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  • 51.
    Ericsson, Elisabeth
    et al.
    Department of Medical and Health Science, Linköpings university, Linköping, Sverige.
    Lundeberg, Stefan
    Smärtbehandlingsenheten, Astrid Lindgrens Barnsjukhus, Stockholm, Sverige.
    Brattwall, Metha
    An/Op/IVA/Sc Sahlgrenska Universitetssjukhuset, Mölndal, Sverige.
    Stalfors, Joacim
    ÖNH-Kliniken, Sahlgrenska Universitetssjukhuset, Göteborg, Sverige.
    Hemlin, Claes
    ÖNH-Kliniken, Aleris Specialistvård Sabbatsberg, Stockholm, Sverige.
    Hessén-Söderman, Anne Charlotte
    ÖNH-Kliniken, Aleris Specialistvård Sabbatsberg, Stockholm, Sverige.
    Hultcrantz, Elisabeth
    Institutionen för klinisk och experimentell medicin, Linköpings universitet, Linköping, Sverige.
    Sunnergren, Ola
    ÖNH- Kliniken, Länssjukhuset Ryhov, Jönköping, Sverige.
    Odhagen, Erik
    ÖNH-Kliniken, Södra Älvsborgs Sjukhus, Borås, Sverige.
    Nationella riktlinjer för farmakologisk behandling av smärta och illamående i samband med tonsillotomi och tonsillektomi på barn och ungdomar (<18 år)2013Inngår i: Ventilen, ISSN 0348-6257, Vol. 4, nr 48, s. 18-19Artikkel i tidsskrift (Annet vitenskapelig)
  • 52.
    Ericsson, Elisabeth
    et al.
    Department of Medical and Health Science, Linköpings university, Linköping, Sweden.
    Lundeberg, Stefan
    Smärtbehandlingsenheten, Astrid Lindgrens Barnsjukhus, Stockholm, Sweden.
    Brattwall, Metha
    An/Op/IVA/Sc Sahlgrenska Universitetssjukhuset, Mölndal, Sweden.
    Stalfors, Joacim
    ÖNH-Kliniken, Sahlgrenska Universitetssjukhuset, Göteborg, Sweden.
    Hemlin, Claes
    ÖNH-Kliniken, Aleris Specialistvård Sabbatsberg, Stockholm, Sweden.
    Hessén-Söderman, Anne-Charlotte
    ÖNH-Kliniken, Aleris Specialistvård Sabbatsberg, Stockholm, Sweden.
    Hultcrantz, Elisabeth
    Avdelningen för neurovetenskap, Linköpings universitet, Linköping, Sweden.
    Sunnergren, Ola
    ÖNH- Kliniken, Länssjukhuset Ryhov, Jönköping, Sweden.
    Odhagen, Erik
    ÖNH-Kliniken, Södra Älvsborgs Sjukhus, Borås, Sweden.
    Nationella riktlinjer för farmakologisk behandling av smärta och illamående i samband med tonsillotomi och tonsillektomi på barn och ungdomar (<18 år)2013Inngår i: Svensk ÖNH-tidskrift, ISSN 1400-0121, Vol. 30, nr 3, s. 1-5Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [sv]

    Riktlinjerna är framtagna av referensgruppen för Tonsilloperation. Syftet med dessa riktlinjer är att optimera det perioperativa omhändertagandet (premedicinering - peroperativt - postoperativt smärtomhändertagande) i samband med tonsilloperationer på barn och ungdomar. Bakgrund och referenser till riktlinjerna finns i ett separat dokument.

    Riktlinjerna gäller för friska barn. Finns det riskfaktorer som ex grav sömnapné, kraftig övervikt, komplicerande sjukdomstillstånd eller organpåverkan behöver den farmakologiska behandlingen anpassas efter situationen.

    Tonsillkirurgi medför svår och långvarig smärta samt hög frekvens av illamående. Smärtan är ofta värst dag 3 till 5 efter tonsillektomi. Tonsillotomi ger generellt upphov till mindre smärta än tonsillektomi. För att uppnå effekt behöver den farmakologiska smärtbehandlingen påbörjas redan vid premedicineringen och fortlöpa under själva anestesin/ingreppet. En multimodal behandling ska eftersträvas och målsättningen är att uppnå en för individen acceptabel smärtnivå i det postoperativa skedet och i hemmet.

    Den farmakologiska behandlingen ska kombineras med preoperativ information om ingreppet till patienten och vårdnadshavare. En lugn och trygg situation före anestesistart ökar chanserna för ett lugnt postoperativt förlopp.

  • 53.
    Ericsson, Elisabeth
    et al.
    Department of Clinical and Experimental Medicine. Linköping University, Linköping, Sweden; Department of ENT - Head and Neck Surgery UHL, Östergötlands Läns Landsting, Linköping, Sweden .
    Lundeborg Hammarström, Inger
    Department of Clinical and Experimental Medicine. Linköping University, Linköping, Sweden.
    Graf, Jonas
    Department of Clinical and Experimental Medicine. Linköping University, Linköping, Sweden.
    McAllister, Anita
    Department of Clinical and Experimental Medicine. Linköping University, Linköping, Sweden; Department of ENT - Head and Neck Surgery UHL, Östergötlands Läns Landsting, Linköping, Sweden.
    Hultcrantz, Elisabeth
    Department of Clinical and Experimental Medicine. Linköping University, Linköping, Sweden.
    Child behavior and quality of life before and after tonsillotomy versus tonsillectomy2008Inngår i: International conference in pediatric otorhinolaryngology, 2008, 2008, s. 40-40Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Introduction: The objective of the present investigation was to compare two techniques for pediatric tonsil surgery with respect to postoperative pain and morbidity and changes in sleep behavior, health related quality of life (HRQL) and benefit due to surgery. Methods: 67 children (4,5-5,5 years) with tonsillar hypertrophy and obstructive sleep related distress with or without recurrent tonsillitis were randomized to either regular tonsillectomy (TE)(n=32) or intracapsular tonsillectomy/tonsillotomy (TT) (n=35) with Radiofrequency surgical technique (Ellman Int) Before TT/TE, the parents completed a validated Quality of Life survey of pediatric obstructive sleep apnea, the OSA18 (Obstructive Sleep Apnea-18) and a standardized assessment of their children-s behavior with the Child Behavior Checklist (CBCL). Six months after surgery, the parents repeated these measurements, and assessed the health related benefits of the surgery using the Glasgow Children´s Benefit Inventory (GCBI). Results: In the TT group, the children recorded less pain from the first day after surgery onwards, used fewer doses of painkillers and were pain-free 3 days earlier than the children in the TE group. Six months after surgery, there was no significant difference between TT and TE with regard to snoring and ENT-infections. The differences were all significant in the total scores and in all the individual domains between the initial OSA-18 and post-surgery scores (p<0.0001). The improvement in the total problem score measured with CBCL was also significant (p<0.01) and there were no differences between the TT and TE children. The improvements in all sub scores of the GCBI indicated a significant health benefit of both TT and TE. Conclusions: TT with RF-surgery is a safe method, which causes less pain and postoperative morbidity than regular TE and has a similar effect on snoring and recurrent infections. Young children with tonsillar hypertrophy and different degrees of obstructive sleep related distress all show an impact on HRQL and behavior. All improve dramatically after a tonsillar operation-improving just as much after TT as after TE. Based on these results, TT should be the first choice for treatment of these small children. Support: Financial support from the Research Council of South East Sweden (FORSS).

  • 54.
    Ericsson, Elisabeth
    et al.
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Anaesthesiology and Intensive Care, Östergötlands Läns Landsting, Linköping, Sweden..
    Lundeborg Hammarström, Inger
    Department of Neuroscience and Locomotion, Speech and Language Pathology, Linköping University, Linköping, Sweden.
    Marcusson, Agneta
    Department of Neuroscience and Locomotion, Dental Clinic, Linköping University, Linköping, Sweden; Department of Oral Surgery UHL, Östergötlands Läns Landsting, Linköping, Sweden.
    Mc Allister, Anita
    Department of Neuroscience and Locomotion, Speech and Language Pathology, Linköping University, Linköping, Sweden; Department of ENT - Head and Neck Surgery UHL, Östergötlands Läns Landsting, Linköping, Sweden.
    Graf, Jonas
    Department of Clinical and Experimental Medicine. Linköping University, Linköping, Sweden.
    Hultcrantz, Elisabeth
    epartment of Neuroscience and Locomotion, Linköping University, Linköping, Sweden; Department of ENT - Head and Neck Surgery UHL, Östergötlands Läns Landsting, Linköping, Sweden.
    Oralmotorik, artikulation och livskvalitet. Sexmånadersuppföljning efter tonsillotomi respektive tonsillektomi2007Inngår i: Rikstämman 2007, 2007, s. 53-53Konferansepaper (Annet vitenskapelig)
  • 55.
    Ericsson, Elisabeth
    et al.
    Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping; Department of clinical and experimental medicine, Division of Oto-rhino-laryngology, Linköping University, Linköping.
    Lundeborg, Inger
    Department of clinical and experimental medicin, Division of speech and language pathology, Linköping University, Linköping.
    Hultcrantz, Elisabeth
    Department of clinical and experimental medicine, Division of Oto-rhino-laryngology, Linköping University, Linköping.
    Child Behavior and quality of life before and after tonsillotomy versus tonsillectomy2009Inngår i: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 73, nr 9, s. 1254-1262Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Compare two techniques for pediatric tonsil surgery with respect to postoperative pain and morbidity and changes in sleep behavior, health related quality of life (HRQL) and benefits due to surgery.

    Methods: 67 children (4.5–5.5 years) with tonsillar hypertrophy and obstructive sleep-disordered breathing with or without recurrent tonsillitis were randomized to either regular tonsillectomy (TE) (n = 32) or intracapsular tonsillectomy/tonsillotomy (TT) (n = 35) with Radiofrequency surgical technique (ellman Int.). Before TT/TE, the parents completed a validated Quality of Life survey of pediatric obstructive sleep apnea, the OSA-18 (Obstructive Sleep Apnea-18) and a standardized assessment of their children’s behavior with the Child Behavior Checklist (CBCL). Six months after surgery, the parents repeated these measurements, and assessed the health related benefits of the surgery using the Glasgow Children’s Benefit Inventory (GCBI).

    Results: In the TT group, the children recorded less pain from the first day after surgery on wards, used fewer doses of painkillers and were pain-free 3 days earlier than the children in the TE group. Six months after surgery, there were no significant difference between TT and TE with regard to snoring and ENT-infections. The differences in the total scores and in all the individual domains between the initialOSA-18 and postsurgery scores were all significant (P < 0.0001). The improvement in the total problem score measured with CBCL was also significant (P < 0.01) and there was no difference between the TT and TE children. The improvements in all subscores of the GCBI indicated a significant health benefit of both TT and TE.

    Conclusions: TT with RF-surgery causes less pain and postoperative morbidity than regular TE and has an equal effect on snoring and recurrent infections. Pre-school children with tonsillar hypertrophy and obstructive sleep-disordered breathing all show an impact on HRQL and behavior before surgery and improve dramatically just as much after TT as after TE. Therefore TT would be considered for treatment of small children

  • 56.
    Ericsson, Elisabeth
    et al.
    Department of Medical and Health Sciences, Linköpings universitet, Linköping, Sweden.
    Nilsson, A.
    Lundberg, L.
    Kjellman, B-M
    Karlsson-Björnström, K.
    Zetterlund, E-L.
    Post Graduate utbildning för specialistutbildade sjuksköterskor inom anestesiologisk vård ett unikt samarbete mellan landsting och universitet2013Konferansepaper (Annet vitenskapelig)
  • 57.
    Ericsson, Elisabeth
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Nilsson, Ulrica
    Örebro universitet, Institutionen för hälsovetenskaper.
    Bramhagen, Ann-Cathrine
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Harden, Sue
    Skåne University Hospital, Malmö, Sweden.
    Idvall, Ewa
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Experiences of a new self-report instrument for post-operative recovery in children2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    The objective was to develop and test an instrument that provides children, also of a younger age, with a quality recovery self-report measure after tonsil surgery.

    Methods: The development of Postoperative Recovery in Children (PRiC) was influenced by Quality of Recovery-24, for use in adults. It includes 23 items covering different aspects of recovery. PRiC was developed both as a traditional text-based instrument and as a version where each item is illustrated by a photo. It was distributed to 260 children undergoing tonsillotomy or total tonsillectomy in day-surgery, to be answered on post-operative days 1, 4 and 10.

    Results: In the photo-version, 27% of the children marked the answers on the instrument themselves, compared to 19% in the text-version (n.s.). Parents of 64% of the children in the photo-group reported that their child participated in answering the questions to a very high degree, compared to 58% in the text-group (n.s.). Some parents described that their children were very proud to fill in the instrument and return them by mail. The questions were mainly described as easy to understand and respond to, especially when illustrated with a photo. Some parents highlighted pain issues and asked for specific questions about what pain medication was given at home. One parent asked for the possibility to respond to the instrument online.

    Conclusion: PRiC can serve as a patient-reported outcome measure for children. PRiC can also provide parents with a tool for communicating with their child about post-operative recovery, especially when using the photo version.

  • 58.
    Ericsson, Elisabeth
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Nilsson, Ulrica
    Örebro universitet, Institutionen för hälsovetenskaper.
    Bramhagen, Ann-Cathrine
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Idvall, Ewa
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background: Patient-reported outcome measures (PROM) are the golden standard for the planning and follow-up of delivered care, which should also be an axiom for children. The current aims were to describe self-reported postoperative recovery in children after tonsil surgery, and to compare tonsillotomy and tonsillectomy in this aspect.

    Methods: 238 children (4-12 years) with a history of obstructive problems and/or recurrent tonsillitis were included. 48% were operated with tonsillotomy (TT) and 52% with total tonsillectomy (TE), all in day surgery. Postoperative recovery was assessed on days 1, 4 and 10 using the validated self-rating instrument, Postoperative Recovery in Children (PRiC), which includes 23 items covering different aspects of recovery after tonsil surgery.

    Results: Daily life activities (sleeping, eating and playing), and physical (e.g., headache, stomach ache, throat ache, otalgia, dizziness, nausea, defecation, urination) and emotional aspects (sadness, frightening dreams) were affected during the recovery period.

    The TE-girls showed higher scores than the boys in many factors. Children above 6 years of age reported higher values for the physical comfort variables while the younger group showed worse emotional states. Postoperative recovery improved from day 1 to 10 in all surgical groups. The TE-group had lower recovery compared to the TT-group (p < 0.01 – 0.001) in most items.

    Conclusion: The goal of postoperative management is to minimise or eliminate discomfort, facilitating the recovery process and avoiding complications. Children are able to describe their recovery after tonsil surgery, and thus, PRiC can serve as a PROM to obtain patient-centred data after tonsil surgery.

  • 59.
    Ericsson, Elisabeth
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Nilsson, Ulrica
    Örebro universitet, Institutionen för hälsovetenskaper.
    Bramhagen, Ann-Cathrine
    Fakulty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Idvall, Ewa
    Fakulty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Self-reported post-operative recovery in children after tonsillotomy and tonsillectomy 2016Inngår i: 13th Congress of the European Society of Pediatric Otorhinolaryngology, 2016Konferansepaper (Fagfellevurdert)
  • 60.
    Ericsson, Elisabeth
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Nilsson, Ulrica
    Örebro universitet, Institutionen för hälsovetenskaper.
    Idvall, Eva
    Malmö University, Malmö, Sweden.
    Bramhagen, Ann-Cathrine
    Malmö University, Malmö, Sweden.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Experiences of a new self-report instrument for post-operative recovery in children2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES

    According the United Nations, children have the right to be heard and to have their opinions respected. Since postoperative recovery is an individual and subjective experience, our aim was to develop and test an instrument that provides children, also of a younger age, with a quality recovery self-report measure after tonsil surgery.

    METHODS

    The development of Postoperative Recovery in Children (PRiC) was influenced by Quality of Recovery-24, for use in adults. It includes 23 items covering different aspects of recovery. PRiC was developed both as a traditional text-based instrument and as a version where each item is illustrated by a photo. It was distributed to 260 children undergoing tonsillotomy or total tonsillectomy in day surgery, to be answered on post-operative days 1, 4 and 10. The children and their parents were also asked to give their opinion about the instrument. The free-text answers were categorised to reflect the content and presentation of the two instrument versions.

    RESULTS

    In the photo version, 27% of the children marked the answers on the instrument themselves, compared to 19% in the text version (n.s.). Parents of 64% of the children in the photo group reported that their child participated in answering the questions to a very high degree, compared to 58% in the text group (n.s.).  Some parents described that their children were very proud to fill in the instrument and return them by mail.

    The questions were mainly described as easy to understand and respond to, especially when illustrated with a photo. Some parents highlighted pain issues and asked for specific questions about what pain medication was given at home. One parent asked for the possibility to respond to the instrument online.

    CONCLUSION

    PRiC can serve as a patient-reported outcome measure for children. PRiC can also provide parents with a tool for communicating with their child about post-operative recovery, especially when using the photo version.

  • 61.
    Ericsson, Elisabeth
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Nilsson, Ulrica
    Örebro universitet, Institutionen för hälsovetenskaper.
    Idvall, Ewa
    Malmö University, Malmö, Sweden.
    Bramhagen, Ann-Cathrine
    Malmö University, Malmö, Sweden.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES

    Tonsil surgery is associated with significant morbidity during recovery. Patient-reported outcome measures (PROM) are the golden standard for the planning and follow-up of delivered care, which should also be an axiom for children. The current aims were to describe self-reported postoperative recovery in children after tonsil surgery, and to compare tonsillotomy and tonsillectomy in this aspect.

    METHODS

    Totally, 238 children (4-12 years old) with a history of obstructive problems and/or recurrent tonsillitis, undergoing tonsil surgery were included. Forty-eight per cent were operated with partial tonsil resection/tonsillotomy (TT) and 52% with total tonsillectomy (TE), all in day surgery.

    Postoperative recovery was assessed on days 1, 4 and 10 using the validated self-rating instrument PRiC, Postoperative Recovery in Children, which includes 23 items covering different aspects of recovery after tonsil surgery. PRiC was distributed both as a traditional text instrument and with photo illustrations. 

    RESULTS

    Daily life activities (sleeping, eating and playing), and physical (e.g., headache, stomach ache, throat ache, otalgia, dizziness, nausea, defecation, urination) and emotional aspects (sadness, frightening dreams) were affected during the recovery period.

    The TE-girls showed significantly higher scores than the boys in many factors.

    Children above 6 years of age reported higher values for the physical comfort variables while the younger group showed worse emotional states.

    Postoperative recovery improved from day 1 to 10 in all surgical groups. The TE-group had lower recovery compared to the TT-group (p < 0.01 – 0.001) in most items.

    CONCLUSION

    The goal of postoperative management is to minimise or eliminate discomfort, facilitating the recovery process and avoiding complications. Children are able to describe their recovery after tonsil surgery, and thus, PRiC can serve as a PROM to obtain patient-centred data after tonsil surgery.

  • 62.
    Ericsson, Elisabeth
    et al.
    Linköpings universitet.
    Wadsby, Marie
    Linköpings universitet.
    Hultcrantz, Elisabeth
    Linköpings universitet.
    Pre-surgical Child Behavior Ratings and Pain Management after Two Different Techniques of Tonsil Surgery2006Inngår i: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 70, nr 10, s. 1749-1758Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 63.
    Eriksson, Mats
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Nilsson, Ulrica
    Örebro universitet, Institutionen för hälsovetenskaper.
    Bramhagen, Ann-Cathrine
    Fakulty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Harden, Sue
    Skåne University Hospital, Malmö, Sweden.
    Idvall, Ewa
    Fakulty of Health and Society, Department of Care Science, Malmö University ,Malmö, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper.
    Experiences of a new self-report instrument for post-operative recovery in children2016Inngår i: 13th Congress of the European Society of Pediatric Otorhinolaryngology, 2016Konferansepaper (Fagfellevurdert)
  • 64.
    Eriksson, Mats
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Nilsson, Ulrica
    Örebro universitet, Institutionen för hälsovetenskaper.
    Bramhagen, Ann-Cathrine
    Fakulty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Idvall, Ewa
    Fakulty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper.
    Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy2017Inngår i: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 96, s. 47-54Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Tonsil surgery is associated with significant morbidity during recovery. Patient-reported outcome measures (PROM) are the golden standard for the planning and follow-up of delivered care, which should also be an axiom for children. The current aims were to describe self-reported postoperative recovery in children after tonsil surgery, and to compare tonsillotomy and tonsillectomy in this respect.

    Methods: In total, 238 children (4–12 years old) with a history of obstructive problems and/or recurrent tonsillitis, and undergoing tonsil surgery were included. Forty-eight per cent were operated with partial tonsil resection/tonsillotomy (TT) and 52% with total tonsillectomy (TE), all in day surgery.

    Postoperative recovery was assessed on days 1, 4 and 10 using the validated self-rating instrument PRiC, Postoperative Recovery in Children. This includes 23 items covering different aspects of recovery after tonsil surgery. A higher score indicates worse status in the respective items.

    Results: Daily life activities (sleeping, eating and playing), physical symptoms (e.g., headache, stomach ache, sore throat, otalgia, dizziness, nausea, defecation, urination), and emotional aspects (sadness, frightening dreams) were affected during the recovery period.

    The TE-girls showed higher scores than the boys regarding stomach ache, defecation and dizziness.

    Children above 6 years of age reported higher values for the physical comfort variables, while the younger group showed worse emotional states.

    Postoperative recovery improved from day 1–10 in all surgical groups. The TE-group showed lower recovery compared to the TT-group (p < 0.01–0.001) in most items.

    Conclusion: The goal of postoperative management is to minimize or eliminate discomfort, facilitating the recovery process and avoiding complications. Children are able to describe their recovery, and thus, PRiC seems to be able to serve as a PROM to obtain patient-centered data after tonsil surgery. The recovery process after TT causes less postoperative morbidity and a quicker return to normal activity compared to TE.

  • 65.
    Gimbler Berglund, Ingalill
    et al.
    Department of Nursing Science, Jönköping University, Jönköping, Sweden.
    Ericsson, Elisabeth
    Division of nursing science, department of medical and health sciences, Linköping University, Linköping, Sweden.
    Proczkowska-Björklund, Marie
    Division of child and adolescent psychiatry, department of clinical and experimental medicine, Linköping University, Linköping, Sweden; Psychiatric department, Höglandssjukhuset, Eksjö/Nässjö, Sweden.
    Fridlund, Bengt
    Department of Nursing Science, Jönköping University, Jönköping, Sweden.
    Nurse anaesthetists' experiences with pre-operative anxiety2013Inngår i: Nursing Children and Young People, ISSN 2046-2336, Vol. 25, nr 1, s. 28-34Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: To explore nurse anaesthetists' experiences and actions when administering and caring for children requiring anaesthesia.

    Method: A qualitative design employing critical incident technique was used. Interviews were carried out with a purposeful sample of nurse anaesthetists (n=32). The nurse anaesthetists' experiences were grouped into two main areas: organisation focused and interrelational focused. Actions were grouped into two main areas: optimising the situation and creating interpersonal interaction.

    Findings: The categories and subcategories of the nurses' experiences appeared to influence the outcome for the child. The nurse anaesthetists' first priority was to create an optimal environment and increase sensitivity in their interactions with the child.

    Conclusion: Sensitivity to the child and flexibility in altering actions are key strategies to avoid physical restraint.

  • 66. Graf, J
    et al.
    Hultcrantz, Elisabeth
    Hälsouniversitetet, Linköpings universitet, Linköping.
    Ericsson, Elisabeth
    Hälsouniversitetet, Linköpings universitet, Linköping.
    Persson, P
    Käll, L.G
    Ydreborg, K
    Wallqvist, J
    Tonsillotomi med radiofrekvensteknik på barn- effekt på recidiverande tonsillit och snarkning2005Inngår i: Svensk ÖNH-tidskrift, ISSN 1400-0121, Vol. 12, s. 16-17Artikkel i tidsskrift (Annet vitenskapelig)
  • 67.
    Graf, Jonas
    et al.
    Department of Clinical and Experimental Medicine, Linköping university, Linköping, Sweden.
    Ericsson, Elisabeth
    Department of Clinical and Experimental Medicine, Linköping university, Linköping, Sweden; Reconstruction Centre, Östergötlands Läns Landsting, Linköping, Sweden.
    Lundeborg Hammarström, Inger
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Hultcrantz, Elisabeth
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Reconstruction Centre, Östergötlands Läns Landsting, Linköping, Sweden.
    Tonsillotomi på förskolebarn: räcker det?2008Inngår i: The Annual General Meeting for the Swedish Society for Medicine, 2008, 2008Konferansepaper (Annet vitenskapelig)
    Abstract [sv]

    Bakgrund

    Under förskoleålder sker en fysiologisk ökning av den sk Waldeyerska ringen med tillväxt av tonsiller och adenoid som del i utvecklingen av barnets immunförsvar Många barn kan under denna tid debutera med obstruktionsbesvär(snarkning och sömnapné). Traditionellt har tonsillerna och adenoiden genom tonsillektomi och abrasio helt avlägsnats för att komma till rätta med dessa symptom, kirurgi förenad med hög postoperativ smärtnivå. På senare tid har tonsillotomi, dvs partiellt borttagande av tonsillerna, återinförts som en något mer skonsam operationsmetod. Immunsystemetpåverkas möjligtvis inte heller i lika stor omfattning. Frågan är om detta ingrepp är tillfyllest på barn som är i den ålder då tonsillerna fortfarande växer? Syftet med föreliggande studie var att jämföra tonsillotomi med radiofrekvenskirurgi med fullständig tonsillektomi på förskolebarn vad beträffar postoperativ morbiditet och långtidseffekt på snarkning och infektionsnbenägenhet upp till två år efter operation med tonsillektomi.

    Metod

    67 förskolebarn(4-5 år)med symtomgivade tonsillhypertrofi randomiserades till reguljär tonsillektomi(TE) eller tonsillotomi(TT) med radiofrekvensteknik. I de flesta fall utfördes samtidigt abrasio. 6 månader efter operationen svarade alla på frågeformulär och 2 år efter operationen bedömdes de åter av ÖNH-läkare. Snarkningen före, direkt efter operationen och vid tiden för läkarbesöket utvärderades då med VAS

    Resultat

    TT barnen registrerade lägre smärta från första dagen efter operation och var helt smärtfria 3 dagar tidigare än TE-barnen. Sex månader efter operationen förelåg ingen skillnad på grupperna vad gäller snarkning och infektionsbenägehet. Efter två år hade två av de 34 TT-barnen och ett av de 33 TE-barnen blivit re-opererade pga recidiv av obstruktionsbesvär, TE-barnet med reabrasio. Övriga barn i båda grupperna var i stort sett besvärsfria vad gäller snarkning och ingen ökad infektionsbenägehet noterades hos något barn. VAS före/ två år efter operationen var 8,4/1,3 för TE och 8,5/1,6 för TT. Tre av TT barnen hade tonsillvävnad något utanför tonsillogen och hälften av TE barnen hade små tonsillrester i logerna.

    Sammanfattning

    Cirka 6 % risk föreligger att ett yngre barn som opereras med tonsillotomi för obstruktionsbesvär behöver göra om operationen inom 2 år. Denna risk bör vägas mot den betydligt lägre postoperativa morbiditeten för tonsillotomi jämfört med tonsillektomi

  • 68.
    Graf, Jonas
    et al.
    University of Linköping.
    Hultcrantz, Elisabeth
    University of Linköping.
    Ericsson, Elisabeth
    Högskolan i Jönköping, HHJ. CHILD.
    Persson, Pekka
    University of Linköping.
    Käll, Lars-Göran
    University of Linköping.
    Ydreborg, Kjell
    University of Linköping.
    Wallqvist, Jan
    University of Linköping.
    Tonsillotomi med radiofrekvensteknik på barn: en randomiserad studie av postoperativ morbiditet2004Inngår i: Svensk ÖNH-tidskrift, ISSN 1400-0121, Vol. 11, nr 1, s. 21-21Artikkel i tidsskrift (Annet vitenskapelig)
  • 69.
    Hallenståhl, Niclas
    et al.
    Department of Otorhinolaryngology, Östersund Hospital, Östersund, Sweden.
    Sunnergren, Ola
    Department of Otorhinolaryngology Ryhov County Hospital, Futurum-The Academy for health and care, County Council, Jönköping, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper.
    Hemlin, Claes
    Sollentuna Specialist Clinic, Stockholm, Sweden.
    Hessén-Söderman, Anne-Charlotte
    Department of Otorhinolaryngology, Cityakuten, Stockholm, Sweden; Division of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Nerfeldt, Pia
    Division of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.
    Odhagen, Erik
    Department of Otorhinolaryngology, Södra, Älvsborgs Hospital, Borås, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ryding, Marie
    Department of Otorhinolaryngology, Östersund Hospital, Östersund, Sweden; Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden.
    Stalfors, Joacim
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sheikh Khalifa Medical City, Ajman, United Arab Emirates.
    Tonsil surgery in Sweden 2013–2015: Indications, surgical methods and patientreported outcomes from the National Tonsil Surgery Register2017Inngår i: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 137, nr 10, s. 1096-1103Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    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.

  • 70.
    Hemlin, Claes
    et al.
    Aleris Specialistvård, Stockholm, Sweden.
    Sunnergren, Ola
    Länssjukhuset Ryhov, Jönköping, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Hessén-Söderman, Anne-Charlotte
    Aleris Specialistvård, Stockholm, Sweden.
    Hultcrantz, Elisabeth
    Linköpings universitet, Linköping, Sweden.
    Odhagen, Erik
    Södra Älvsborgs Sjukhus, Borås, Sweden.
    Stalfors, Joacim
    Sahlgrenska Universitetssjukhus, Göteborg, Sweden.
    Tonsillectomy indication has impact on postoperative complication rate in children2014Konferansepaper (Fagfellevurdert)
  • 71.
    Hemlin, Claes
    et al.
    Aleris Sabbatsberg Hospital, Stockholm,Sweden.
    Sunnergren, Ola
    County Hospital Ryhov, Jönköping, Sweden.
    Hultcrantz, Elisabeth
    Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery, Linköping University, Linköping, Sweden.
    Ericsson, Elisabeth
    Department of Medical and Health Sciences, Nursing Science, Linköping University, Linköping, Sweden.
    Hessén Söderman, Anne- Charlotte
    Karolinska University Hospital, Solna, Sweden.
    Roos, Kristian
    Capio Lundby Hospital, Gothenburg, Sweden.
    Passmark, Henrik
    Karolinska institutet, Solna, Sweden.
    Stalfors, Joacim
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    A Patient questionnaire can give valid information on the prescence of morbidity after tonaillar surgery: results of a validation study2012Konferansepaper (Annet vitenskapelig)
  • 72.
    Hessen Soderman, Anne-Charlotte
    et al.
    Department of Otolaryngology, Karolinska University Hospital, Stockholm, Sweden.
    Ericsson, Elisabeth
    Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Hemlin, Claes
    Division of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
    Hultcrantz, Elisabeth
    Department of Otorhinolaryngology, Aleris Sabbatsberg, Stockholm, Sweden; Division of Otorhinolaryngology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Månsson, Ingemar
    Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Roos, Kristian
    Department of Otorhinolaryngology, Capio Lundby, Gothenburg, Sweden.
    Stalfors, Joacim
    Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Reduced Risk of Primary Postoperative Hemorrhage After Tonsil Surgery in Sweden: Results from the National Tonsil Surgery Register in Sweden Covering More Than 10 Years and 54,696 Operations2011Inngår i: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 121, nr 11, s. 2322-2326Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives/Hypothesis: To analyze the incidence of primary bleeding following tonsil surgery and to evaluate risk factors. less thanbrgreater than less thanbrgreater thanStudy Design: Register study of the results from the National Tonsil Surgery Register in Sweden covering the period 1997 to 2008 and 54,696 operations. less thanbrgreater than less thanbrgreater thanMethods: Data were collected by means of three questionnaires, two filled in by professionals and one 6 months post-operatively by the patient/parent. less thanbrgreater than less thanbrgreater thanResults: A total of 719 patients experienced primary postoperative bleeding during the hospital stay (1.3%). A number of independent factors were correlated with decreased risk of post-tonsillectomy hemorrhage: younger age (P andlt; .0001), female sex (P andlt; .0001), type of surgery (tonsillotomy) (P = .0006), and surgery performed on a day-surgery basis (P andlt; .0001). Indication for surgery and number of operations performed at the department did not correlate with postoperative bleeding risk. A significant decrease in primary postoperative hemorrhage rate from 2% to 0.96% was found during the study period. less thanbrgreater than less thanbrgreater thanConclusions: Primary hemorrhage following tonsil surgery is rare. During the study period, a significant decrease in primary bleeding rates occurred. The changes in practice with an increasing proportion of day-surgery cases and tonsillotomy have contributed to the reduced risk, but cannot completely explain the reduction.

  • 73.
    Hessen-Söderman, Anne-Charlotte
    et al.
    Karolinska Universitetssjukhuset, Solna, Sweden.
    Stalfors, Joacim
    Institutionen för kliniska vetenskaper vid Sahlgrenska akademin, Göteborg, Sverige.
    Ericsson, Elisabeth
    , HHJ. CHILD, Högskolan i Jönköping, Jönköping, Sverige.
    Hemlin, Claes
    ÖNH-kliniken, Sabbatsbergssjukhus, Stockholm, Sverige.
    Roos, Kristian
    ÖNH-kliniken, Lundbysjukhus, Göteborg, Sverige.
    Hultcrantz, Elisabeth
    Hälsouniversitetet, Linköping. Sverige.
    Blödning efter tonsilloperation: Resultat ur nya nationella kvalitetsregistret2009Konferansepaper (Annet vitenskapelig)
    Abstract [sv]

    Bakgrund: Det nya kvalitetsregistret för tonsilloperation startade 090301. Uppgifter angående operationsmetod och använd utrustning registreras nu samt om mer än en operationsindikation har använts. Nytt är en postop. 30-dagarsenkät som föräldrarna/vuxna patienter får besvara via nätet. Då får man besked angående det postoperativa förloppet inkl. sekundära blödningar.

    Resultat: Fem månader efter start har 2341 patienter registrerats varav 2020 är opererade. 1109 har besvarat 30-dagarsenkäten och ännu ingen 6- månaders-formuläret. Det vanligaste ingreppet är Tonsillektomi (TE) med 976 operationer följt av tonsillotomi (TT)+Abrasio, 495 ingrepp, därefter TE+Abrasio 413 och TT 104. Primär blödning är ungefär lika vanligt för de tre första ingreppen, 2,6%, 1,8% resp. 2,4% och enbart TT 0%.Sekundär blödning, som rapporterats av föräldrarna/patienten efter 30 dagar visar TE 9%, TE+Abrasio 2,6% , TT 2% och TT + Abrasio 0.7%. Av metoder har kallt stål använts flitigast: 1078 operationer med 2,7% primära blödningar och 6% sekundära, följt av Radiofrekvens, 684 operationer med 1,5% primära och 1,6% sekundära blödningar. Diatermisax har använts på 131 patienter med 1,5% primära och 22% sekundärblödningar, Ultracision vid 79 operationer med 0 primär och 7,7% sekundärblödning samt Laser vid 22 operationer med 1,5% primär och 9% sekundärblödning.

    Diskussion: De olika prevalenser av postoperative blödning som resultaten visar är inte entydiga: Enbart TE görs nästan enbart på vuxna, oftast på infektionsindikation, vilket kan förklara en högre blödningsförekomst jämfört med TE+Abrasio, som istället enbart görs på barn med obstruktionsindikation, med mindre blödning som följd. Skillnaden i blödning, mellan TE och TT är dock klar, eftersom relativt många individer är opererade i båda grupperna och man genomgående har signifikant lägre blödning för TT. När det gäller operationsmetod visar de ”heta” metoderna lägre primärblödning men fler sekundär-blödningar än kallt stål. Radiofrekvens, som arbetar vid lägre temperatur har de lägsta blödningstalen både vad gäller primär- och sekundärblödning. En bias är att enbart hälften av de opererade har skickat in 30-dagarsenkät. De minst nöjda, dvs. de som blött efteråt, är kanske mer villiga att påtala detta, vilket i så fall generellt ger för höga blödningstal. Konklusion: TT ger färre primära och sekundära blödningar än TE. ”Heta” tekniker ger ett stort antal sekundära blödningar. Högre svarsfrekvens eftersträvas.

  • 74.
    Hessén Söderman, Anne- Charlotte
    et al.
    Karolinska University Hospital, Solna, Sweden .
    Ericsson, Elisabeth
    Nursing, Linköpings University, Linköping, Sweden .
    Hemlin, Claes
    Aleris Sabbatsberg Hospital, Stockholm, Sweden.
    Hultcrantz, Elisabeth
    Oto-Rhino-Laryngologi, Linköpings university, Linköping, Sweden.
    Roos, Kristian
    Capio Lundby Hospital, Göteborg, Sweden.
    Sunnergren, Ola
    County Hospital Ryhov, Jönköping, Sweden.
    Stålfors, Joacim
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Posttonsillectomy haemorrhage rates related to surgical technique2012Konferansepaper (Annet vitenskapelig)
  • 75.
    Hessén Söderman, Anne-Charlotte
    et al.
    Aleris Sabbatsberg, Stockholm, Sweden.
    Odhagen, Erik
    Sahlgrenska universitetssjukhus, Göteborg, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Hemlin, Claes
    Aleris Sabbatsberg, Stockholm, Sweden.
    Hultcrantz, Elisabeth
    Linköpings universitet, Linköping, Sweden.
    Sunnergren, Ola
    Länssjukhuset, Jönköping, Sweden.
    Stalfors, Joacim
    Sahlgrenska universitetssjukhus, Göteborg, Sweden.
    Posttonsillectomy haemorrhage rates related to technique for dissection and for haemostasis, analysis of 6723 patients in the national tonsil surgery register in Sweden2014Konferansepaper (Fagfellevurdert)
  • 76.
    Hessén-Söderman, Anne-Charlotte
    et al.
    Department of Otorhinolaryngology, Aleris Sabbatsberg, Stockholm, Sweden; Division of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Odhagen, Erik
    Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Hemlin, Claes
    Sollentuna Specialist Clinic, Stockholm, Sweden.
    Hultcrantz, Elisabeth
    Department of Otorhinolaryngology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Sunnergren, Ola
    Department of Otorhinolaryngology, Ryhov County Hospital and Futurum, The Academy for Health and Care, County Council, Jönköping, Sweden.
    Stalfors, Joacim
    Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
    Post-tonsillectomy haemorrhage rates are related to technique for dissection and for haemostasis: an analysis of 15734 patients in the National Tonsil Surgery Register in Sweden2015Inngår i: Clinical Otolaryngology, ISSN 1749-4478, E-ISSN 1365-2273, Vol. 40, nr 3, s. 248-254Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To analyse post-tonsillectomy haemorrhage(PTH) rates related to technique for dissection and haemostasis.Study Design: Register study from the National TonsilSurgery Register in Sweden (NTSRS).

    Methods: All patients, subjected to tonsillectomy (TE)without adenoidectomy from 1 March 2009 to 26 April 2013,were included in the study. The surgeon reports data abouttechnique and early PTH, while late PTH is reported by thepatient in a questionnaire 30 days after surgery.

    Results: 15734 patients with complete data concerningtechnique for dissec tion and for haemostasis were identifiedin the NTSRS. Techniques used were cold steel dissectionwith uni- or bipolar diathermy haemostasis (65.3%),diathermy scissors (15.7%), coblation (9.1%), cold steeldissection with cold haemostasis (7.4%) and ultrascision(2.5%). Early and late PTH were reported in 3.2% and 9.4% of the cases, respectively, and return to theatre (RTT) in2.7%. The rat es for PTH and RTT related to technique wereanalysed. Compared with cold dissection+ cold haemostasis,late PTH rate was 2.8 times higher after cold dissection + hothaemostasis, 3.2 times higher after coblation, 4.3 timeshigher after diathermy scissors and 5.6 times higher afterultrascision. The risk for RTT was higher for all hottechniques except for coblation, while ultrascision resultedin a lower risk for early PTH.

    Conclusions: All hot techniques resulted in a higher risk forlate PTH compared with cold steel dissection +coldhaemostasis. The risk for RTT was higher for all hottechniques except for coblation, while ultrascision resultedin a lower risk for early PTH. An early PTH was associatedwith an increased risk for late PTH.

  • 77.
    Hessén-Söderman, Lotta
    et al.
    Department of Otorhinolaryngology, Aleris Sabbatsberg, Stockholm, Sweden; Division of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper.
    Hemlin, Claes
    Sollentuna Specialist Clinic, Stockholm, Sweden.
    Odhagen, Erik
    Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Nerfeldt, Pia
    Karolinska University Hospital, Huddinge, 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 University Hospital, Gothenburg, Sweden.
    Tonsillektomi, tonsillotomi med coblation: vad säger vetenskapen och vårt kvalitetsregister?2016Inngår i: ÖNH-tidskrift, ISSN 1400-0121, Vol. 23, nr S1, s. 26-26Artikkel i tidsskrift (Annet vitenskapelig)
    Fulltekst (pdf)
    Tonsillektomi, tonsillotomi med coblation - vad säger vetenskapen och vårt kvalitetsregister?
  • 78.
    Hultcrantz, Elisabeth
    et al.
    Department of Clinical and Experimental Medicine, Division of Otorhinolaryngology Faculty of Medicine, Linköping University, Linköping, Sweden.
    Ericsson, Elisabeth
    Department of Clinical and Experimental Medicine, Division of Otorhinolaryngology Faculty of Medicine, Linköping University, Linköping, Sweden.
    Factors Influencing the Indication for Tonsillectomy: A Historical Overview and Current Concepts2013Inngår i: Journal for Oto-Rhino-Laryngology, ISSN 0301-1569, E-ISSN 1423-0275, Vol. 75, nr 3, s. 184-191Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Tonsil surgery has been performed for more than 3,000 years. During the 19th century when anesthesia became available, techniques were refined and the number of procedures performed increased. Repeated throat infections often causing big tonsils was the reason why parents asked for the procedure. During the preantibiotic era, scarlet fever was feared since potential heart or kidney complications were life-threatening. The technique used before 1900 was tonsillotomy since neither a fingernail, snare nor the later guillotine were used extracapsularly. Bleeding was small and the surgery ambulatory. Extracapsular tonsillectomy developed around the turn of the 20th century with the purpose of avoiding remnants the focal infection theory was prevailing. The whole tonsil was now extirpated with good visibility of the tonsillar area in a deeply anesthetized patient. During the first half of the 20th century, the two methods competed, but by 1950, total tonsillectomy had become the only correct tonsil surgery. The indication was still recurrent infections. The risk for serious bleeding increased; therefore large clinics arose where patients remained for at least a week after tonsillectomy. When oral penicillin for children became available during the 1960s, the threat of throat infection decreased and the number of tonsillectomies declined. The awareness of obstructive problems in children rose at the same time when obstructive sleep apnea syndrome became a disease for adults (1970s). Tonsillotomy was revived during the 1990s and is today used increasingly in many countries. The indication is mainly obstructive sleep apnea syndromeor sleep-disordered breathing, especially in small children. Total tonsillectomy is still preferred for recurrent infections, which include periodic fever/adenitis/pharyngitis/aphthous ulcer syndrome and recurrent peritonsillitis.

  • 79.
    Hultcrantz, Elisabeth
    et al.
    Linköpings universitet.
    Ericsson, Elisabeth
    Linköpings universitet.
    Pediatric Tonsillotomy with Radiofrequency Technique: Less Morbidity and Pain2004Inngår i: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 114, nr 5, s. 871-877Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 80.
    Hultcrantz, Elisabeth
    et al.
    Oto-Rhino-Laryngologi, Linköpings universitet, Linköping, Sverige.
    Ericsson, Elisabeth
    Omvårdnad, Linköpings universitet, Linköping, Sverige.
    Hemlin, Claes
    Aleris Sabbatsberg Hospital, Stockholm, Sverige.
    National Guidelines for Tonsillotomy in children in Sweden2012Konferansepaper (Annet vitenskapelig)
  • 81.
    Hultcrantz, Elisabeth
    et al.
    Avdelningen för otorhinolaryngologi, Institutionen för klinisk och experimentell medicin, Linköpings universitet, Linköping, Sweden.
    Ericsson, Elisabeth
    Avdelningen för omvårdnad, Hälsouniversitetet i Linköping, Linköping, Sweden.
    Hemlin, Claes
    Aleris specialistvård Sabbatsberg, Stockholm, Sweden.
    Eggertsen, Robert
    Instiutionen för medicin/Avdelningen för Samhällsmedicin och folkhälsa/allmänmedicin, Göteborgs Universitet, Göteborg, Sweden.
    Lundeborg-Hammarström, Inger
    Institutionen för klinisk och experimentell medicin/logopedi, Linköpings universitet, Linköping, Sweden.
    Marcusson, Agneta
    Käkkliniken Universitetetssjukhuset, Linköping, Sweden.
    Proczkowska-Björklund, Marie
    Barn- och ungdomspsykiatri, Psykiatriska kliniken, Eksjö/Nässjö (Höglandet ), Sweden.
    Stjernquist-Desatnik, Anna
    Öron-näsa-hals-kliniken, Universitetssjukhuset, Lund, Sweden.
    Zettergren-Wijk, Lena
    Avdelningen för tandreglering, Folktandvården Gävleborg AB, Gävle, Sweden.
    Moa, Gunnar
    The National Board of Health and Welfare (Socialstyrelsen), Stockholm, Sweden.
    Törnqvist, Helene
    The National Board of Health and Welfare (Socialstyrelsen), Stockholm, Sweden.
    Indikation för tonsillotomi på barn och ungdomar2011Rapport (Annet vitenskapelig)
  • 82.
    Hultcrantz, Elisabeth
    et al.
    Avdelningen för Otorhinolaryngologi, Inst för Kliniks och Experimentell Medicin, Hälsouniversitetet, Linköping, Sverige.
    Ericsson, Elisabeth
    HHJ. CHILD,Högskolan i Jönköping, Jönköping, Sverige.
    Hemlin, Claes
    Avdelningen för Otorhinolaryngologi, Aleris Sabbatsberg, Stockholm, Sverige.
    Hessen Soderman, Anne-Charlotte
    Avdelningen för Otorhinolaryngologi, Karolinska Universitetssjukhus, Stockholm, Sverige.
    Roos, Kristian
    Avdelningen för Otorhinolaryngologi, Capio Lundby, Göteborg, Sverige.
    Stahlfors, Joacim
    Avdelningen för Otorhinolaryngologi, Sahlgrenska Universitetssjukhus, Göteborg, Sverige.
    Tonsillectomy or Tonsillotomy: Is a change of paradigm on-going? Data out of a new National Tonsil Surgery Register in Sweden2010Konferansepaper (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES

    To study the current prevalence of different tonsil surgery techniques in children with obstructive symptoms in Sweden and the rates of primary and secondary bleeding as a function of the procedure and technique used.

    METHODS

    The new National Tonsil Surgery Register in Sweden was used; this registry was opened in March 2009.The data for patients aged 1–15 years operated for obstruction was analyzed. To the registry, age, sex,indication for surgery, surgical procedure and techniques is recorded prospectively, as is primary bleedings occurring during hospital stay. 30 days after surgery, complications such as secondary bleedings,uncontrolled pain and nosocomial infections are reported by parents in questionnaires collected using asecure internet-page.

    RESULTS

    A total of 3980 patients between 1–15 years were operated during the period covered, of whom 3172 for obstructive symptoms. Of the 1876 that have thus far answered the 30 day post-operative questionnaire 511 were operated with adenotonsillectomy (A+TE) and 943 with adenotonsillotomy (A+TT), 246 were operated with tonsillectomy (TE) and 174 with tonsillotomy (TT). Primary bleedings were reported in 55/3172 patients: 2.4% after A+TE, 1.8% after A+TT, 1.9% after TE and 0.35% after TT. Secondary bleedings were noted in 36/1876 patients: 3.3% after A+TE, 0.85% after A+TT, 4.1% after TE and 0.6% after TT. The used surgical techniques (TE/TT) were cold steel (455/17), radiofrequency (72/864), diathermy (39/2), ultracision (23/24) or laser (3/22).

    CONCLUSIONS

    TT for the indication, “obstruction” has become more common than TE. TT results in fewer both primary and secondary postoperative bleedings. Further analyzes

  • 83.
    Hultcrantz, Elisabeth
    et al.
    Linköpings universitet, Linköping, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    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.
    From case reports to registry studies: tonsil surgery resaerch in Sweden2014Konferansepaper (Fagfellevurdert)
  • 84.
    Hultcrantz, Elisabeth
    et al.
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Ericsson, Elisabeth
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Anesthesia and Intensive Care, County Council of Östergötland, Linköping, Sweden.
    Hemlin, Claes
    Ear-, Nose- and Throat Clinic, Aleris Sabbatsberg Hospital, Stockholm, Sweden.
    Hessén-Söderman, Anne-Charlotte
    Ear-, Nose- and Throat Clinic, Aleris Sabbatsberg Hospital, Stockholm, Sweden.
    Roos, Kristian
    Ear-, Nose- and Throat Clinic, Capio Lundby Hospital, Gothenburg, Sweden.
    Sunnergren, Ola
    Ear-, Nose- and Throat Clinic, County Hospital Ryhov, Jönköping, Sweden.
    Stalfors, Joacim
    Ear-, Nose- and Throat Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Paradigm shift in Sweden from tonsillectomy to tonsillotomy for children with upper airway obstructive symptoms due to tonsillar hypertrophy2013Inngår i: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 270, nr 9, s. 2531-2536Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Tonsillotomy (TT) is now used more often than tonsillectomy (TE) for tonsil obstructive symptoms in Sweden. Both TE and TT give high patient satisfaction although TT results in fewer postoperative bleedings and shorter time when analgesics are needed. The objective of this study is to analyze the current prevalence of different tonsil surgery procedures, the rates of early and late bleeding and other complications. Data from the National Tonsil Surgery Register in Sweden were analyzed. Patients 1–15 years operated for symptoms due to tonsil hypertrophy were included. Surgical procedure, technique and bleedings during hospital stay were registered. Thirty days after surgery, unplanned contacts due to bleeding, infection or pain were reported as were symptom relief after 6 months. 24,083 patients were registered. Of the 10,826 children 1–15 years operated for obstructive symptoms, 64 % were TT or TT+A, and 34 % TE, TE+A. 69 % answered the 30-day questionnaire and 50 % the 6 months. Bleeding in hospital occurred in 1.38 %, late bleedings in 2.06 %: 3.7 % after TE+A, 0.8 % after TT+A. Differences in readmissions due to bleeding, number of days using analgesics, health care contacts due to pain and nosocomial infections were significant between TT and TE, but not differences with regard to symptom relief after 6 months.

  • 85.
    Hultcrantz, Elisabeth
    et al.
    Hälsouniversitetet, Linköpings universitet, Linköping.
    Smedje, H
    Månsson, I
    Hallén, L
    Ericsson, Elisabeth
    Hälsouniversitetet, Linköpings universitet, Linköping.
    Tonsillektomi: skall vi fortsätta med det?2005Inngår i: Svensk ÖNH-tidskrift, ISSN 1400-0121, Vol. 12, s. 15-16Artikkel i tidsskrift (Annet vitenskapelig)
  • 86.
    Kallunki, Jenny
    et al.
    The center for Orthodonitics and pedodontics, County Council of Östergötland, Linköping, Sweden.
    Marcusson, Agneta
    Departments of Dentofacial ortopaedics, University Hospital, Linköping, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Tonsillotomy versus tonsillectomy: a randomized trial regarding dentofacial morphology and post-operate growth in children with tonsillar hypertrophy2014Konferansepaper (Fagfellevurdert)
  • 87.
    Kallunki, Jenny
    et al.
    Center for Orthodontics and Pedodontics, County of Östergöland, Linköping, Sweden.
    Marcusson, Agneta
    Departments of Dentofacial Orthopaedics, Linköping University Hospital, Linköping, Sweden.
    Ericsson, Elisabeth
    Medical and Health Sciences, Linköping University, Linköping, Sweden; Anesthesia and Intensive Care, County Council of Östergötland, Linköping, Sweden.
    Tonsillotomy versus tonsillectomy: a randomized trial regarding dentofacial morphology and post-operative growth in children with tonsillar hypertrophy2014Inngår i: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 36, nr 4, s. 471-478Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives:The primary aim of this study was to analyse two different methods of tonsil surgery, tonsillectomy (TE) and tonsillotomy (TT), regarding post-operative dentofacial growth in children with tonsillar hypertrophy. A secondary aim was to analyse these results in relation to cephalometric standards.Material and methods:The study group consisted of 64 subjects (39 boys and 25 girls), mean age 4.8 years ± 4 months. They were randomized to a complete removal of the pharyngeal tonsil, TE, (n = 31) or a partial removal, TT, (n = 33). Pre-operative and 2 years post-operative study material were obtained and analysed. The results were compared with cephalometric standards.Results:Pre-operative, children with hypertrophic tonsils displayed an increased vertical relation (P < 0.05) compared with cephalometric standards. Post-operative, no significant difference could be detected between the two surgical procedures regarding dentofacial growth. Mandibular growth with an anterior inclination was significant (P < 0.001/TE, P < 0.01/TT) for both groups. An increased upper and lower incisor inclination was noted (P < 0.01/TE,TT). The vertical relation decreased (P < 0.001/TE, P < 0.05/TT) as well as the mandibular angle (P < 0.01/TE, P < 0.001/TT). Reduction was also significant for the sagittal intermaxillar (P < 0.001/TE,TT) relation. These post-operative results, together with a more prognatic mandible (P < 0.05/TE,TT) and chin (P < 0.001/TE, P < 0.01/TT), might indicate a more horizontal direction of mandibular growth.Conclusion:TE and TT yielded equal post-operative dentofacial growth in children treated for hypertrophic tonsils. This result should be considered when deciding upon surgical technique.

  • 88.
    Lundeborg Hammarström, Inger
    et al.
    Hälsouniversitetet, Linköpings universitet, Linköping.
    Ericsson, Elisabeth
    Hälsouniversitetet, Linköpings universitet, Linköping.
    McAllister, Anita
    Hälsouniversitetet, Linköpings universitet, Linköping.
    Hultcrantz, Elisabeth
    Hälsouniversitetet, Linköpings universitet, Linköping.
    Effects of tonsil surgery on speech and oral motor function2008Inngår i: The 12th Congress of the International Clinical Phonetics and Linguistics association, 2008, s. 119-119Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Large tonsils decrease the upper airways and cause oral breathing in children. If oral breathing persists, it leads to muscular and postural alterations, which, in turn cause dentoskeletal changes. In Sweden 6% of all children, have tonsil surgery performed. The indications are usually recurrent tonsillitis or severe snoring and/or sleep apneoa. Oral motor dysfunction including swallowing problems , disordered speech and aberrant dentofacial growth are less recognized problems as indications for treatment. We report results from a project aiming at comparing oral motor function and speech in children trated with two different surgical methods, tonsillectomy (TE) and partial tonsil resection, tonsillotomy (TT). 67 children aged 4-5 years old on ordinary waiting list for tonsil surgery were randomized to either TE or TT. They were assessed with the Swedish version of Nordic Orofacial Test (NOT-S) and a Swedish phonological test. A voice recording was also made. The assessment was repeated 6 months after surgery. The results were compared to a control group without tonsil problems. No significant differences were found between the children operated with TE or TT. Both groups performed significantly better on the oral motor test at the postoperative assessment, and voice quality had improved. However, compared to the control group, the children with enlarged tonsils had a delay in phonological development, preoperatively that remained at the 6-month postoperative control   

  • 89.
    Lundeborg, Inger
    et al.
    Logopedi, Linköpings universitet, Linköping, Sverige.
    Ericsson, Elisabeth
    Omvårdnad , Linköpings universitet, Linköping, Sverige.
    Different techniques of pediatric tonsil surgery: Effects on oral motor function, speech and language behavior and quality of life2011Konferansepaper (Fagfellevurdert)
  • 90.
    Lundeborg, Inger
    et al.
    LDepartment of Clinical and Experimental Medicine, IKE/Speech Language Pathology, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Ericsson, Elisabeth
    School of Health Sciences Science, Department of Nursing Science, Jönköping University, Jönköping, Sweden.
    Hutltcrantz, Elisabeth
    Department of Clinical and Experimental Medicine, Division of Oto-Rhino-Laryngology, Linköping University, Linköping, Sweden.
    McAllister, Anita M.
    IKE/Speech Language Pathology, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Influence of adenotonsillar hypertrophy on s-articulation in children: effects of surgery2011Inngår i: Logopedics, Phoniatrics, Vocology, ISSN 1401-5439, E-ISSN 1651-2022, Vol. 36, nr 3, s. 100-108Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Tonsillar hypertrophy is common in young children and affects several aspects of the speech such as distortions of the dento-alveolar consonants. The study objective was to assess /s/-articulation, perceptually and acoustically, in children with tonsillar hypertrophy and compare effects of two types of surgery, total tonsillectomy and tonsillotomy. Sixty-seven children, aged 50-65 months, on the waiting list for surgery, were randomized to tonsillectomy or tonsillotomy. The speech material was collected preoperatively and 6 months postoperatively. Two groups of age-matched children were controls. /S/-articulation was affected acoustically with lower spectral peak locations and perceptually with less distinct /s/-production before surgery, in comparison to controls. After surgery /s/-articulation was normalized perceptually, but acoustic differences remained. No significant differences between surgical methods were found.

  • 91.
    Lundeborg, Inger
    et al.
    Division of Speech and Language Pathology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Hultcrantz, Elisabeth
    Division of Oto-Rhino-Laryngology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Ericsson, Elisabeth
    Division of Oto-Rhino-Laryngology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    McAllister, Anita
    Division of Speech and Language Pathology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Acoustic and perceptual aspects of vocal function in children with adenotonsillar hypertrophy: effects of surgery2012Inngår i: Journal of Voice, ISSN 0892-1997, E-ISSN 1873-4588, Vol. 26, nr 4, s. 480-487Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate outcome of two types of tonsil surgery (tonsillectomy [TE] + adenoidectomy or tonsillotomy [TT] + adenoidectomy) on vocal function perceptually and acoustically.

    Study Design: Sixty-seven children, aged 50–65 months, on waiting list for tonsil surgery were randomized to TE (n = 33) or TT (n = 34). Fifty-seven age- and gender-matched healthy preschool children were controls. Twenty-eight of them, aged 48–59 months, served as control group before surgery, and 29, aged 60–71 months, served as control group after surgery.

    Methods:  Before surgery and 6 months postoperatively, the children were recorded producing three sustained vowels (/ɑ/, /u/, and /i/) and 14 words. The control groups were recorded only once. Three trained speech and language pathologists performed the perceptual analysis using visual analog scale for eight voice quality parameters. Acoustic analysis from sustained vowels included average fundamental frequency, jitter percent, shimmer percent, noise-to-harmonic ratio, and the center frequencies of formants 1–3.

    Results: Before surgery, the children were rated to have more hyponasality and compressed/throaty voice (P < 0.05) and lower mean pitch (P < 0.01) in comparison to the control group. They also had higher perturbation measures and lower frequencies of the second and third formants. After surgery, there were no differences perceptually. Perturbation measures decreased but were still higher compared with those of control group (P < 0.05). Differences in formant frequencies for /i/ and /u/ remained. No differences were found between the two surgical methods.

    Conclusion: Voice quality is affected perceptually and acoustically by adenotonsillar hypertrophy. After surgery, the voice is perceptually normalized but acoustic differences remain. Outcome was equal for both surgical methods.

  • 92.
    Lundeborg, Inger
    et al.
    Division of Speech and Language Pathology, Department of Clinical and Experimental Medicine, Linköping University, Linköping.
    McAllister, Anita
    Division of Speech and Language Pathology, Department of Clinical and Experimental Medicine, Linköping University, Linköping.
    Graf, Jonas
    Division of Otorhinolaryngology, Department of Clinical and Experimental Medicine, Linköping University, Linköping.
    Ericsson, Elisabeth
    Division of Otorhinolaryngology, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Nursing Science, School of Health Sciences, Jönköping.
    Hultcrantz, Elisabeth
    Division of Otorhinolaryngology, Department of Clinical and Experimental Medicine, Linköping University, Linköping.
    Oral Motor Dysfunction in Children with adenotonsillar hypertrophy: effects of Surgery2009Inngår i: Logopedics, Phoniatrics, Vocology, ISSN 1401-5439, E-ISSN 1651-2022, Vol. 34, nr 3, s. 111-116Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Adenotonsillar hypertrophy is associated with a wide range of problems. The enlargement causes obstructive symptoms and affects different functions such as chewing, swallowing, articulation, and voice. The objective of this study was to assess oral motor function in children with adenotonsillar hypertrophy using Nordic Orofacial Test-Screening (NOT-S) before and 6 months after surgery consisting of adenoidectomy combined with total or partial tonsil removal. A total of 67 children were assigned to either tonsillectomy (n33) or partial tonsillectomy, ‘tonsillotomy’ (n34); 76 controls were assessed with NOT-S and divided into a younger and older age group to match pre- and post-operated children. Most children in the study groups had oral motor problems prior to surgery including snoring, open mouth position, drooling, masticatory, and swallowing problems. Post-surgery oral motor function was equal to controls. Improvement was independent of surgery method.

  • 93.
    Lundeborg, Inger
    et al.
    Division of Speech and Language Pathology, Department, University of Linköping, Linköping.
    McAllister, Anita
    Division of Speech and Language Pathology, Department, University of Linköping, Linköping.
    Samuelsson, Christina
    Division of Speech and Language Pathology, Department, University of Linköping, Linköping.
    Ericsson, Elisabeth
    Division of Oto-Rhino-Laryngology, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Nursing Science, School of Health Sciences, Jönköping.
    Hultcrantz, Elisabeth
    Division of Oto-Rhino-Laryngology, Department of Clinical and Experimental Medicine, Linköping University, Linköping.
    Phonological Development in Children with Obstructive Sleep Disordered Breathing2009Inngår i: Clinical Linguistics & Phonetics, ISSN 0269-9206, E-ISSN 1464-5076, Vol. 23, nr 10, s. 751-61Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Adeno-tonsillar hypertrophy with obstructive sleep disordered breathing (OSDB) is known to affect oral-motor function, behaviour, and academic performance. Adeno-tonsillectomy is the most frequently performed operation in children, with total tonsillectomy (TE) being more common than partial resection, ‘tonsillotomy’ (TT). In the present study 67 children, aged 50–65 months, with OSBD were randomized to TE or TT. The children’s phonology was assessed pre-operatively and 6 months post-operatively. Two groups of children served as controls. Phonology was affected in 62.7% of OSBD children before surgery, compared to 34% in the control group (p < .001). Also, OSBDchildren had more severe phonological deficits than the controls (p < .001). Phonology improved 6 months equally after both surgeries. Despite improvement post-operatively, the gap to the controls increased. Other functional aspects, such as oral motor function, were normalized regardless of surgical method—TE or TT. The impact of OSBD should be considered as one contributing factor in phonological impairment.

  • 94.
    Nerfeldt, Pia
    et al.
    Karolinska Universitetssjukhuset, Huddinge, Sweden.
    Stalfors, Joacim
    Sahlgrenska Universitetssjukhuset, Göteborg, Sweden.
    Sunnergren, Ola
    Department of Otorhinolaryngology, Ryhov County Hospital, Jönköping, Sweden; Futurum-The Academy for health and care, County Council, Jönköping, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper.
    Odhagen, Erik
    Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hessén-Söderman, Anne-Charlotte
    Department of Otorhinolaryngology, Aleris Sabbatsberg, Stockholm, Sweden; Division of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Hemlin, Claes
    Sollentuna Specialist Clinic, Stockholm, Sweden.
    Paediatric Tonsil Surgery in Sweden 2015: Indications, Methods and Complication Rates2016Konferansepaper (Fagfellevurdert)
  • 95.
    Nilsson, Lena
    et al.
    Division of Drug Research, Anesthesiology and Intensive Care, Department of Medical and Health Sciences, Linköpings university, Linköping, Sweden; Department of Anesthesia and Intensive Care, University Hospital, Linköping, Sweden.
    Pihl, A.
    Department of Anesthesia and Intensive Care, Vrinnevi Hospital, Norrköping, Sweden; Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Tågsjö, M
    Department of Anesthesia and Intensive Care, Vrinnevi Hospital, Norrköping, Sweden; Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Ericsson, Elisabeth
    Department of Anesthesia and Intensive Care, University Hospital, Linköping, Sweden; Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Adverse events are common on the intensive care unit: results from a structured record review2012Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 56, nr 8, s. 959-965Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Intensive care is advanced and highly technical, and it is essential that, despite this, patient care remains safe and of high quality. Adverse events (AEs) are supposed to be reported to internal quality control systems by health-care providers, but many are never reported. Patients on the intensive care unit (ICU) are at special risk for AEs. Our aim was to identify the incidence and characteristics of AEs in patients who died on the ICUduring a 2-year period.

    Methods: A structured record review according to the Global Trigger Tool (GTT) was used to review charts from patients cared for at the ICU of a middle-sized Swedish hospital during 2007 and 2008 and who died during or immediately after ICU care. All identified AEs were scored according to severity and preventability.

    Results: We reviewed 128 records, and 41 different AEs were identified in 25 patients (19.5%). Health care-associated infections, hypoglycaemia, pressure sores and procedural complications were the most common harmful events. Twenty two (54%) of the AEs were classified as being avoidable. Two of the 41AEs were reported as complications according to the Swedish Intensive Care Registry, and one AE had been reported in the internal AE-reporting system.

    Conclusion: Almost one fifth of the patients who died on the ICU were subjected to harmful events. GTT has the advantage of identifying more patient injuries caused by AEs than the traditional AE-reporting systems used on many ICUs.

  • 96.
    Nilsson, Ulrica
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Idvall, Ewa
    Department of Care Sciences, Faculty of Heath and Society, Malmö University, Malmö, Sweden.
    Bramhagen, Ann-Cathrine
    Department of Care Sciences, Faculty of Heath and Society, Malmö University, Malmö, Sweden.
    Psychometric evaluation of the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery and postoperative behavior and recovery inchildren undergoing tonsil surgery2019Inngår i: Journal of Perioperative Practice, ISSN 1750-4589, Vol. 29, nr 4, s. 94-101Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The study comprised a prospective, comparative cross-sectional survey in 143 (of 390) children undergoing tonsil surgery. Parents answered the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS), and children answered the questionnaire Postoperative Recovery in Children (PRiC). The PHBQ-AS had positive correlation with the PRiC and with general health. On day 10 after surgery, up to one-third of the children still reported physical symptoms (PRiC). No gender or age differences concerning the items of behavior (PHBQ-AS) were found. The quality of postoperative recovery (PRiC) in girls was lower, with higher levels of nausea, dizziness, coldness, and headache compared to the boys. Children <6 years of age reported higher levels of dizziness and lower sleep quality and lower general health.

  • 97.
    Odhagen, Erik
    et al.
    Södra Älvsborgs Sjukhus, Borås, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Hemlin, Claes
    Aleris Specialistvård, Stockholm, Sweden.
    Hessén-Söderman, Anne-Charlotte
    Aleris Specialistvård, Stockholm, Sweden.
    Hultcrantz, Elisabeth
    Linköpings universitet, Linköping, Sweden.
    Sunnergren, Ola
    Länssjukhuset Ryhov, Jönköping, Sweden.
    Stalfors, Joacim
    Sahlgrenska Universitetssjukhus, Göteborg, Sweden.
    Risk of secondary surgery after tonsillectomy versus tonsillectomy, a population study, covering 13 years and 120,719 tonsil surgeries in Sweden2014Konferansepaper (Fagfellevurdert)
  • 98.
    Odhagen, Erik
    et al.
    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, Jönköping County Council, Jönköping, 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.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper.
    Nerfeldt, Pia
    Karolinska Universitetssjukhuset, Huddinge, Sweden.
    Stalfors, Joacim
    Sahlgrenska Universitetssjukhus, Göteborg, Sweden.
    Readmission Rates Due to Post-Tonsillectomy Haemorrhage in Sweden: SIGNIFICANT DIFFERENCES BETWEEN SURGICAL CENTRES: Significant Differences Between Surgical Centres2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Objectives: Post-surgical haemorrhage is the major complication of tonsil surgery. Post-tonsillectomy haemorrhage often results in readmission to hospital, sometimes demands return to theatre and can be a life-threatening occurrence. There are large differences in previously reported rates of post-tonsillectomy haemorrhage. The aim of this study is to determine readmission rates due to post-tonsillectomy haemorrhage in Sweden 2012-2014.

    Method: This is a population-based cohort study based on matched data from two healthcare registries in Sweden; the Swedish National Patient Register (NPR) and the National Tonsil Surgery Register in Sweden (NTSRS). All patients who underwent tonsillectomy, with or without simultaneous adenoidectomy, on benign indications from 2012 to 2014 were included in the study. The unique Personal Identity numbers were used to follow patients over time in NPR and identify readmission due to haemorrhage within 30 days from surgery. In NTSRS, readmission was reported by the patient in a questionnaire 30 days after surgery.

    Results: By matching the two registries a total of 22 800 unique patients were identified and included in the study. A total of 1726 patients (7.6%) were readmitted to hospital due to post-surgical haemorrhage. Tonsil surgery was conducted at 56 different surgical centres. Readmission rates due to post-tonsillectomy haemorrhage ranged from 0% to 22.4% at different surgical centres. 11 of 56 surgical centres had significant lower readmission rates compared to the average in Sweden. 12 of 56 surgical centres had significant higher readmission rates than the average.

    Conclusions: The rate of hospital readmissions due to post-surgical haemorrhage following tonsillectomy in Sweden 2012-2014 was 7.6%. There were significant differences in readmission rates between different surgical centres. This suggests that quality improvement interventions should be explored in units with high readmission rates to decrease post-tonsillectomy morbidity.

  • 99.
    Odhagen, Erik
    et al.
    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, Conuty Council, Jönköping, 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.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Stalfors, Joacim
    Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Risk of reoperation after tonsillotomy versus tonsillectomy: a population-based cohort study2016Inngår i: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 273, s. 3263-3268Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Tonsil surgery to address upper airway obstruction in children can be performed either as a tonsillectomy (TE) or as a tonsillotomy/intracapsular/partial tonsillectomy (TT). The advantage of TT is a decreased risk of postoperative morbidity. The disadvantage is the risk of tonsil regrowth with recurrence of symptoms and/or problems with future tonsil infections, which may demand a reoperation of the tonsils. The aim of this study is to compare the risk of reoperation of the tonsils following TE and TT in children with tonsil-related upper airway obstruction. This is a retrospective register-based cohort study of the Swedish National Patient Register. All children aged 1–12 years who underwent TE or TT from 2007 to 2012 for the main indication of upper airway obstruction were included in the study. The unique Personal Identity numbers were used to follow patients over time in the register and identify additional tonsil surgery. A total of 27,535 patients were included in the study, contributing 76,054 person-years of follow-up. A total of 684 patients (2.5 %) underwent a second tonsil surgery during follow-up. The incidences of reoperation were 1.94 per 1000 person-years in the TE group and 16.34 per 1000 person-years in the TT group. The risk for reoperation was seven times higher (HR 7.16) after TT compared to TE. Younger age was significantly associated with reoperation for both TE and TT and the difference in risk between TE and TT gradually decreased with time. The most common indication for reoperation after both TE and TT was ‘‘Upper airway obstruction’’.

  • 100. Palm, Claes
    et al.
    Can, Zerif
    Ericsson, Elisabeth
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Betydelsen av simuleringsövning för intensivvårdspersonal för att bemästra kritiska situationer2013Konferansepaper (Fagfellevurdert)
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