To Örebro University

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

During a period of 5 years, a total of 47 patients, 16-60 years of age, with major closed head injury (CHI) were admitted to 2 Swedish medical centres. Seven to 11 years after injury, 25 of them (mean age 40.8 years; range 25-59 years) were evaluated using peripheral and central auditory tests, and most of them also completed 2 questionnaires concerning self-assessed hearing ability and quality of life. Twenty-two patients did not participate in the long-term follow-up tests: 15 were excluded for medical reasons and 4 did not wish to participate; an additional 2 were impossible to trace and 1 had died. As many as 68% of patients (17/25) demonstrated abnormalities on 1 or more of the audiometric tests, 14 on pure-tone audiometry (p < 0.02) and/or central audiometric tests (3 on central tests only and 2 on pure-tone audiometry only). Four out of six patients with available early post-traumatic audiograms showed a significant progressive deterioration. As a group, their assessments of hearing ability and quality of life were equal to or better than those of the controls. These results may indicate that a higher priority should be given to obtaining an early audiologic evaluation of every CHI patient than is the rule today. The impact of post-traumatic progress and central lesions on social hearing at an advanced age is highlighted.

Conclusions: Despite the need for special fitting strategies, improvements in speech discrimination tests support the use of cochlear implantation (CI) for patients with Cogan syndrome. Adequate preimplant counselling is mandatory, to prevent high expectations and to stress the necessity for bilateral implantation.

Objective: In 60% of patients with Cogan syndrome, CI remains the only treatment option. Literature data agree that once the electrode array is properly inserted, functional outcomes are very good. Nevertheless, results may deteriorate due to progressive cochlear ossification. A few studies have documented the outcomes of CI in these patients, but none have reported the long-term results.

Methods: This was a retrospective study describing the outcomes of 3 implanted patients with Cogan syndrome – among 300 adult patients who received a cochlear implant, 3 had become deaf due to Cogan syndrome.

Results: In one patient the cochlear ossification advanced and the speech perception abilities worsened from the highest category to identification of words in closed set. The second patient complained of an abrupt reduction of loudness at 18 months post-implant, which required an increased electrical stimulation. The third patient reached the identification category probably due to auditory dyssynchrony, as an atypical consequence of the syndrome.

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.

OBJECTIVE: Obstructive sleep apnea has been reported to occur in 20-50% of children with Down's syndrome in case series of patients referred for evaluation of suspected sleep apnea. In this population-based controlled study, we aimed to investigate whether sleep apnea is related to Down's syndrome.

MATERIAL AND METHODS: Every child aged 2-10 years with Down's syndrome residing in the Umeå healthcare district (n = 28) was invited to participate in the study, with their siblings acting as controls. Successful overnight sleep apnea recordings and echocardiography were performed in 17/21 children with Down's syndrome and in 21 controls.

RESULTS: Obstructive sleep apnea could not be diagnosed, either in children with Down's syndrome or in the control children. The apnea-hypopnea index in the children with Down's syndrome was 1.2 +/- 1.5 and did not differ from that in controls. Snoring and hypertrophy of the tonsils were more common in children with Down's syndrome than in controls. Children with Down's syndrome slept for a shorter time (p < 0.001) and changed body position more often (p < 0.05) than the control children.

CONCLUSIONS: Snoring, restless sleep and hypertrophy of the tonsils were common among children with Down's syndrome. Obstructive sleep apnea was, however, not related to Down's syndrome in the present population-based controlled study.

BACKGROUND: Base of tongue cancer incidence and patient survival is increasing why treatment sequelae becomes exceedingly important. Osteoradionecrosis (ORN) is a late adverse effect of radiotherapy and brachytherapy (BT) could be a risk factor. Brachytherapy is used in three out of six health care regions in Sweden.

AIMS: Investigate if patients treated in regions using BT show an increased risk for ORN and whether brachytherapy has any impact on overall survival. MATERIAL AND METHODS: We used data from the Swedish Head and Neck Cancer Register between 2008-2014. Due to the nonrandomized nature of the study and possible selection bias we compared the risk for ORN in brachy vs non-brachy regions.

RESULTS: Fifty out of 505 patients (9.9%) developed ORN; eight of these were treated in nonbrachy regions (16%), while 42 (84%) were treated in brachy regions. Neither age, sex, TNM-classification/stage, p16, smoking, neck dissection, or chemotherapy differed between ORN and no-ORN patients. The risk for ORN was significantly higher for patients treated in brachy regions compared to non-brachy regions (HR = 2,63, p = .012), whereas overall survival did not differ (HR = 0.95, p = .782).

CONCLUSIONS AND SIGNIFICANCE: Brachytherapy ought to be used cautiously for selected patients or within prospective randomized studies.

Interleukins 6 (IL-6) and 12 (IL-12), and the chemoattractant chemokine RANTES were studied in ethmoidal mucosa, using reverse transcriptase polymerase chain reaction. The 49 patients had chronic sinusitis or nasal/paranasal polyposis, and some also allergy. To the best of our knowledge, this is the first study that demonstrates RANTES and IL-12 on mRNA level in human sinonasal mucosa in situ. mRNA for IL-6, IL-12 and RANTES were detected in 2, 8 and 6 patients with chronic sinusitis, respectively, and in mucosa from patients with polyposis a positive expression was observed in 4, 14 and 10 cases. There were no statistically significant differences. Analysing the entire group of 49 patients, disregarding type of mucosal disease, the number of patients with positive RANTES was significantly higher than that for IL-6. Similarly, IL-12 positivity was more frequently expressed than IL-6. mRNA for IL-6 was expressed in only 2 of the allergic patients. The cytokine production studied thus seems to be unrelated to the clinically defined entities. There is thus a local production in human diseased sinonasal mucosa of RANTES, as well as of IL-6 and IL-12. The local production of RANTES is an important prerequisite for recruitment and migration of inflammatory cells into the tissue. IL-12 is a co-stimulator of antigen-specific responses of established T helper 1 (Th1) clones, and regulates the responsiveness of the clones to a number of T cell growth factors. The study supports a shift towards Th1 cells in these disease entities.

Conclusions: Speech recognition in noise is affected when otitis media with effusion (OME) is present in young adults with unilateral cleft lip and palate.

Objective: The objective of this study was to describe the hearing and performance on auditory tasks of young adults with unilateral cleft lip and palate as compared to young adults without cleft lip and palate.

Methods: Twenty-six young adults with unilateral cleft lip and palate and 23 young adults without cleft lip and palate participated in the study. Pure tone audiometry, tympanometry, speech recognition in noise at the word and sentence level, and masking level difference were examined.

Results: Results revealed elevated hearing thresholds in the young adults with cleft lip and palate as compared with young adults without cleft lip and palate. No differences concerning speech recognition in noise and binaural processing were observed between the young adults with cleft lip and palate and those without. However, there was poorer speech recognition performance in those adults with unilateral cleft lip and palate and OME on the day of testing as compared with young adults with unilateral cleft lip and palate without OME on the day of testing.

Conclusion. This study on eye motility demonstrates a new application of electro-oculography which proved to have a high potential for establishing and diagnosing the cause of diplopia in orbital floor fractures. Electro-oculography is objective and easy to perform even when the restricted eye is covered. The ‘uninjured’ eye can be used as the reference. Any motility difference between the left and the right eye was easily detected. Objective. It is essential in orbital floor fractures to distinguish entrapment from other causes of diplopia. We investigated whether vertical eye motility and restricted elevation can be detected and characterized by means of electro-oculography. Materials and methods. Electronystagmography equipment used for vestibular testing in daily ENT practice was used in a different context. Unilateral mechanical restriction was generated in the test subjects through fixation of one eye bulb. The velocity and range of eye motility of both eyes were measured and compared in 12 healthy test subjects and 7 patients with long-term vertical diplopia after orbital floor fractures. Results. Simulated entrapment was easily detected as a distinct difference between right and left eye motility recordings (p<0.001). Recordings of patients with diplopia differed significantly from those of healthy test subjects with respect to velocity (p<0.05) and range of motility (p<0.05).

Aim: To describes how tonsil surgery was performed in Sweden from 2013 to 2015 with data from the National Tonsil Surgery Registry in Sweden (NTSRS).

Method: The registry collects data from both professionals and patients through questionnaires. A total of 33,870 tonsil surgeries were analysed, comprising approximately 80% of all tonsil surgeries in Sweden from 2013 to 2015.

Results: The two most common procedures were tonsillectomy (41%) and tonsillotomy with adenoidectomy (38%). Tonsillectomy was most commonly performed to treat frequent tonsillitis, while the main indication for tonsil surgery with combined adenoidectomy and for tonsillotomy alone was upper airway obstruction. The most commonly used techniques were cold steel (70%) for tonsillectomy/adenotonsillectomy and radiofrequency (79%) for tonsillotomy/adenotonsillotomy. Ninety-five percent of patients reported symptom relief after 180 d. Day surgery was utilised in 70% of the surgeries. The rate of readmission due to post-tonsillectomy haemorrhage was 5.1%. Male patients more often underwent tonsil surgery at preschool ages due to upper airway obstruction; in comparison, female patients to a larger extent underwent surgery in their early teens because of previous infections.

Conclusions: The NTSRS provides an opportunity to survey tonsil surgery in Sweden and to launch and follow up improvement programmes as desired.

Conclusion: Using a local anesthetic agent before obtaining nasal biopsies by nasal brushing makes the sampling procedure smooth, avoids lacrimation, nasal itching/irritation, and/or sneezing and provides enough viable cells to establish primary cultures.

Objectives: To examine the use of local anesthesia to avoid the irritation experienced by the subject when nasal biopsies are obtained by nasal brushing in order to culture viable nasal epithelial cells.

Methods: Nasal epithelial cells were collected from the mid-part of the inferior turbinate of healthy volunteers by brushing with interdental brushes, after spraying a topical anesthetic on the nasal mucosa. Immunocytochemistry was performed to assess the purity of epithelial cells.

Results: Cell samples ranging from 1.16 x 10(5) to 3.06 x 10(5) cells/per sample were obtained. Of 11 samples, 7 formed confluent cultures, while the remaining 4 samples showed only patches of epithelial cells. Neither fungal nor bacterial contamination posed a problem. Immunocytochemistry of the cytospin slides confirmed the presence of epithelial cells in the cultures. No adverse effects were experienced by the volunteers.

Background: Electrochemotherapy (ECT) is a cancer treatment modality where the intracellular accumulation of chemotherapeutic agents is enhanced by an applied electrical field.

Aims/Objectives: To evaluate the long-term efficacy, safety and functional outcome after ECT treatment in high-risk non-melanoma skin cancer (NMSC) with curative intent.

Materials and methods: Seven patients with SCC or BCC in the head and neck area were treated with ECT with intratumoral bleomycin administration.

Results: Five patients were cured by ECT as a mono-modality treatment after a median 10-year follow-up period. Two patients had recurrences and/or persisting tumors after treatment that required salvage surgery and radiotherapy. In two patients, the eye was spared with no visual impairment. In another patient, full facial nerve function was spared.

Conclusions: ECT can be a curative as well as an organ and function-sparing mono modality treatment in high-risk NMSC.

Conclusion: Electroporation therapy appears to be a safe treatment achieving excellent local tumor control and very good functional results in our study and it should be further clinically evaluated.

Objectives: The objectives of this study were to assess local tumor control, survival, and effects on speech and eating after treatment of tongue cancer with electroporation therapy, a new local therapeutic modality. In this approach intracellular accumulation of a chemotherapeutic agent is achieved by using a locally applied electrical field.

Methods: Fifteen patients with primary T1 and T2 oral tongue cancer were treated with electroporation therapy with intratumorally administered bleomycin. Postoperative radiotherapy was performed when the tumor infiltration was 5 mm or more. The follow-up time was 24 months for the surviving patients and 20.4 months overall. The effects on eating and speech were assessed using the PSS-HN scale and voice recordings.

Results: No local recurrence was recorded in any patient during the follow-up. Three patients died, two from progressive regional disease. Of the 12 surviving patients, 2 patients had regional recurrence and 10 patients including the 5 patients treated with EPT alone were tumor-free both locally and regionally at the last follow-up. The functional outcome for speech and eating were very good.

Conclusion: ECT can be a safe curative mono modality treatment, especially in tongue cancer. The future role for ECT in head and neck cancer needs to be further investigated.

Introduction: Electrochemotherapy (ECT) is a cancer treatment modality that uses electroporation to increase the intracellular accumulation of hydrophilic chemotherapeutic drugs, especially bleomycin.

Objectives: To report the 5-year local tumor control, safety of treatment and survival after ECT, and the 1-year quality-of-life (QoL) data.

Materials and methods: Nineteen patients with primary head and neck cancer were included and treated with ECT with curative intent. All except one patient had squamous cell carcinoma (SCC). Radiotherapy (RT) was performed in all patients with SCC and tumor infiltration ‡5 mm. The EORTC H&N 35 questionnaire was used at baseline and 12 months after treatment. The Wilcoxon signed rank test and McNemar’s test were used for paired data and Mann Whitney U-test and Fishers exact test were used for independent data (sub-group comparison).

Results: There were no local recurrences in the follow-up period. Thirteen patients were treated with adjuvant RT. The six patients that were treated with ECT alone were tumor-free and alive 5 years after treatment. There was one serious adverse event reported; aspiration after treatment of a tongue base tumor. The tumor-specific 5-year survival was 75%. The QoL outcome 1 year after ECT showed a significant increase in problems with senses (taste, smell), speech, mouth opening and xerostomia. The QoL outcome also showed worse outcome in the smoking patients regarding speech, in the patients receiving adjuvant RT regarding mouth dryness and swallowing and in the patients with non-tongue oral cavity cancer regarding need for painkillers.

Conclusion: Electrochemotherapy (ECT) is an efficacious treatment. It should, however, be used with some caution in the treatment of head and neck cancer.

Objectives: To assess local tumor control, safety, survival, and functional outcome after treatment of cancer in the head and neck region with ECT.

Methods: Four patients with primary T2 cancer of the oral cavity or oropharynx and one patient with a metastasis of renal cancer in the masseter muscle were treated with ECT with intratumorally administered bleomycin. Control biopsies were carried out 2 months after treatment. Postoperative radiotherapy was performed based on tumor T-stage and the depth of tumor infiltration. Serious adverse events and treatment malfunctions were recorded. The follow-up time was 24 months for the surviving patients and 20 months overall. The PSS-HN scale was used to assess the functional outcome.

Results: No local recurrence was recorded in any patient during the follow-up. However, only one patient was treated with ECT alone. There were four serious adverse events: one nearly lethal bleeding, two cases of osteoradionecrosis, and a fistula. One patient died from distant metastasis. The other patients were tumor-free both locally and overall at 24 months. The median functional outcome in all parameters was worse 1 year after treatment.

Human tracking eye movements were recorded in healthy volunteers of varying age. The target motion was either predictable (pure sinusoids or sinusoidal frequency sweep) or unpredictable (pseudorandomized). Gain and phase values for the tracking and the smooth pursuit eye movement signal were calculated as a function of target frequency from 0.2 to 2 Hz. Max. target velocity was 20 or 40 deg/sec. In the low frequency area the smooth pursuit gain for predictable stimulation was higher than the gain elicited by the pseudorandomized stimulation. In the high-frequency area, gain values did not differ significantly. For the predictable stimulation, the phase of the smooth component was always a lag, increasing with increasing frequency. At low frequencies of the pseudorandomized signal a phase lead was observed. At higher frequencies the lead turned into a lag that was greater than for the predictable stimulation. The young and old groups showed reduced smooth pursuit gain values, compared with the main group specially when the target waveform was pseudorandomized. The reduced smooth pursuit ability was mostly compensated for by an increased amount of saccades.

Postural control was investigated by static posturography in 18 workers exposed to industrial solvents, 9 patients with psycho-organic syndrome due to industrial solvent exposure, and 52 controls. Both groups of exposed subjects showed larger sway areas with eyes open as well as closed, compared with the controls. No differences were found in the Romberg quotient (the relationship between sway areas with eyes closed/open). The correlation between static posturography and the otoneurological test battery was positive for the visual suppression test in the styrene group. In the industrial solvent group no significant correlations were found. The visual suppression test and some auditory tests were pathological in the exposed groups. The otoneurological test battery—especially the visual suppression test and static posturography—seems to contribute in the assessment of solvent related CNS lesions.

Background: The prevalence of disabling hearing loss is increasing worldwide. However, previous studies on hearing loss prevalence have enrolled small populations or only provided estimates.

Aim: To establish the prevalence of severe-to-profound hearing loss (STPHL) in the adult Swedish population and compare it with the cochlear implantation rate in Sweden.

Material and methods: We established a database containing over 15 million audiograms obtained from regions covering > 99% of the Swedish population by extracting audiogram data from the computer software application, Auditbase. We used this database to calculate the percentage of adult patients with bilateral hearing levels >= 70 dB. We collected data regarding cochlear implantations in Sweden from the National Board of Welfare and Health.

Results: The prevalence of STPHL in the adult Swedish population was 0.28%. There were regional variations in the prevalence and rate of cochlear implantation; however, there was no association between both parameters.

Conclusions: This study presents an updated and reliable prevalence figure for STPHL in Sweden.

Significance: Patients with STPHL have extensive rehabilitation requirements; accordingly, it is important to determine the accurate prevalence of STPHL to inform the allocation of adequate resources.

Background: Tinnitus is one of the most frequent chronic conditions in adults with wide range of consequences.

Aims/Objectives: The aim of the current study was to determine the problems and life effects reported by individuals with tinnitus using the International Classification of Functioning, Disability and Health (ICF) framework.

Material and Methods: The study used a cross-sectional survey design. A total of 344 individuals with tinnitus completed a series of questionnaires. The responses to open-ended questions were linked to ICF categories.

Results: Activity limitations and participation restrictions were most dominant consequence of tinnitus followed by effect on the body function with limited emphasis on the contextual factors. Frequently reported responses to body function involved emotional functions (b152), attention function (b140), and sleep functions (b134). Commonly reported responses to activity limitations and participation restrictions were recreation and leisure (d920), conversation (d350), communicating with—receiving—spoken messages (d310), listening (d115), and remunerative employment (d850). Sound intensity (e2500) and sound quality (e2501) were the frequently reported responses to environmental factors. Coping styles, past and present experiences, and lifestyle were the most frequently occurring personal factors.

Conclusions and significance: The study highlighted some key influencing factors of tinnitus in different ICF domains which can be helpful in rehabilitation planning.

Two groups of 10 healthy volunteers each with a mean age of 28 years (17-39) were tested in low-frequency rotatory experiments (sinusoidal harmonic acceleration, SHA), at frequencies of 0.01-0.32 Hz. The purpose was to ascertain whether voluntary enhancement and reduction of gain and phase occurred with voluntary performances. The different tests were alertness in darkness, stationary and moving targets, imaginary stationary and moving targets in darkness, proprioceptive moving targets and acoustic stationary and moving targets. Alertness tests in darkness demonstrated a gain increase (0.5-0.7) at 0.01-0.32 Hz, and a decreasing phase lead (40-2 degrees) with increasing frequency. The alertness tests served as a reference for the other tests. In tests with stationary targets, the gain reached unity and the phase was almost 0 degrees. In imaginary stationary target tests, gain and phase were significantly increased compared with alertness. Stationary acoustic targets in darkness significantly enhanced the gain. An increased phase lead was also found. In visual suppression tests (moving target), the gain was near 0. In imaginary moving target tests, the gain decreased significantly. In darkness the gain was significantly more depressed with a proprioceptive moving target than during imaginary moving target. Testing with proprioceptive + acoustic moving target in darkness, displayed an additional gain depression and negative phase at 0.08 Hz. The conclusion is that the influence of non-vestibular mechanisms substantially affects low frequency sinusoidal rotatory testing.

Twelve subjects with bilateral vestibular loss, with a mean age of 27 years (18-49) were studied. The loss was based on symptoms of oscillopsia and ice-water caloric tests. Nine subjects were evaluated by low-frequency sinusoidal harmonic acceleration (SHA) rotatory tests (0.01-0.32 Hz), and 3 subjects with high broad-frequency band rotatory tests (0.25-3.25 Hz). During alertness tests (darkness) all subjects had absent or very low gains. When tested with a stationary light in the middle of the swing, the SHA tests showed perfect compensatory eye movements with gains of 1 and phases of approximately 0 degrees. In the broad-frequency test, the gain was near 1 below 1 Hz, decreasing rapidly at higher frequencies. In imaginary stationary target tests (darkness), the gain was enhanced to 'normal' values (0.5) with a phase lead in the low-frequency range (SHA). This could not be replicated in the high-frequency tests. Testing with stationary acoustic guidance (darkness), further enhanced the gain in the SHA tests. A small increase of gain could also be found in the high-frequency tests. Compensatory eye movements, when tested in low-frequency rotatory tests (less than 1 Hz), are to a large extent influenced by non-vestibular mechanisms. By voluntary modifications, normal gains could be produced by patients with 'bilateral vestibular loss'. The phase lead found is proposed to be of central non-vestibular origin. Testing in higher frequency ranges (greater than 1 Hz) could not replicate these findings, thus the broad-frequency band rotatory test should be preferred for adequate vestibular quantification.

Nine subjects with long-term (8–30 years) occupational exposure to industrial solvents and a confirmed diagnosis of psycho-organic syndrome (POS) have been studied with audiological and otoneurological test batteries. The results were compared to a matched control group of nine industrial workers not exposed to solvents and to normal data from healthy volunteers. In the clinical examination, the Romberg test identified 5/9 workers as pathologic and concurrently the stabilometry showed significantly larger sway areas in the POS-group. In the audiological test battery, the significantly pathologic tests were discrimination of interrupted speech and evoked cortical responses to frequency glides (CRA-delta-f). The saccade test disclosed abnormal findings in 5/9 workers. In the smooth pursuit test, abnormality was found at some test frequencies using pseudorandomized stimulus. The VOR-suppression test was significantly abnormal at all test frequencies. The test battery used strongly indicates CNS lesions due to industrial solvents.

Fifteen voluntary subjects with a mean age of 26 years (17–39), participated in two rotatory experiments. The rotatory test used was sinusoidal harmonic acceleration (SHA) test at frequencies of 0.01–0.32 Hz. Compensatory eye movements were measured by means of EOG. Experiment A included rotation in darkness during alerting tasks (day 1), rotation in darkness with no tasks (day 2) and rotation in darkness during alerting tasks (day 3). In the altertness tests, the gain varied between 0.5 and 0.77. Phase values decreased with increasing frequency. The alertness results between days 1 and 3 did not differ in gain or phase. The gain of day 2 (no tasks) displayed significantly reduced gain at all frequencies, and a more pronounced decrease in phase than in the alertness tests. Experiment B compared testing with eyes open (day 1) and eyes closed (day 2) during alerting tasks. These tests displayed significantly decreased gain at all frequencies with eyes closed compared with eyes open and with more negative phase at 0.08–0.32 Hz with eyes closed. The results indicate a central effect of the alertness level on compensatory eye movements, and the effect of eye closure might be explained by bio-mechanical and possibly even central effects on the eye movements. In low-frequency testing, as short a test time as possible should be used, and due to different alertness levels, the results should be evaluated with great caution.

BACKGROUND: In surgical resection of squamous cell carcinoma of the oral tongue (SCCOT), achieving clear margins is important for prognosis. Insufficient histopathological margins are common, particularly deep margins.

AIMS/OBJECTIVES: The aim of the present study was to determine whether ultrasound (US)-assisted resection could decrease the proportion of insufficient histopathological deep margins in SCCOT.

MATERIAL AND METHODS: 34 patients with SCCOT undergoing US-assisted resection (study group) were compared to 76 whose resections were performed without US (conventional group). Outcome measures were insufficient deep histopathological resection margins and mean difference in deep margins.

RESULTS: Insufficient deep resection margins (<5.0 mm) were seen in 8 of 34 (23.5%) in the study group, compared to 31 of 76 (40.8%) in the conventional group, unadjusted RR 0.58 [95% CI 0.30-1.12; p = .11], adjusted RR 0.82 [95% CI 0.35-1.92; p = .64]. Unadjusted mean difference was 1.4 mm (95% CI 0.1-2.7, p = .04), adjusted mean difference 1.1 mm (95% CI -2.7 to 0.5, p = .19).

CONCLUSIONS: Intraoperative US can visualize the deep resection margins in T1/T2 SCCOT. US-assisted resection seems to decrease the number of insufficient histopathological deep margins, though the results are not statistically significant. Comparatively good results in the conventional group is one explanation for the lack of significance.

CLINICALTRIALS.GOV ID: NCT04059861.

BACKGROUND: Chronic rhinosinusitis (CRS) is an inflammatory disease of the nose and the paranasal sinuses, often associated with an infection by Staphylococcus aureus (S. aureus). Disturbance in the function of ion channels is regarded as an etiological factor for pathogenesis of CRS.

AIMS: The study aims to measure the mRNA expression of the ENaC and CFTR ion channels in nasal epithelial cells (NECs) and to investigate the effect of both the budesonide and S. aureus on these ion channels.

MATERIALS AND METHOD: NECs biopsies obtained from healthy volunteers and patients with CRS. NECs were infected with S. aureus strains and/or budesonide to study the mRNA expression levels of the ENaC and CFTR ion channels.

RESULTS: The mRNA expression level of CFTR was increased while that of ENaC was decreased. S. aureus infection and budesonide treatment induced a significant modulation of ENaC and CFTR ion channels expression.

CONCLUSION: The CFTR and ENaC ion channel physiology are of importance in the pathogenesis of CRS. Exposure to S. aureus infection and treatment with budesonide modulated the mRNA expression of CFTR and ENaC ion channels.

SIGNIFICANCE: Better understanding of the pathophysiology of CRS.

Conclusion: Patients operated with tonsillar surgery report a high degree of symptom relief 6 months after surgery.

Objective: The purpose of this study was to analyze symptom relief 6 months after tonsil surgery in relation to age, indication, surgical procedure, primary bleeding and unplanned postoperative visits. The National Tonsil Surgery Register in Sweden offers data from 54,696 patients registered during 1997-2008.

Methods: This was a prospective assessment by questionnaire. Data were collected using three questionnaires, two completed by professionals and one 6 months postoperatively by the parents/patients.

Results: Among 54,696 patients, the most common surgical indications were obstruction (49.7%), followed by recurrent tonsillitis (35.2%). Symptom relief 6 months after surgery was high in all indication groups (>92%), and highest for patients operated on the indication peritonsillitis (>98%). The indications obstruction, recurrent tonsillitis or chronic tonsillitis reported a high degree (>96%) of symptom relief. Of the patients who underwent tonsillectomy with adenoidectomy, 97.5% were symptom-free compared to 96% of patients who had tonsillectomy alone and 96.1% who underwent tonsillotomy (p < 0.0001). In all, 13.9% of patients required an unplanned visit to the clinic postoperatively. Only 148 of 54,696 patients reported worsening of symptoms after surgery.

BACKGROUND: In Sweden, an estimated prevalence of adult patients with severe-to-profound hearing loss is 0.2%, which corresponds to roughly 20,000. We know little about the use of cochlear implants (CIs) in this population and why not most of them are not offered CI.

OBJECTIVES: To investigate the reasons for no rehabilitation with CI among this patient group.

MATERIALS AND METHODS: Data were collected from 1076 patients in the Swedish Quality Register of Otorhinolaryngology. A baseline questionnaire and the reason for no CI, was evaluated.

RESULTS: Only 14.5% of the patients started a CI investigation, and 8.5% were rehabilitated with CI. Significantly more women (56.5%) than men received CI. The most common reasons for not receiving CI, were hearing reason (30.5%), indicating satisfaction with technical equipment, and unknown reason (25%). The oldest patient group (81-100 years old) had the highest risk for unknown reasons. Patients receiving extended audiological rehabilitation (53.5%) had a significantly lower risk for unknown reasons.

CONCLUSIONS: It is worrying that the oldest patient group (81-100 years old) seemed to have fewer chances to start a CI investigation. An extended audiological rehabilitation increased the chances that professionals would discuss CI.

SIGNIFICANCE: This study shows that surprisingly few patients are offered CI despite their severe-to-profound hearing loss.

CONCLUSIONS: Patients with severe vision impairment in combination with severe-to-profound hearing loss seem to have a higher risk for effects on QoL, including: mobility, the ability to provide self-care and perform usual activities, and levels of anxiety and depression, compared with patients with only severe-to-profound hearing loss.

OBJECTIVES: To study the quality-of-life (QoL) and audiological rehabilitation of the severely vision-impaired patient population among adults with severe-to-profound hearing loss in Sweden.

METHOD: A study of data collected from 543 patients with severe-to-profound hearing loss combined with severe vision impairment among the total of 2319 persons registered in the Swedish Quality Register of Otorhinolaryngology. QoL was measured with the following instruments: EQ5D, PIRS, and HADS. Audiological rehabilitation was described and evaluated.

RESULTS: The patients with dual sensory loss were younger, were more likely to live alone, and had a lower level of education than the control group. The QoL of the study group was significantly negatively affected. In total, 89% of the study group had been rehabilitated with hearing aids, while 8% had received rehabilitation with cochlear implants. A total of 32% of the study group had received extended audiological rehabilitation.

Conclusion: Photodynamic therapy (PDT) is a viable and safe option for early laryngeal cancer that would be less suitably treated with radiation or trans-oral laser surgery (TLS). The cure rates with PDT appear to be comparable to those of conventional therapy, and the voice outcomes are also comparable. In the case of many sarcomas, PDT appears to be an organ- and function-sparing therapy, although it is more costly than other treatments.

Objectives: The aim of this study was to show the results of PDT when it is used as a primary treatment of early laryngeal cancer. Methods: We studied the results of PDT when used as a primary treatment. We looked at survival, effect on tumor, side effects, voice, and costs.

Results: The follow-up period was a median of 59 months. Nine of 10 patients were cured of their laryngeal cancer. PDT alone cured seven patients. All four of the sarcomas were cured using temoporfin. Two of three tumors that involved the anterior commissure were cured using only interstitial illumination with PDT. No serious side effects were noted. The patient's voices were improved after treatment in 5 of 10 cases, and none had a worsened voice.

BACKGROUND: A peritonsillar abscess (PTA) is a common complication to acute tonsillitis. Needle aspiration (NA) is the gold standard for diagnosis of PTA. NA is usually painful and not risk-free. Ultrasound (US) is a noninvasive, portable radiological modality that could potentially be used in the diagnosis of PTA and selection of patients for NA. The reliability of US is dependent on the experience of the examiner which limits is usefulness.

AIM: To evaluate the reliability of US in the diagnosis of PTA by an inexperienced examiner.

METHODS: Thirty patients with suspected PTA were included. They were first examined with trans-cervical US by a medical student then clinically examined by a physician that performed a NA if clinically motivated. They were then followed for at least two days.

RESULTS: Three patients were excluded from analysis because no NA was performed. In these patients, US correctly classified them as negative for PTA. In the remaining 27 patients, the sensitivity and negative predictive value was 100%. The specificity was 64.3% and the positive-predictive value was 72.2%.

CONCLUSION: US can be very useful in the diagnosis of PTA and the selection for NA even with an inexperienced examiner.

SIGNIFICANCE: The results highlight the usefulness of ultrasound in otolaryngology.

OBJECTIVE: To evaluate the canal wall up (CWU) technique combined with mastoid obliteration used in cholesteatoma surgery from the aspects of safety and function.

STUDY DESIGN: Retrospective chart review. Information was extracted from a medical database and complementary data from patient files and audiograms were collected and recorded retrospectively.

SETTING: A tertiary-stage hospital and a secondary-stage hospital. Surgeons of various levels of experience.

METHOD: Data from a consecutive group of 230 primary operations for cholesteatoma surgery using CWU with obliteration employing the combined approach tympanoplasty (CAT) technique, from January 1994 to December 2009 were analyzed.

RESULTS: In 90% of the ears, the anatomy was normalized with an intact ear drum. The frequency of residual cholesteatoma was 1% and the frequency of recurrent cholesteatoma 8%. Hearing was improved one year postoperatively and remained improved three years postoperatively. No patient suffered a total hearing loss.

CONCLUSIONS: CWU procedure comprising CAT with obliteration of the mastoid is a safe surgical method with a low frequency of residual and recurrent disease and a good hearing preservation.

Cervical vertigo, the entity of neck disorder and associated vestibular symptoms, was investigated in 15 suspected subjects and results were compared with 15 age-matched controls. A modified dynamic posturography investigation with different head positions was used. Head position was recorded 3-dimensionally with electrogoniometry. Differences on a sway-referenced forceplate were found.