intravenously in the initial phase of anesthesia. At the end of surgery, if no bleeding problems, cox-inhibitors can be given.After discharge from hospital, the recommendations for pain relief are paracetamol combined with cox-inhibitors (ibuprofen, diclofenac) and if needed oral clonidine in favor of opioids. When pain intensity decreases, discontinue the analgesic treatment in the following order: opioid, clonidine, paracetamol and at last ibuprofen. The need for analgesic treatment after tonsillectomy is usually 5-8 days, after tonsillotomy only 3-5 days.Parents are recommended to contact the hospital if the child has difficulties in drinking or eating adequately and/or suffers from pain despite taking the recommended medication regularly.

    Conclusions: Swedish guidelines for tonsil-surgery provide practical evidence-based pain treatment recommendations.

  • 42.
    Ericsson, Elisabeth
    et al.
    Linköpings universitet.
    Graf, Jonas
    Linköpings universitet.
    Hultcrantz, Elisabeth
    Linköpings universitet.
    Pediatric Tonsillotomy with the Radiofrequency Technique – Long-term Follow-up2006In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 116, no 10, p. 1851-1857Article in journal (Refereed)
    Abstract [en]

    Objectives: Compare the effects of partial tonsil resection using a radiofrequency technique, tonsillotomy (TT), with total tonsillectomy (TE, blunt dissection) after 1 and 3 years. Compare frequency of relapse in snoring or infections and possible long-term changes in behavior among TT children with those in TE children.

    Method: Ninety-two children (5-15 yr) randomized to TT (n = 49) or TE (n = 43) groups because of obstructive problems with or without recurrent tonsillitis. One year after surgery, general health, degree of obstruction, history of infections, and behavior were investigated using two questionnaires, the Qu1 and Child Behavior Checklist, as well as an ENT visit. After 3 years, two questionnaires, Qu2 and the Glasgow Children's Benefit Inventory, were answered by mail.

    Results: After 1 year, both groups were in good health. The effect on snoring and total behavior was the same for both groups, and the rate of recurrence of infections was not higher in the TT group. After 3 years, two children in the TT group were tonsillectomized (4%, 2/49), one because of peritonsillitis and another because of increased snoring. Otherwise, no differences existed between the groups in general health, snoring, or number of infections.

    Conclusion: Removing only the protruding parts of the tonsils has the same beneficial long-term effect on obstructive symptoms and recurrent throat infections as complete TE in the majority of cases. The need for re-operation is low; therefore, it appears inadvisable to follow the current common practice of routinely removing the whole tonsil given its higher morbidity and risk for serious complications.

  • 43.
    Ericsson, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Graf, Jonas
    Department of Anesthesia and Intensive Care, Linköping University, Linköping; Division of Otorhinolaryngology, Department of Clinical and Experimental Medicine, Linköping University, Linköping.
    Lundeborg-Hammarström, Inger
    Division of Speech and Language Pathology, Department of Clinical and Experimental Medicine, Linköping University, Linköping.
    Hultcrantz, Elisabeth
    Division of Otorhinolaryngology, Department of Clinical and Experimental Medicine, Linköping University, Linköping.
    Tonsillotomy versus tonsillectomy on young children: 2 year post surgery follow-up2014In: Journal of Otolaryngology - Head & Neck Surgery, ISSN 1916-0216, Vol. 43, no 26Article in journal (Refereed)
    Abstract [en]

    Objectives: To study the long-term effect of tonsillotomy and tonsillectomy in young children after two years in comparison to the results after six months.

    Method: Children, age 4-5 with Sleep Disordered Breathing (SDB) and tonsil hyperplasia, were randomized to TE (32) or TT (35). TT was performed ad modum Hultcrantz with radiofrequency technique (Ellman). An adenoidectomy with cold steel was performed in the same session for 80% of cases. The patients were assessed prior to surgery, at six and 24 months postoperatively. Effects of surgery were evaluated clinically, through questionnaire (general health/snoring/ENT-infections), Quality of Life (QoL), survey of pediatric obstructive sleep apnea with OSA-18, and children’s behavior with the Child Behavior Checklist.

    Results: After two years there was still no difference between the groups with respect to snoring and frequency or severity of upper airway infections. Both TT and TE had resulted in large improvement in short and long term QoL and behavior. Three TT-children and one TE child had been re-operated due to recurrence of obstructive problems, the TE-child and one of the TT-children with adenoidectomy and two of the TT-children with tonsillectomy. Three of the TT-children had tonsil tissue protruding slightly out of the tonsil pouch and twelve TE-children had small tonsil remnants within the tonsil pouches, but with no need for surgery.

    Conclusion: Younger children have a small risk of symptom-recurrence requiring re-surgery within two years after TT. For the majority, the positive effect on snoring, infections, behavior and quality of life remain and is similar to TE.

  • 44.
    Ericsson, Elisabeth
    et al.
    School of Health Science, Jönköping University, Jönköping.
    Hemlin, Claes
    Avdelningen för Otorhinolaryngologi, Aleris Sabbatsberg, Stockholm, Sweden.
    Hessen-Söderman, Ann-Charlotte
    Avdelningen för Otorhinolaryngologi, Karolinska Universitetssjukhuset, Solna, Sweden.
    Hultcrantz, Elisabeth
    Avdelningen för Otorhinolaryngologi, Inst för Kliniks och Experimentell Medicin, Hälsouniversitetet, Linköpings universitet, Linköping, Sweden.
    Månsson, Ingemar
    Avdelningen för Otorhinolaryngologi, Sahlgrenska Universitetssjukhuset, Göteborg, Sweden.
    Roos, Kristian
    Avdelningen för Otorhinolaryngologi, Capio Lundby sjukhus, Göteborg, Sweden.
    Stahlfors, Joacim
    Avdelningen för Otorhinolaryngologi, Sahlgrenska Universitetssjukhuset, Göteborg, Sweden.
    The role of information and instruction to children and parents in homemanagement after tonsil surgery: what is it helpful for them to know?2010Conference paper (Refereed)
    Abstract [en]

    OBJECTIVES

    To create national recommendations for information after tonsil surgery to improve the management ofchildren.

    METHODS

    1. A search of Medline addressing evidence on expectations and advice about medication and nonpharamacological techniques to relieve pain after tonsil surgery and 2. A questionnaire focusing on the routines for information before and after tonsil surgery was administrated to all ENT-clinics in Sweden with 99% response rate.

    RESULTS

    There is evidence that information has an empowering effect upon parents to feel more control over their child’s care. Lack of information leads to anxiety and increased perception of pain in the child. Children and parents who were given specific information related to pain and morbidity, reported less pain and were less anxious than those with no or insufficient information. Constructive information should be given gradually, starting preoperatively, to parents and children. A leaflet should contain sufficient information about what happens before, during and is to be expected after surgery, the risks and possible complications, and advice and recommendation of medication and non-pharmacological techniques. Results from the national enquiry (N=48) showed the provision of a variety of different written information from the various clinics, often insufficient. Based on these findings, an information leaflet for patients and a checklist based on the literature for the staff to use at discharge were developed (both will be available).

    CONCLUSIONS

    A checklist for the staff insures that parents and children get consistent advice. A leaflet provided before surgery helps children and parents with methods to relieve pain. This could decrease the number of complications and later consultations and give shorter recovery.

  • 45.
    Ericsson, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hemlin, Claes
    Aleris Specialistvård, Stockholm, Sverige.
    Stalfors, Joacim
    Sahlgrenska Universitetssjukhuset, Göteborg, sverige.
    Hessén-Söderman, Anne-Charlotte
    Aleris Specialistvård, Stockholm, Sverige.
    Odhagen, Erik
    Södra Älvsborgs Sjukhus, Borås, Sverige.
    Sunnergren, Ola
    Länssjukhuset Ryhov, Jönköping, Sverige.
    Kvalitetsregistret för tonsilloperation2014In: Nationellt kvalitetsregister Öron- Näs och Halssjukvård - Årsrapport 2013: Du kan vara med och förbättra vården / [ed] Joacim Stalfors, Västra Götalandsregionen , 2014, , p. 100p. 34-97Chapter in book (Other academic)
  • 46.
    Ericsson, Elisabeth
    et al.
    Linköpings universitet.
    Hultcrantz, Elisabeth
    Linköpings universitet.
    Tonsil Surgery in Youths – Good Results with Less Invasive Method2007In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 117, no 4, p. 654-661Article in journal (Refereed)
    Abstract [en]

    Objective: Comparison of two types of tonsil surgery for 16- to 25-year-old patients, with respect to primary morbidity, snoring, and recurrent infections after 1 year. Teenagers and young adults are a significant proportion (26%) of the population that receive tonsil surgery each year and appear to suffer more pain than younger children. Recurrent tonsillitis, in combination with obstructive problems, is the main indication for surgery.

    Method: One hundred fourteen patients 16 to 25 years of age were randomized to tonsillotomy (TT) with radiosurgery (RF) (Ellman International) or to cold tonsillectomy (TE). Pain and analgesics were logged until patients were pain free.

    Results: Thirty-two patients were operated on with TT and 44 with TE. The TT group had less blood loss during surgery and no postoperative bleedings, compared with the TE group (2 primary and 4 late hemorrhages). The TT group recorded significantly less pain from the first day, had less need of analgesics (diclofenac and paracetamol), and were pain free and in school/at work 4 days earlier than the TE group. After 7 days, the TE patients had lost a mean of 1.8 kg compared with TT, with no significant weight loss. After 1 year, both groups were satisfied. The positive effect on snoring was the same for both groups. There were few throat infections in both groups.

    Conclusion: TT with RF is an effective method for tonsil surgery for many teenagers and young adults, with much less postoperative morbidity than regular TE. Long-term follow-up is necessary.

  • 47.
    Ericsson, Elisabeth
    et al.
    School of Health Science, Jönköping University, Jönköping, Sweden.
    Hultcrantz, Elisabeth
    Department of Clinical and Experimental Medicine. Linköping University, Linköping, Sweden.
    Månsson, Ingemar
    Hälso- och sjukvårdsstyrelsen, Västra Götalandsregionen, Göteborg, Sweden, .
    Roos, Kristian
    Capio Lundby Sjukhus AB, Göteborg, Sweden .
    Stalfors, Joachim
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Weitz, Per
    Central Hospital, Västerås, Sweden.
    Erfarenheter från kvalitetsregistret för tonsilloperation 1997-20082008In: Medicinska Riksstämman, Göteborg 26-28 nov, 2008, 2008Conference paper (Other academic)
    Abstract [sv]

    Bakgrund

    Kvalitetsregister för svensk ÖNH-sjukvård infördes successivt med början 1997, ett av registren ägnades tonsillektomi. Detta register har nu varit i bruk i drygt 10 år. Det kommer att avslutas med operationer utförda t.o.m. 081231. Registret beräknas komma att omfatta ca 50 000 ingrepp, det fortsätter sedan i modifierad form och med ny teknik för insamling av data. Med anledning av att en period för tonsilloperationsregistret nu avslutas, ges här en översiktlig rapport om erfarenheterna.

    Metod

    Kvalitetsregistret är tänkt att användas såväl på kliniknivå som på nationell nivå. På kliniknivå ska effekter och bieffekter av ingreppet jämföras dels med riksgenomsnittet och dels med sig själv över tid. På riksnivå kan förändringar i indikationer, operationsmetoder och organisatoriska förändringar m.m. studeras. Rapporten analyserar utvecklingen av det nuvarande tonsilloperationsregistret med fokus på den nationella nivån samt presenterar några rapporter som tillkommit i anslutning till registret.

    Resultat

    En översiktlig presentation ges av: ⋅ Registrets data på nationell bas ⋅ Hälso- och sjukvårdsrapport 2001 ⋅ Oväntad ålders- och könsfördelning ⋅ Oplanerade återbesök ⋅ Patienters upplevelse av komplikationer till tonsillektomi ⋅ Nationella indikationer för tonsilloperation ⋅ M.m.

    Sammanfattning

    En sammanfattning av utvecklingen av ett nationellt kvalitetsregister med 50 000 tonsilloperationer presenteras.

  • 48.
    Ericsson, Elisabeth
    et al.
    Linköpings universitet.
    Ledin, Torbjörn
    Linköpings universitet,.
    Hultcrantz, Elisabeth
    Linköpings universitet.
    Long-Term Improvement of Quality of Life as a Result of Tonsillotomy (With Radiofrequency Technique) and Tonsillectomy in Youths2007In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 117, no 7, p. 1272-1279Article in journal (Refereed)
    Abstract [en]

    Objective: This is a 1 year follow-up to compare the effects of partial tonsil resection using the radiofrequency technique (RF) tonsillotomy (TT) with total tonsillectomy (TE) (blunt dissection). Obstructive symptoms, tendency for infections, and health-related quality of life (HRQL) were studied and compared with the HRQL data from a normal population.

    Method: The study group consisted of 74 patients (16-25 yr old) randomized to TT (n = 31) or TE (n = 43) with obstructive throat problems with or without recurrent tonsillitis. The Short Form 36 (SF-36) and EuroQul Visual Analogue Scale were used to evaluate HRQL. A questionnaire investigated the degree of obstruction and history of infections.

    Results: Preoperatively, both groups reported significantly lower HRQL in all dimensions of the SF-36 compared with the normal population (P < .05-P < .001). After 1 year, a large improvement (P < .01-P < .001) in both groups in HRQL was found. No differences were found when these groups were compared with the normal population or between the study groups. The effect on snoring was the same for both groups, and the rate of recurrence of infections was low and not any higher in the TT group.

    Conclusion: Preoperative obstructive problems in combination with recurrent tonsillitis have a negative impact on HRQL. Both the TT and TE groups demonstrated large improvements on HRQL, infections, and obstructive problems 1 year after surgery, indicating that the surgical methods are equally effective. With its reduced postoperative complications, less pain, shorter recovery time, and cost reduction, TT with RF should be considered the method of choice.

  • 49.
    Ericsson, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lundeberg, Stefan
    Astrid Lindgrens barnsjukhus, Karolinska universitetssjukhus, Stockholm, Sweden.
    Brattwall, Metha
    Sahlgrenska Universitetssjukhus, Göteborg, Sweden.
    Hemlin, Claes
    Aleris Specialistvård, Stockholm, Sweden.
    Hessén-Söderman, Anne-Charlotte
    Aleris Specialistvård, Stockholm, Sweden.
    Hultcrantz, Elisabeth
    Linköpings universitet, Linköping, Sweden.
    Odhagen, Erik
    Södra Älvsborgs Sjukhus, Borås, Sweden.
    Sunnergren, Ola
    Länssjukhuset Ryhov, Jönköping, Sweden.
    Stalfors, Joacim
    Sahlgrenska Universitetssjukhus, Göteborg, Sweden.
    Pharmacological treatment in children after tonsil-surgery: updated Swedish national guidelines2014Conference paper (Refereed)
  • 50.
    Ericsson, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lundeberg, Stefan
    Astrid Lindgrens barnsjukhus, Karolinska universitetssjukhus, Stockholm, Sweden.
    Brattwall, Metha
    Sahlgrenska Universitetssjukhus, Göteborg, Sweden.
    Hemlin, Claes
    Aleris Specialistvård, Stockholm, Sweden.
    Hessén-Söderman, Anne-Charlotte
    Aleris Specialistvård, Stockholm, Sweden.
    Odhagen, Erik
    Södra Älvsborgs Sjukhus, Borås, Sweden.
    Sunnergren, Ola
    Länssjukhuset Ryhov, Jönköping, Sweden.
    Stalfors, Joacim
    Sahlgrenska Universitetssjukhus, Göteborg, Sweden.
    National guidelines of pharmacological treatment in children: the implementations process2014Conference paper (Refereed)
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