| 1. |
- Axelsson, Sara, et al.
(författare)
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Bell's palsy : the effect of prednisolone and/or valaciclovir versus placebo in relation to baseline severity in a randomised controlled trial
- 2012
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Ingår i: Clinical Otolaryngology. - : Wiley. - 1749-4478 .- 1365-2273 .- 1749-4486. ; 37:4, s. 283-290
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To evaluate the treatment effect of prednisolone and/or valaciclovir in Bells palsy patients with different baseline severity of palsy.Design: Patient data were collected from the Scandinavian Bells Palsy Study, a prospective, randomised, double-blind, placebo-controlled, multi-centre trial.Setting: Sixteen otorhinolaryngological centres in Sweden and one in Finland.Participants: Altogether, 829 patients aged 1875 years were treated within 72 h of palsy onset. Patients were randomly assigned to treatment with prednisolone plus placebo (n = 210), valaciclovir plus placebo (n = 207), prednisolone plus valaciclovir (n = 206), placebo plus placebo (n = 206). Follow-up was 12 months.Main outcome measures: Facial function was assessed using the Sunnybrook grading scale at baseline and at 12 months. Complete recovery was defined as Sunnybrook score = 100.Results: All patients, regardless of baseline severity, showed significantly higher complete recovery rates if treated with prednisolone compared with no prednisolone. In patients with severe palsy, recovery at 12 months was 51% with prednisolone treatment versus 31% without prednisolone (P = 0.02). Corresponding results were 68%versus 51% (P = 0.004) for moderate, and 83%versus 73% (P = 0.02) for mild palsy. In patient groups with moderate and mild palsy at baseline, significantly fewer prednisolone-treated patients had synkinesis at 12 months (P = 0.04 and P < 0.0001, respectively). For patients with severe palsy at baseline, prednisolone versus no prednisolone made no significant difference regarding synkinesis at 12 months. Valaciclovir did not add any significant effect to prednisolone regarding recovery rate or synkinesis at 12 months.Conclusion: Prednisolone treatment resulted in higher complete recovery rates, regardless of severity at baseline. Prednisolone treatment should be considered in all patients irrespective of degree of palsy.
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| 2. |
- Curran, A. J., et al.
(författare)
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Exfoliated malignant cells in glove and instrument washings following head and neck surgery
- 1996
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Ingår i: Clinical Otolaryngology. - : John Wiley & Sons. - 1749-4478 .- 1365-2273 .- 1749-4486. ; 21:3, s. 281-283
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Tidskriftsartikel (refereegranskat)abstract
- Loco-regional recurrence following resection of squamous cell carcinoma of the upper aero-digestive tract is a major problem. Cells exfoliated from malignant tumours have been considered capable of implanting and giving rise to local recurrence or metastatic deposits. A prospective study was performed examining washings from the gloves and instruments used in major head and neck operations to determine if exfoliated cells were indeed present. Following removal of the main tumour specimen all surgeons washed their hands in a solution containing a cell fixative and all instruments were soaked in the solution. Samples were then centrifuged and stained using a modified PAP technique. On occasions nuclear fragments consistent with squamous cell carcinoma were present in both glove and instrument washings. We recommend that all surgeons change gloves and instruments following removal of the main tumour specimen and prior to irrigation of the operative field with a tumoricidal agent.
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| 3. |
- Faag, Carina, et al.
(författare)
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Symptoms experienced by patients with peripheral vestibular disorders : evaluation of the Vertigo Symptom Scale for clinical application
- 2007
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Ingår i: Clinical Otolaryngology. - : Blackwell Publishing. - 1749-4478 .- 1365-2273. ; 32:6, s. 440-446
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To describe symptoms during an episode of dizziness in a sample of patients suffering from peripheral vestibular disorders and to compare them with the items in the Vertigo Symptom Scale.Design: A descriptive study from a sample of patients with peripheral vestibular disorders.Setting: Patients visiting a department of audiology at a university hospital.Participants: Twenty patients with peripheral vestibular disorders. The inclusion criteria were that the patient had had at least three spontaneous attacks of vertigo and/or was constantly unsteady during the last 3 months for at least 75% of the time when awake.Main outcome measures: Patients were instructed to complete a diary where they recorded symptoms that arose during an episode of dizziness. These symptoms were compared with the content of the Vertigo Symptom Scale.Results: The most frequent symptoms as mentioned by the patients in their diaries were a feeling that things are spinning or moving around, nausea, feeling unsteady/about to lose one’s balance, fatigue, headache, a feeling as if the ground you walk on is distant and ear-related such as tinnitus and a feeling of pressure in the ear. Pain in the heart or chest region, a heavy feeling in the arms or legs, pain in the lower part of the back and excessive sweating were not mentioned at all or by very few patients. Analysis showed that some of the symptoms included in the Vertigo Symptom Scale occurred less during an episode of dizziness than others in this sample of patients with peripheral vestibular disorders.Conclusion: It was found that the Vertigo Symptom Scale is an adequate base but may need to be developed for use in patients diagnosed with peripheral vestibular symptoms to be able to evaluate care and treatment.
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| 4. |
- Berglund, Malin, 1970, et al.
(författare)
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Hearing outcome after myringoplasty in Sweden: A nationwide registry-based cohort study
- 2020
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Ingår i: Clinical Otolaryngology. - : Wiley. - 1749-4478 .- 1749-4486 .- 1365-2273. ; 45:3, s. 357-363
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To present hearing results after successful primary myringoplasty surgeries registered in the Swedish Quality Registry for Myringoplasty and to evaluate the chance of hearing improvement and the risk of hearing loss. Design A retrospective nationwide cohort study based on prospectively collected registry data between 2002 and 2012. Settings Registry data from secondary and tertiary hospitals performing myringoplasty. Participants Patients with healed tympanic membrane after primary myringoplasty surgery performed from 2002 to 2012 in Sweden. Main outcome measures Postoperative hearing results, hearing gain and air-bone gap (ABG). Results In 2226 myringoplasties, air conduction audiograms were recorded, and the average preoperative pure tone average (PTA(4)) of the group was 28.5 dB, which improved postoperatively to 19.6 dB with an average of 8.8 dB improvement. Bone conduction was measured for 1476 procedures. Closure of the ABG to 10 dB or less was achieved in 51% of the ears and to less than 20 dB in 89% of the ears. Sixty-one percent of patients with preoperatively deteriorated hearing experienced improved hearing, but 3% of all patients experienced deteriorated hearing. After the surgery, 93% of the patients were satisfied. Conclusions Hearing results after successful myringoplasty surgery are often favourable, but although the tympanic membrane is healed, hearing improvement is not guaranteed, and hearing deterioration can also occur.
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| 5. |
- Beukes, E. W., et al.
(författare)
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Positive experiences related to living with tinnitus : A cross-sectional survey
- 2018
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Ingår i: Clinical Otolaryngology. - : Wiley-Blackwell Publishing Inc.. - 1749-4478 .- 1365-2273. ; 43:2, s. 489-495
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveThe aim of this study was to gain insights related to positive experiences reported by adults with tinnitus living in the United Kingdom.DesignA cross‐sectional survey design was used in a sample of adults with tinnitus who were interested in undertaking an Internet‐based intervention for tinnitus.SettingThe study was UK wide and data collection was online.ParticipantsParticipants consisted of 240 adults (137 males, 103 females), with an average age of 48.16 years and average tinnitus duration of 11.52 years (SD: 11.88).Main outcome measuresTinnitus severity was measured by means of the Tinnitus Functional Index. To evaluate the secondary effects of tinnitus, the Insomnia Severity Index, the Hearing Handicap Inventory for Adults‐Screening Version and the Cognitive Failures Questionnaires were administered. Positive experiences related to tinnitus were explored using an open‐ended question format.ResultsAround a third of participants (32.5%) reported positive experiences associated with tinnitus. The number of positive responses ranged from one to eight responses per participant, although there were fewer participants with more than one positive response. The predominant themes concerned for (i) coping; (ii) personal development; (iii) support, and to a lesser extent (iv) outlook. Younger participants, those with a lower hearing disability and those with fewer cognitive failures were more likely to report positive experiences associated with having tinnitus.ConclusionsThis study has identified that personal development and a positive outlook are possible despite experiencing tinnitus. Ways to facilitate positive experiences related to tinnitus should be promoted, as these may reduce the negative consequences associated with tinnitus. The most prevalent positive theme was the ability to cope with tinnitus. Positive experiences were also drawn from having clinical and other support networks. This highlights the importance of providing tinnitus interventions that can assist people in coping with tinnitus, particularly to those less likely to relate tinnitus to any positive experiences. Those most likely to be helped include those who are older with greater cognitive difficulties and a greater hearing disability.
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| 6. |
- Bylund, Nina, et al.
(författare)
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Synkinesis in Bell's palsy in a randomised controlled trial
- 2017
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Ingår i: Clinical Otolaryngology. - : Wiley. - 1749-4478 .- 1365-2273. ; 42:3, s. 673-680
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study the development of synkinesis in Bell's palsy. Frequency, severity, gender aspects and predictors were analysed.DESIGN: Data from the randomised controlled Scandinavian Bell's palsy trial including 829 patients.MAIN OUTCOME MEASURES: Frequency and severity of synkinesis at 12 months were the main outcome measures. Mean Sunnybrook synkinesis scores, voluntary movement scores and composite scores between 6 and 12 months were compared.RESULTS: In 743 patients with a 12-month follow-up, synkinesis frequency was 21.3%. There was no gender difference. Synkinesis was moderate to severe in 6.6% of patients. Those with synkinesis at 6 months had a synkinesis score of 4.1 (±2.8 sd), which increased to 4.7 (±3.2) (P = 0.047) at 12 months (n = 93). Sunnybrook composite score at 1 month was the best predictor for synkinesis development with receiver operating characteristics and area under the curve (AUC) 0.87. Risk for synkinesis increased with a lower Sunnybrook composite score. Furthermore, at 1 month, symmetry of voluntary movement had higher predictive value for synkinesis than resting symmetry with AUC 0.87 and 0.77, respectively. Gentle eye closure and open-mouth smile were the only independent significant predictive items (AUC 0.86).CONCLUSIONS: Moderate-to-severe synkinesis was present in 6.6% of patients. The mean synkinesis score increased between 6 and 12 months, and outcome should therefore be evaluated after at least 12 months. Sunnybrook composite score and symmetry of voluntary movement at 1 month were good predictors for synkinesis.
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| 7. |
- Hessén-Söderman, Anne-Charlotte, et al.
(författare)
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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 Sweden
- 2015
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Ingår i: Clinical Otolaryngology. - : Wiley. - 1749-4478 .- 1365-2273. ; 40:3, s. 248-254
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 8. |
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| 9. |
- Ntouniadakis, Eleftherios, 1983-, et al.
(författare)
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Dyspnea Index : An upper airway obstruction instrument; translation and validation in Swedish
- 2021
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Ingår i: Clinical Otolaryngology. - : John Wiley & Sons. - 1749-4478 .- 1365-2273 .- 1749-4486. ; 46:2, s. 380-387
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE: Upper airway dyspnea is a challenging condition in which assessing the discomfort experienced by the patient is essential. There are three patient-reported outcome (PRO) instruments developed particularly for this patient group, none of which is available in Swedish. The aim of this study was to translate the Dyspnea Index (DI) into Swedish and validate the instrument for use in the Swedish-speaking population by investigating its basic psychometric properties.DESIGN: A prospective instrument validation study.SETTING: Tertiary referral center.PARTICIPANTS: Fifty-three (n=53) patients with upper airway dyspnea and 19 healthy controls.MAIN OUTCOME MEASURES: The questionnaire was translated into Swedish (swDI) with a forward-backward method. Reliability, repeatability, responsiveness and construct validity were assessed by asking the subjects to complete the swDI, a visual analog scale (VAS) at exertion and at rest and the Voice Handicap Index (VHI).RESULTS: The swDI showed excellent internal consistency (Cronbach's α: 0.85) and repeatability (interclass correlation coefficient: 0.87 and Pearson's r: 0.89) in the patient group. No ceiling effect was observed (maximum score achieved was 39; 85% of the patients scored ≤36). SwDI scores moderately correlated with VAS at exertion (r: 0.59) and at rest (r: 0.42), yet poorly with the VHI (r: 0.36). The effect size (ES) was 3.8.CONCLUSIONS: The swDI is a valid, robust and reliable questionnaire for self-assessment in Swedish-speaking patients with upper airway obstruction. A future anchor-based longitudinal study is needed to assess the smallest detectable change (SDC) and minimum important change (MIC) that were not estimated in our study.
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| 10. |
- Westman, Eva, 1966-, et al.
(författare)
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Prophylactic antibiotics has no benefit for outcome in clean myringoplasty : a register-based cohort study from SwedEar
- 2023
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Ingår i: Clinical Otolaryngology. - : John Wiley & Sons. - 1749-4478 .- 1365-2273. ; 48:6, s. 895-901
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate if prophylactic antibiotics (PA) in conjunction with myringoplasty of clean and uninfected ears entails a reduction of postoperative infections within 6 weeks after surgery, and whether it affects the healing rate of the tympanic membrane (TM) at follow-up, 6–24 months after surgery.Design: A retrospective cohort study of prospectively collected data. Setting: Data extracted from The Swedish Quality Register for Ear Surgery (SwedEar), the years 2013–2019.Participants: All patients in SwedEar with a registered clean conventional myringoplasty (tympanoplasty type I) including a follow-up visit.Main Outcome Measures: The effect of PA use on TM healing rate at follow-up and postoperative infection within 6 weeks of surgery.Results: In the study group (n = 1665) 86.2% had a healed TM at follow-up. There was no significant difference between the groups that had PA administered (87.2%) or not (86.1%). A total of 8.0% had a postoperative infection within 6 weeks. Postoperative infection occurred in 10.2% of the group that received PA (n = 187) compared with 7.7% of the group that did not receive PA. However, this difference was not statistically significant. Postoperative infection within 6 weeks significantly lowered the frequency of healed TMs.Conclusion: PA administered during clean conventional myringoplasty does not improve the chance of having a healed TM at follow up, nor decrease the risk of having a postoperative infection within 6 weeks after surgery.
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