| 1. |
- Helin, I, et al.
(author)
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Muco-epidermoid tumour of the bronchus
- 1984
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In: International Journal of Pediatric Otorhinolaryngology. - 0165-5876. ; 7:3, s. 289-295
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Journal article (peer-reviewed)abstract
- A 7-year-old boy with recurrent pneumonia of the right lower lobe is described. At bronchoscopy a small tumour almost totally obliterating the right lower lobe was detected. Surgical treatment was undertaken. Histopathologic studies showed findings consistent with those of a muco-epidermoid tumour. The case emphasizes bronchoscopy as an important investigation in children with recurrent pneumonia. It also shows the importance of performing the bronchoscopy during a prolonged course of antibiotic prophylaxis in order to ensure a minimum of infected mucus within the bronchi. This report is completed with a short review of the literature on muco-epidermoid tumours of the bronchus in children. Their favourable prognosis and very low malignant potential is underlined.
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| 2. |
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| 3. |
- Brown, C., et al.
(author)
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On the physics of the infant feeding bottle and middle ear sequela : Ear disease in infants can be associated with bottle feeding
- 2000
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In: International Journal of Pediatric Otorhinolaryngology. - 0165-5876 .- 1872-8464. ; 54:1, s. 13-20
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Journal article (peer-reviewed)abstract
- Background: When using conventional feeding bottles, negative pressure is generated in the oral cavity, as well as, in the bottle when fluid is removed by sucking. The negative pressure inside the bottle causes the infant to suck excessively and the intraoral negative pressure may subsequently be transmitted to the middle ear via the eustachian tube. Methods: In seven infants, simultaneous pressure recordings were performed in the feeding vessel and the middle ear using three types of feeding bottles. Results: With conventional non-ventilated and under-ventilated bottles a negative pressure formed while the infant sucked and negative intratympanic pressure was frequently generated. Conclusions: It is suggested that this sequence of events may lead to secretory otitis and it's accompanying consequences. In contrast, a fully ventilated bottle showed positive pressure throughout the feeding procedure, which is similar to normal breast-feeding, and negative pressure changes were not recorded in the middle ear.
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| 4. |
- Bunne, Marie, et al.
(author)
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Variability of Eustachian tube function in children with secretory otitis media. Evaluations at tube insertion and at follow-up
- 2000
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In: International Journal of Pediatric Otorhinolaryngology. - 0165-5876 .- 1872-8464. ; 52:2, s. 131-141
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Journal article (peer-reviewed)abstract
- Objective: Despite the variable clinical course of diseases related to Eustachian tube function, the variability of tubal function has been less focused than outcomes of single tests. This study aimed to compare the passive and active tubal function and its variability in children with secretory otitis media (SOM) at tube insertion and at follow-up. Method: Thirty-eight ears in 19 children aged 4-10 years (mean 7.0 years) with long-standing SOM were examined 4-6 h after tube insertion, at 4 months and at 9 months. The pressure in the middle ear and the nasopharynx were recorded while performing (1) forced opening test, (2) equalization of +100 and −100 daPa, (3) Valsalva test, and (4) sniff test. The procedure was repeated after 30 min. Relationships were analyzed by uni- and multi-variate analysis of variance. Results: From tube insertion to 4 months, the mean forced opening pressure increased from 282±128 to 355±153 daPa (P<0.01), and the mean closing pressure from 91±51 to 126±82 daPa (P<0.01). There was no further change at 9 months. Female gender, serous effusion (in contrast to mucoid), and more than three previous episodes of acute otitis media were related to higher opening and closing pressures. At tube insertion, 60% and 16% equalized +100 and −100 daPa, respectively, and 28% succeeded in performing Valsalva inflation. The sniff test was positive in 32%, indicating a closing failure. These rates did not change significantly over time. For individual ears, outcomes of all tests varied considerably when retested after 30 min; Po changed by ±12% and Pc by ±26%, and 9-29% of the ears changed from a positive to negative response, or vice versa, in the equalization, Valsalva, and sniff tests. Conclusions: The unexpected finding of weaker closing forces at the day of tube insertion and increased tubal resistance at follow-up might be ascribed to changes in the muco-adhesive forces related to the disease and tube treatment. The pronounced intra-individual variability of test outcomes indicates that tubal function is dynamic and variable in ears prone to SOM, which emphasizes that results of single tubal function tests have very low prognostic value.
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| 5. |
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| 6. |
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| 7. |
- Forséni, M., et al.
(author)
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Detection and localization of interleukin-6 in the rat middle ear during experimental acute otitis media, using mRNA in situ hybridization and immunohistochemistry
- 2001
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In: International Journal of Pediatric Otorhinolaryngology. - 0165-5876 .- 1872-8464. ; 57:2, s. 115-121
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Otitis media is one of the most common diseases among children. A well-known sequela of acute, chronic, and secretory otitis media is tympanosclerosis. With the exception of surgery, there is no causal treatment available for this condition, which may cause hearing disabilities. This study aimed to describe the localization of interleukin (IL)-6 mRNA and its gene product in the rat middle ear during pneumococcal otitis media. IL-6 is known to be involved in inflammatory and bone remodeling processes. METHODS: Using an experimental model of pneumococcal acute otitis media, the expression of interleukin IL-6, was analyzed. Sprague-Dawley rats were sacrificed at different time points varying from 1 h to 6 days intervals after inoculation. The middle ears were analyzed by messenger RNA in situ hybridization, and by immunohistochemistry with cell-type specific antibodies directed against IL-6. RESULTS: Transcripts of IL-6 were observed only on day 1 post-inoculation, whereas the final gene product was observed at all intervals after inoculation. IL-6 was localized in the bony part of the bulla nearest to the mucosa, around mucosal vessels, and in the ciliae of the mucosal epithelium. The results demonstrated that IL-6 was synthesized locally as early as 1 h after bacterial middle ear challenge, and that although transcription could not be detected after 24 h, the cytokine product persisted for at least 5 days after the infection was introduced. CONCLUSIONS: IL-6 was shown to be produced early in the inflammatory process during induced pneumococcal otitis media in the rat. No production was seen after 24 h although the protein remained in the tissue for at least 5 days. IL-6 could initiate a differentiation of macrophages to osteoclasts and thereby participate in a bone remodeling process leading to tympanosclerosis development.
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| 8. |
- Hedin-Skogman, Barbro, et al.
(author)
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Acute facial palsy in children - a 2-year follow-up study with focus on Lyme neuroborreliosis
- 2003
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In: International Journal of Pediatric Otorhinolaryngology. - 0165-5876. ; 67:6, s. 597-602
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Journal article (peer-reviewed)abstract
- Objective: Acute facial palsy in children is believed to be a rather benign neurological condition. Follow-up-studies are sparse, especially including a thorough otoneurological re-examination. The aim of this study was to examine children with a history of facial palsy in order to register the incidence of complete recovery and the severity and nature of sequelae. We also wanted to investigate whether there was a correlation between sequelae and Lyme Borreliosis, treatment or other health problems. Methods: Twenty-seven children with a history of facial palsy were included. A re-examination was performed by an Ear-Nose-Throat (ENT) specialist 1–2.9 years (median 2) after the acute facial palsy. The otoneurological examination included grading the three branches of the facial nerve with the House-Brackman score, otomicroscopy and investigation with Frenzel glasses. A paediatrician interviewed the families. Medical files were analysed. Result: The incidence of complete recovery was 78% at the 2-year follow-up. In six out of 27 children (22%), the facial nerve function was mildly or moderately impaired. Four children reported problems with tear secretion and pronunciation. There was no correlation between sequelae after the facial palsy and gender, age, related symptoms, Lyme neuroborreliosis (NB), treatment, other health problems or performance. Conclusion: One fifth of children with an acute facial palsy get a permanent dysfunction of the facial nerve. Other neurological symptoms or health problems do not accompany the sequelae of the facial palsy. Lyme NB or treatment seems to have no correlation to clinical outcome. Factors of importance for complete recovery after an acute facial palsy are still not known.
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| 9. |
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| 10. |
- Hultcrantz, Elisabeth, et al.
(author)
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Tonsillectomy or tonsillotomy? : a randomized study comparing postoperative pain and long-term effects
- 1999
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In: International Journal of Pediatric Otorhinolaryngology. - 0165-5876 .- 1872-8464. ; 51:3, s. 171-6
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Journal article (peer-reviewed)abstract
- Background: tonsillectomy (TE) is currently the most common treatment for children with snoring and sleep apnea. Many of these children have not had any severe throat infections. To cure such children from their obstructive problems, without influencing the immunological function of the tonsils, tonsillotomy (TT) with CO2-laser was performed in a randomized study comparing it to regular tonsillectomy, with special attention to postoperative pain and symptom recurrence. Method: 41 children 3.5–8 years-old were included — 21 ‘TT’s’ and 20 ‘TE’s’. They were all operated under the same anesthesia and followed the same postoperative scheme for analgesia. A visual analogue scale for pain measurements with faces was used for the first 24 h. After that, each day until pain-free, the parents registered the child’s pain on a three graded scale, what the child was able to eat, and the amount of analgesic drugs used. Results: all the children were cured from their breathing obstruction. The mean time used for the surgery was the same and no postoperative bleeding was seen in either group. ‘TT children’ were pain-free after 5 days and ‘TE children’ after 8 days. Eight to ten days after surgery, the TT-children had gained weight and the TE children lost weight significantly. The TE group used twice as much analgesic drugs as the TT group during the first postoperative week. The TT group was healed with normal-looking, but small tonsils after 8–10 days; the TE group often still showed edema and crusts. At the one-year follow-up 2/21among the ‘TT-children’ snored, but did not require re-surgery. Conclusion: tonsillotomy is much less painful than TE and children recover more quickly. Results with respect to breathing obstruction are almost the same for both methods at 1-year follow-up.
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| 11. |
- Johansson, Ewa, et al.
(author)
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Tonsillectomy - Clinical consequences twenty years after surgery?
- 2003
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In: International Journal of Pediatric Otorhinolaryngology. - 0165-5876 .- 1872-8464. ; 67:9, s. 981-988
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Journal article (peer-reviewed)abstract
- Tonsillectomy (T) is one of the most common surgical procedures performed on children. Long-term follow-up studies concerning its consequences are lacking. This study is the first study done on a group of patients that underwent T in their childhood, about 20 years ago. The investigation is a cohort study, which followed-up 18 patients who were tonsillectomized 20 years ago. It was to be determined whether these subjects suffer from more respiratory tract infections (or other infections) today, than people who are not tonsillectomized. A group of 54 age-matched subjects were selected for comparison. A questionnaire was mailed to the study population. No significant differences were found between the groups in the frequency of upper respiratory tract infection (URI). The mean number of URI's was approximately [MSOffice1]2.5 per year in both groups. The duration of the URI's was identical in each group. A high temperature was present to the same extent in each group. Absence from work, number of visits to physicians and the use of antibiotics were the same in each group. However, the prevalence of chronic disease was greater in the T-group than in the comparison group. The difference was significant with a Relative Risk of 9.41 and a Confidence Interval differing from 1 (1.13
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| 12. |
- Keck, T, et al.
(author)
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Rhinolith of the nasal septum
- 2000
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In: International journal of pediatric otorhinolaryngology. - 0165-5876. ; 53:3, s. 225-228
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Journal article (peer-reviewed)
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| 13. |
- Linder, Arne, et al.
(author)
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Using the carbon dioxide laser for tonsillotomy in children
- 1999
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In: International Journal of Pediatric Otorhinolaryngology. - 0165-5876 .- 1872-8464. ; 50:1, s. 31-6
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Journal article (peer-reviewed)abstract
- Carbon dioxide laser tonsillotomies were performed on 33 children aged 1-12 years for the relief of obstructive symptoms due to tonsillar hyperplasia. As opposed to conventional tonsillectomy, only the protruding part of each tonsil was removed. A carbon dioxide laser delivering 20 W was used for the excision. Twenty-one children were seen in active short-term follow-up and the records of all the children were checked for possible surgery related events up to 20-33 months after surgery. Laser tonsillotomy was uniformly effective in relieving the obstruction, with good hemostasis. The tonsillar remnants healed completely within 2 weeks. No major adverse events occurred. Post-operative pain appeared slight and easily controlled. There was no gain in operating time compared with conventional tonsillectomy. The laser tonsillotomies were in most cases done in day surgery. No recurrence of obstructive problems was reported up to 20-33 months after surgery. It was concluded that tonsillotomy, using a carbon dixoide laser, is a valid treatment for obstructive symptoms caused by enlarged tonsils, which can be performed with little bleeding and post-operative pain. The improved hemostasis may enable a shift from in-patient to day surgery.
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| 14. |
- Magnúsdóttir, Anna Björk, et al.
(author)
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Experimental study of the virulence of Streptococcus pneumoniae with reduced susceptibility to penicillin
- 2000
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In: International Journal of Pediatric Otorhinolaryngology. - 0165-5876 .- 1872-8464. ; 55:1, s. 1-9
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Journal article (peer-reviewed)abstract
- Streptococcus pneumoniae is a major cause of morbidity and mortality in all age groups. In a few years, penicillin non-susceptible pneumococci (PNSP) have emerged worldwide as a new threat. In order to better understand the mechanisms behind the rapid expansion of these strains, the virulence of 10 clinical and two transformed PNSP strains were compared with the virulence of three fully susceptible strains in a mouse model of bacteremia and a rat model of acute otitis media. Serotype, antibiotic susceptibility, and to some extent also genetic profile and growth rate of the strains were investigated before inoculation. The animals were monitored for up to 7 days after challenge by clinical examinations/otomicroscopy and cultures from middle ears and blood. The results of the study demonstrated that the PNSP strains had a significantly reduced ability to persist at the infectious site, and to some extent also to induce infections, compared with fully susceptible strains. The reduction was most evident for strains isolated from sources other than blood. It is therefore possible that other factors than virulence factors are of importance for the ability of PNSP strains to expand.
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| 15. |
- Melhus, Åsa, et al.
(author)
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A resolved pneumococcal infection protects against nontypeable Haemophilus influenzae : an evaluation of different routes of whole cell immunization in protection against experimental acute otitis media
- 1997
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In: International Journal of Pediatric Otorhinolaryngology. - 0165-5876 .- 1872-8464. ; 39:2, s. 119-131
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Journal article (peer-reviewed)abstract
- A conferred cross-protection between Haemophilus influenzae type b (Hib) and nontypeable H. influenzae (NTHi) was demonstrated in a previous study of experimental recurrent otitis media. To explore cross-protection further, and to compare oral administration of whole cells with two more conventional routes for vaccination against acute otitis media (AOM), a total number of 79 rats were immunized perorally, subcutaneously and intrabullarly with H. influenzae or pneumococci and thereafter challenged in the middle ear with NTHi or Hib 4 or 9 weeks later. Otomicroscopic changes, bacterial cultures, and serum IgG antibody levels were monitored. The study demonstrated that while peroral administration did not elicit any protection, a resolved pneumococcal AOM could reduce the susceptibility to reinfection with NTHi. In the latter case no cross-reacting antibodies were detected, but the protective rate was 50% or more, and it was comparable with that found after subcutaneous or intrabullar immunization with homologous NTHi or Hib strains. The results suggest that the protection of the rat middle ear mucosa may involve unspecific responses.
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| 16. |
- Melhus, Åsa, et al.
(author)
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Effect of Haemophilus influenzae type b conjugate vaccine in combination with peroral immunization with Escherichia coli on experimental otitis media
- 1996
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 36:1, s. 1-12
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Journal article (peer-reviewed)abstract
- The protective ability of a conjugated Haemophilus influenzae type b vaccine, ACT-HIB, used singly or in combination with orally administered Escherichia coli, was investigated in a rat model for acute otitis media. The humoral response to ACT-HIB was also analyzed. The study demonstrated that ACT-HIB vaccination resulted in a prompt antibody response, and that ACT-HIB was efficient in preventing middle ear infections caused by Haemophilus influenzae type b. The efficiency increased if the vaccine was combined with Escherichia coli. The results suggest that Escherichia coli could possibly be useful in the future as a vaccine vehicle, and since Haemophilus influenzae acute mastoiditis seems to be almost exclusively due to serotype b, the incidence of this infection may be reduced with the conjugated Haemophilus influenzae type b vaccines.
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| 17. |
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| 18. |
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| 19. |
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| 20. |
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| 21. |
- Alm, Fredrik, 1983-, et al.
(author)
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Adherence to Swedish guidelines for pain treatment in relation to pediatric tonsil surgery : A survey of the multidisciplinary team
- 2017
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier. - 0165-5876 .- 1872-8464. ; 101, s. 123-131
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Journal article (peer-reviewed)abstract
- Background: Pain management in children after tonsil surgery is essential, and optimal pain treatment has been discussed for many years. Data from the National Tonsil Register in Sweden (NTRS) and a national mapping system have demonstrated the need for national pain treatment guidelines for pediatric tonsil surgery. As a result, Swedish national guidelines, together with updated patient information on the website tonsilloperation.se, were developed and implemented in 2013.Objectives The objective of this study was to evaluate the professionals’ opinions of and adherence to pain treatment guidelines for pediatric tonsil surgery patients in a two-year follow-up.Method: This descriptive cross-sectional study was based on data from an inter-professional questionnaire, which was validated by an expert group using a content validity index (S-CVI 0.93). The questionnaire was sent to all Swedish ear, nose and throat (ENT) departments (n=49) that the NTRS identified as performing tonsil surgery on children younger than 18 years of age. In each clinic, we asked for responses from staff in each of the following professions: ENT physicians, anesthesia physicians, registered nurse anesthetists, and registered nurses in the ENT departments.Results: Respondents from 48 ENT departments participated, and 139/163 (85%) completed questionnaires were returned. The guidelines were reported as being clear, ensuring patient safety and providing optimal pharmacological treatment. Treatment was given according to the guidelines: Half of the departments gave pre- or intraoperative treatment with clonidine, betamethasone and high-dose paracetamol (acetaminophen). A multimodal pain approach (paracetamol and COX inhibitors) after hospital discharge was prescribed by all departments after tonsillectomy and, more extensively, after tonsillotomy. One-third of the departments prescribed paracetamol with a higher normal dose for the first three postoperative days. Half of the departments prescribed rescue analgesics, clonidine or opioids after tonsillectomy. None of the departments prescribed codeine or tramadol, drugs that are discouraged in the guidelines. The majority of the departments used the website tonsilloperation.se to provide information to the patients and their caregivers.Conclusion: The respondents' opinions of and the ENT departments adherence to the Swedish national guidelines were considered to be good. The national implementation process in Sweden has impacted the manner in which ENT departments treat pain after tonsil surgery.
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| 22. |
- Anmyr, Lena, et al.
(author)
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Children with hearing impairment : living with cochlear implants or with hearing aids
- 2011
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In: International Journal of Pediatric Otorhinolaryngology. - Amsterdam : Elsevier. - 0165-5876 .- 1872-8464. ; 75:6, s. 844-849
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Journal article (peer-reviewed)abstract
- Objective The aim of this study was to enhance knowledge about the life circumstances of children with cochlear implants or hearing aids, regarding daily functioning and attitude to the impairment. Methods Data were obtained from 36 children with cochlear implants and 38 children with hearing aids via study-specific questionnaires with fixed answer alternatives. The questions covered (1) usage of aids and related factors, (2) hearing in different everyday situations, (3) thoughts about the children's own hearing and others’ attitudes to it, and (4) choice of language. The data were analyzed using SPSS, and presented via the theoretical frame of the International Classification of Functioning, Disability and Health, Child and Youth version (ICF-CY). Results Children with CI and HA functioned equally well in daily life, but there were also certain differences. Symptoms from neck and shoulders were more common among children with hearing aids than among children with cochlear implants (p < .001). Children with hearing aids used their aids significantly less often than those with cochlear implants (p < .001). The participation variables showed that children with hearing aids had significantly more hearing problems in team sports (p = .033) and outdoor activities (p = .019), in comparison to children with cochlear implants. The two groups had similar thoughts regarding their own hearing, mostly considering it not to be a problem. They also did not generally think that other people found their hearing to be a problem. Conclusions Children with cochlear implants and children with hearing aids have, in some aspects, equally good functioning in everyday life situations. However, certain differences were found in dimensions of functioning, regarding neck and shoulder pain, usage of aids and sign language, and hearing problems in some activities.
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| 23. |
- Anmyr, Lena, et al.
(author)
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Sense of coherence, social networks, and mental health among children with a cochlear implant
- 2015
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 79:4, s. 610-615
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Journal article (peer-reviewed)abstract
- Objective: The aim of this study was to explore the personal and social resources of children with a cochlear implant from a child's perspective. Method: This descriptive cross-sectional study included 19 children with cochlear implants, aged 9-12 years. Data was collected, using the children's sense of coherence (CSOC) scale, the Network map, and the strengths and difficulties questionnaire (SDQ). The data was analyzed using descriptive and correlation statistics. Results: Most children had a strong sense of coherence. School life was an important arena for their social network. The mental health was comparable to normal hearing children. Still, some of the children with implants had low SOC and poor mental health. High SOC and closeness of the social network, especially in school, were associated with good mental health. Conclusion: This study shows that Swedish school-aged children with cochlear implants as a group have access to personal and social resources as strong sense of coherence and social networks. Still, there are individual children with psychosocial problems who need support and treatment.
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| 24. |
- Anmyr, Lena, et al.
(author)
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Strengths and difficulties in children with cochlear implants : Comparing self-reports with reports from parents and teachers
- 2012
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 76:8, s. 1107-1112
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Journal article (peer-reviewed)abstract
- Objective: The aim was to explore and compare how children with cochlear implants, their parents, and their teachers perceive the children's mental health in terms of emotional and behavioral strengths and difficulties.Methods: The self-report, parents', and teachers' versions of the Strengths and Difficulties Questionnaire (SDQ) were used to assess the mental health of 22 children with cochlear implants. The children's assessments were then compared to the parents' and 17 teachers' assessments. The data were analyzed using the SPSS software package.Results: Total difficulties (p = .000), emotional symptoms (p = .000), and conduct problems (p = .007) were greater according to the children than according to parents and teachers. Younger children (9 years, n = 12) reported more emotional symptoms than older children (12 and 15 years, n = 10). Almost a quarter of the children rated themselves in a way indicating mental ill-health. Parents and teachers each indicated mental ill-health for one child.Conclusions: Children with cochlear implants express greater concerns about their mental health than their parents and teachers do. This is important knowledge for adults in families, schools, and health care in order to support these children and offer treatment when needed.
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| 25. |
- Benatti, Alice, et al.
(author)
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Endocochlear inflammation in cochlear implant users : Case report and literature review
- 2013
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In: International Journal of Pediatric Otorhinolaryngology. - Amsterdam : Elsevier. - 0165-5876 .- 1872-8464. ; 77:6, s. 885-893
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Research review (peer-reviewed)abstract
- Objectives: Cochlear implantation is a relatively safe procedure with a low complication rate. The overall rate of complications among cochlear implant patients ranges from 6% to 20%. Major complications are those that are life-threatening or require surgery, whereas minor complications are those that can be medically treated. Nonetheless, certain complications, even if highly rare, may require specific investigations and treatments. Among these rare complications are those with endocochlear involvement, such as cochleitis or labyrinthitis, with fibrosis or ossification that could lead to explantation. The aims of the present study were to report a particular case of post-operative cochleitis and to review the rate of complications after cochlear implantation, emphasising those conditions with proven endocochlear involvement.Methods: We refer to the case of an eight-year-old Italian boy affected by the sudden onset of headache, ipsilateral otalgia and facial paresis, who presented to our clinic for inexplicable worsening of the performance of his implant and his residual hearing, six years after surgery. A complete investigation including (clinical history, routine, autoimmune and serological blood tests, electrophysiological measurements from the cochlear implant and neuroimaging) was performed and is herein described. Additionally, a comprehensive review of the literature was conducted using internet search engines; 274 papers were selected, 88 of which were best suited to our purposes.Results: In our case, the progression of the symptoms and the performance decrement required explantation, followed by a complete recovery. Reviewing the literature revealed only three reports concerning cases of proven endocochlear phlogosis that required revision surgery. Wound swelling/infection and vertigo remain the two most common complications of cochlear implantation. Failure of the device is the third most frequent complication (10.06% of all complications and 1.53% of cochlear implantations). Other rare conditions (such as granulating labyrinthitis with cochlear fibrosis, ossification and erosion, silicone allergy and the formation of a biofilm around the internal device) are possible and unpredictable. Although rare (approximately 1%), such cases may require explantation.Conclusions: Despite efforts by both surgeons and manufacturers, device-related and surgical complications still occur. These and other rare conditions demand specific management, and their frequency may be underestimated. Further studies are needed to assess more realistic rates of complications and devise more efficient strategies for early diagnosis and treatment.
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| 26. |
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| 27. |
- Bidarian-Moniri, Armin, et al.
(author)
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Autoinflation for treatment of persistent otitis media with effusion in children: A cross-over study with a 12-month follow-up
- 2014
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876. ; 78:8, s. 1298-1305
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Journal article (peer-reviewed)abstract
- Objectives: The aims of the present study were to evaluate the efficacy of and compliance with a new device for autoinflation in the treatment of persistent otitis media with effusion (OME) in young children. Methods: Forty-five children with persistent OME with a bilateral type B or C2 tympanogram for at least three months and history of subjective hearing loss, waiting for grommet surgery, were randomised to a treatment and a control group. Twenty-three children aged between three and eight years started as the treatment group with the new device for autoinflation. Another 22 children, aged between two and eight years were included as controls. After a period of four weeks, a cross-over was performed. Both groups underwent otomicroscopy, tympanometry and audiometry at inclusion and after one and two months for the evaluation of treatment efficiency. The primary outcome measurements were improvement in middle-ear pressure and hearing thresholds at eight weeks. Both groups were then followed up for another 10 months. Results: In the treatment group, the mean middle-ear pressure for both ears and the mean hearing thresholds for the best ear improved by 166 daPa (p <0.0001) and 6 dB (p <0.0001), respectively after four weeks, while in the control group, non-significant alterations were observed. After the cross-over of the control group to treatment, equivalent improvements in the mean middle-ear pressure and the mean hearing thresholds of 187 daPa (p <0.0001) and 7 dB (p <0.01), respectively were achieved also in this group. After treatment in both groups at eight weeks, four of 45 children were submitted to grommet surgery. During the long-term follow-up another five children were submitted to surgery due to recurrence of disease. All the children managed to perform the manoeuvre and no side-effects were detected. Conclusion: The device demonstrated efficiency in improving both middle-ear pressure and hearing thresholds in most children after four weeks of treatment. It might therefore be possible to consider this method of autoinflation in children with persistent OME during the watchful waiting period. (C) 2014 Published by Elsevier Ireland Ltd.
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| 28. |
- Borg, Erik, et al.
(author)
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Speech and language development in a population of Swedish hearing-impaired pre-school-children, a cross-sectional study
- 2007
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 71:7, s. 1061-1077
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Journal article (peer-reviewed)abstract
- Objective: There is little information on speech and language development in preschool children with mild, moderate or severe hearing impairment. The primary aim of the study is to establish a reference material for clinical use covering various aspects of speech and language functions and to relate test values to pure tone audiograms and parents' judgement of their children's hearing and language abilities. Methods: Nine speech and language tests were applied or modified, both classical tests and newly developed tests. Ninety-seven children with normal hearing and 156 with hearing impairment were tested. Hearing was 80 dB HL PTA or better in the best ear. Swedish was their strongest language. None had any additional diagnosed major handicaps. The children were 4-6 years of age. The material was divided into 10 categories of hearing impairment, 5 conductive and 5 sensorineural: unilateral; bilateral 0-20; 21-40; 41-60; 61-80 dB HL PTA. The tests, selected on the basis of a three component language model, are phoneme discrimination; rhyme matching; Peabody Picture Vocabulary Test (PPVT-III, word perception); Test for Reception of Grammar (TROG, grammar perception); prosodic phrase focus; rhyme construction; Word Finding Vocabulary Test (word production); Action Picture Test (grammar production); oral motor test. Results: Only categories with sensorineural toss showed significant differences from normal. Word production showed the most marked delay for 21-40 dB HL: 5 and 6 years p < 0.01; for 41-60 dB: 4 years p < 0.01 and 6 years p < 0.01 and 61-80 dB: 5 years p < 0.05. Phoneme discrimination 21-40 dB HL: 6 years p < 0.05; 41-60 dB: 4 years p < 0.01; 61-80 dB: 4 years p < 0.001, 5 years p < 0.001. Rhyme matching: no significant difference as compared to normal data. Word perception: sensorineural 41-60 dB HL: 6 years p < 0.05; 61-80 dB: 4 years p < 0.05; 5 years p < 0.01. Grammar perception: sensorineural 41-60 dB HL: 6 years p < 0.05; 61-80 dB: 5 years p < 0.05. Prosodic phrase focus: 41-60 dB HL: 5 years p < 0.01. Rhyme construction: 41-60 dB HL: 4 years p < 0.05. Grammar production: 61-80 dB HL: 5 years p < 0.01. Oral motor function: no differences. The Word production test showed a 1.5-2 years delay for sensorineural impairment 41-80 dB HL through 4-6 years of age. There were no differences between hearing-impaired boys and girls. Extended data for the screening test [E. Borg, A. Risberg, B. McAllister, B.M. Undemar, G. Edquist, A.C. Reinholdsson, et at., Language development in hearing-impaired children. Establishment of a reference material for a ""Language test for hearing-impaired children"", Int. J. Pediatr. Otorhinolaryngot. 65 (2002) 15-26] are presented. Conclusions: Reference values for expected speech and language development are presented that cover nearly 60% of the studied population. The effect of the peripheral hearing impairment is compensated for in many children with hearing impairment up to 60 dB HL. Above that degree of impairment, language delay is more pronounced, probably due to a toss of acuity. The importance of central cognitive functions, speech reading and signing for compensation of peripheral limitations is pointed out.
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| 29. |
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| 30. |
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| 31. |
- Busi, Micol, et al.
(author)
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Novel mutations in the SLC26A4 gene
- 2012
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In: International Journal of Pediatric Otorhinolaryngology. - Amsterdam : Elsevier. - 0165-5876 .- 1872-8464. ; 76:9, s. 1249-1254
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Journal article (peer-reviewed)abstract
- Objectives: Mutations in the SLC26A4 gene (7q22.3–7q31.1) are considered one of the most common causes of genetic hearing loss. There are two clinical forms related to these mutations: syndromic and non-syndromic deafness. The first one is named Pendred Syndrome (PS) when deafness is associated with thyroid goiter; the second is called DFNB4, when no other symptoms are present. Both are transmitted as an autosomal recessive trait, but simple heterozygotes can develop both forms of deafness. Actually it is thought that Pendred Syndrome occurs when both alleles of SLC26A4 gene are mutated; DFNB4 seems due to monoallelic mutations. PS and DFNB4 can be associated with inner ear malformations. In most of the cases (around 80%), these consist in Enlarged Vestibular Aqueduct (EVA). EVA can also be present without SLC26A4 mutations.Understanding the role of new SLC26A4 variants should facilitate clinical assessment, as well as diagnostic and therapeutic approaches. This investigation aims to detect and report genetic causes of two unrelated Italian boys with hearing loss.Methods: Patients and family members underwent clinical, audiological and genetic evaluations. To identify genetic mutations, DNA sequencing of SLC26A4 gene (including all 21 exons, exon-intron boundaries and promoter region) was carried out.Results: Both probands were affected by congenital, progressive and fluctuating mixed hearing loss. Temporal bone imaging revealed a bilateral EVA with no other abnormalities in both cases. Probands were heterozygotes for previously undescribed mutations in the SLC26A4 gene: R409H/IVS2+1delG (proband 1) and L236P/K590X (proband 2). No other mutations were detected in GJB2, GJB6 genes or mitochondrial DNA (mit-DNA).Conclusions: The IVS2+1delG and K590X mutations have not yet been described in literature but there is some evidence to suggest that they have a pathological role. The results underlined the importance of considering the complete DNA sequencing of the SLC26A4 gene for differential molecular diagnosis of deafness, especially in those patients affected by congenital, progressive and fluctuating mixed hearing loss with bilateral EVA.
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| 32. |
- Cadena, Adriana Cuasquen, et al.
(author)
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School-based hearing screening in Sweden – An evaluation of current practices
- 2021
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876. ; 150
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Journal article (peer-reviewed)abstract
- Objectives: Routines for school hearing screening vary between municipalities in Sweden, and no study has been carried out to investigate how this is conducted throughout the country. The aim of the present study was to determine the extent of school hearing screening, and how it is performed in all the municipalities in Sweden. Methods: An online survey was used to collect information on school hearing screening from municipalities in Sweden (N = 290). The survey included questions on the performance of hearing screening, including stimulus level and frequencies tested, the criteria for referral for further hearing evaluation, as well as the equipment and room used for testing, and who carried out the screening. Questions were also included on experience of, and attitudes towards hearing screening. Results: Answers were received from 225 municipalities (response rate 78%). Universal school hearing screening was performed in 202 municipalities, while in the other municipalities hearing screening was performed when a child was evaluated due to speech delay or learning difficulties. Many different protocols were used involving different stimulus levels, frequencies, and referral criteria. The most common was testing with pure tone audiometry with a lowest stimulus level of 20 dB HL at five frequencies, 500–6000 Hz. Hearing screening was usually performed in the preparation class (6 years of age), while in other municipalities it was performed in year 1 (7 years of age). Hearing screening was usually performed once in primary school, while some municipalities carried out screening once in primary school and once in high school. More rarely, hearing screening was conducted twice in primary school. In 25 % of the municipialities, newly arrived immigrant children were screened. Difficulties in performing hearing screening were reported, such as lack of soundproof rooms, lack of time and technical difficulties. There was an opinion among the participants that identifying students with hearing loss is important, as it affects their learning ability and communication skills. and they expressed a desire for national guidelines. Conclusions: Hearing screening is performed in the vast majority of municipally run schools in Sweden. The way in which screening was performed varied regarding the stimulus level and frequencies used, as well as the criteria for referral to a specialist. The attitude towards hearing screening was positive among the participants. Hearing screening of newly immigrated children is important as their previous medical history is often unknown. There is a need for national guidelines on hearing screening of Swedish schoolchildren. Efforts must continue to ensure that the same level of healthcare regarding children's hearing is provided throughout the whole of Sweden.
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| 33. |
- Castiglione, Alessandro, 1976-, et al.
(author)
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EYA1-related disorders : two clinical cases and a literature review
- 2014
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In: International Journal of Pediatric Otorhinolaryngology. - Amsterdam : Elsevier. - 0165-5876 .- 1872-8464. ; 78:8, s. 1201-1210
-
Research review (peer-reviewed)abstract
- Objectives: To delineate the diagnostic and rehabilitative aspects of syndromes that have overlapping features, we present the cases of two unrelated Caucasian males affected by hearing impairment, preauricular pits and cervical fistulae. Specific findings that are helpful in the diagnosis and management of EYA1-related disorders are highlighted.Methods: Genetic, otologic, imaging, eye and renal evaluations were conducted to achieve a detailed and comprehensive assessment, leading to the most accurate diagnosis and appropriate treatment. A literature review was also carried out.Results: Diagnostic criteria indicated that the two patients were affected by BOS1 (Branchio-Otic Syndrome 1). We also identified a novel sporadic missense mutation in the EYA1 gene: p.G533R (c.1597G>A, NM_000503.4), a highly conserved, heterozygotic amino acid substitution. In the other case, we identified the p.X593QextX6 (c.1777T>A, NM_000503.4) substitution. Both variants lead to isoform 1 (EYA1B and EYA1C) which is composed of 592 amino acids. Clinical and in silico evidence suggests a pathogenic role for the new mutations. Imaging evaluation revealed a complex pathology, characterized by external, inner and middle ear malformations, without renal anomalies.Conclusions: Our results demonstrate the importance of considering the imaging evaluation and the complete DNA sequencing of the EYA1 gene for the differential diagnosis of deafness and related branchio-oto-renal disorders.
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| 34. |
- Célind, Jimmy, et al.
(author)
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Adherence to treatment guidelines for acute otitis media in children. The necessity of an effective strategy of guideline implementation
- 2014
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876. ; 78:7, s. 1128-1132
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Journal article (peer-reviewed)abstract
- Objectives: Acute otitis media is the single diagnosis responsible for most prescriptions of antibiotics in Sweden and the USA. The treatment of acute otitis media has significant impact on child health, healthcare costs, and the development of anti-microbial resistance. In the Swedish national guidelines from the year 2000, watchful waiting was recommended for most children over 2 years of age. The aims of the present study were to assess the degree of adherence to acute otitis media guidelines at a busy pediatric emergency department of a university hospital and to determine whether an information campaign changed the result. Methods: Audit of 91 patient records before and 80 patient records after an information campaign consisting of an oral presentation, posting of flow charts, and sending of educational material to prescribing physicians. Four endpoints were studied: choosing to use antibiotics, choice of antibiotic, dosage of antibiotic, and duration of treatment. Results: Before the information campaign, adherence to guidelines was between 70% (dosage) and around 90% (duration). No significant change was seen after the information campaign. The endpoint choosing to use antibiotics showed a large divergence in adherence in children under 2 years (96%) compared to older children (39%). Conclusions: Overall adherence to recommendations was 70-90% but adherence to watchful waiting was poor. Information did not improve adherence, suggesting insufficient educational power or the existence of barriers other than lack of knowledge. Specific barriers should be identified, and implementation and follow-up should be part of producing guidelines in order to achieve the desired results. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
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| 35. |
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| 36. |
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| 37. |
- Edfeldt, Lennart, et al.
(author)
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Surgical treatment of paediatric cholesteatoma : Long-term follow up in comparison with adults
- 2012
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 76:8, s. 1091-1097
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Journal article (peer-reviewed)abstract
- Objective: This study was designed to analyse long-term results after surgery of acquired (ACH) and congenital cholesteatoma (CCH) of the middle ear in children and compare these with adults.Methods: Computer-based analysis of consecutively operated paediatric patients for ACH and CCH in a tertiary referral centre was made in 57 cases under the age of 12 operated 1983-2004 by three surgeons using identical technique. A canal wall down and total reconstruction procedure (TRP) with obliteration of the mastoid cavity, canal wall reconstruction, ossiculoplasty with consistent use of autologous bone and an "aeration enhancement procedure" (AEP) with silicon sheet in selected cases were used. Pre- and post-operative PTA (0.5-3 kHz) and pure-tone average air-bone gap (PTA-ABG) together with surgical parameters were assessed 1, 3 and 6 years following surgery.Results: Results showed stable hearing over 6 years with low incidence of persistent and recurrent disease comparable with results from adult patients. In nearly half of the cases, silastic sheeting was used. In 21 cases, stapes was eroded. Bone conduction thresholds levels remained unaffected 6 years after surgery. No deaf ears, postoperative facial dysfunction or other lesions related to surgery were observed. Six years after surgery every evaluated ear was found to be water-resistant and infection-free.Conclusion: Our results suggest that one-stage eradication of ACH and CCH in children using total reconstruction procedure (TRP) provide long-term improvement or preservation of hearing, with a low incidence of persistent or recurrent disease. No difference in surgical outcome between children and adults was found.
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| 38. |
- Edquist, Gertrud, et al.
(author)
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Expressive vocabulary of school-age children with mild to moderately severe hearing loss
- 2022
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier. - 0165-5876 .- 1872-8464. ; 162
-
Journal article (peer-reviewed)abstract
- Objectives: The main goal of this study was to describe the expressive vocabulary of school-age children with mild to moderately severe hearing loss (CHL group) and to compare their performance with children with normal hearing (CNH group) of the same age. Another aim was to examine the interaction between nonword repetition and expressive vocabulary size. Furthermore, the interaction between results on vocabulary tests and background factors, such as the age of diagnosis, age of hearing aid fitting, and amount of hearing aid use, was explored. Method: School-aged children with mild to moderately severe, permanent bilateral hearing loss and children with normal hearing were included in this cross-sectional study. The children participated in assessments of naming pictures, defining words, and repetition of nonwords and sentences. Results of the CHL group and the CNH group were compared. The analysis also included the degree of hearing loss, the age of diagnosis, amount of hearing aid use, and level of parental education. Results: The CHL group performed significantly below the CNH group on all measures: picture naming, defining words, nonword repetition, and repetition of sentences. The proportion of words pronounced with correct phonological structure when picture naming was more limited in the CHL group than in the CNH group. There was a significant positive correlation between the amount of hearing aid use and nonword repetition ability in the CHL group. Age of diagnosis and age of hearing aid fitting was not significantly correlated with the outcomes of the vocabulary assessments in this study.Conclusion: Despite the technological advancement of hearing aids, the expressive vocabulary in school-aged children with mild to moderately severe, permanent bilateral, hearing impairment does not reach the same level as for children with normal hearing, although there is a variation in performance within the group. The variation in the CHL group was not uniquely impacted by either age, degree of hearing loss, or the age of diagnosis. The amount of hearing aid use seems to impact the perception of new words. More studies of expressive vocabulary are needed, because they capture a dimension of word learning that seems particularly sensitive to hearing loss and hearing aid use.
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| 39. |
- Elander, Johanna, et al.
(author)
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Extended genetic diagnostics for children with profound sensorineural hearing loss by implementing massive parallel sequencing. Diagnostic outcome, family experience and clinical implementation
- 2022
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876. ; 159
-
Journal article (peer-reviewed)abstract
- Objectives: The aim of this study was to investigate genetic outcomes, analyze the family experience, and describe the process of implementing genetic sequencing for children with profound sensorineural hearing loss (SNHL) at a tertial audiological center in southern Sweden. Design: This is a prospective pilot study including eleven children with profound bilateral SNHL who underwent cochlear implant surgery. Genetic diagnostic investigation was performed with whole exome sequencing (WES) complemented with XON-array to identify copy number variants, using a manually curated gene panel incorporating 179 genes associated with non-syndromic and syndromic SNHL. Mitochondrial DNA (mtDNA) from blood was examined separately. A patient reported experience measures (PREM) questionnaire was used to evaluate parental experience. We also describe here the process of implementing WES in an audiology department. Results: Six female and five male children (mean 3.4 years, SD 3.5 years), with profound bilateral SNHL were included. Genetic variants of interest were found in six subjects (55%), where three (27%) could be classified as pathogenic or likely pathogenic. Among the six cases, one child was found to have a homozygous pathogenic variant in MYO7A and two children had homozygous likely pathogenic variants in SLC26A4 and PCDH15, respectively. One was carrying a compound heterozygote frameshift variant of uncertain significance (VUS) on one allele and in trans, a likely pathogenic deletion on the other allele in PCDH15. Two subjects had homozygous VUS in PCDH15 and ADGRV1, respectively. In five of the cases the variants were in genes associated with Usher syndrome. For one of the likely pathogenic variants, the finding was related to Pendred syndrome. No mtDNA variants related to SNHL were found. The PREM questionnaire revealed that the families had difficulty in fully understanding the results of the genetic analysis. However, the parents of all eleven (100%) subjects still recommended that other families with children with SNHL should undergo genetic testing. Specifically addressed referrals for prompt complementary clinical examination and more individualized care were possible, based on the genetic results. Close clinical collaboration between different specialists, including physicians of audiology, audiologists, clinical geneticists, ophthalmologists, pediatricians, otoneurologists, physiotherapists and hearing habilitation teams was initiated during the implementation of the new regime. For all professionals involved, a better knowledge of the diversity of the genetic background of hearing loss was achieved. Conclusions: Whole exome sequencing and XON-array using a panel of genes associated with SNHL had a high diagnostic yield, added value to the families, and provided guidance for further examinations and habilitation for the child. Great care should be taken to thoroughly inform parents about the genetic test result. Collaborations between departments were intensified and knowledge of hearing genomics was increased among the staff.
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| 40. |
- Engström, Elisabet, et al.
(author)
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Auditory event-related potentials and mismatch negativity in children with hearing loss using hearing aids or cochlear implants : A three-year follow-up study
- 2021
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier. - 0165-5876 .- 1872-8464. ; 140
-
Journal article (peer-reviewed)abstract
- Objectives: The primary aim was to examine how event-related potentials (ERPs) and mismatch negativity (MMN) change and develop over time among children with hearing loss (HL) using hearing aids (HAs) or cochlear implants (CIs). Children with normal hearing (NH) were tested as a reference group.Methods: This three-year follow-up study included 13 children with sensorineural HL (SNHL); 7 children using bilateral HAs and 6 children using CIs; and 10 children with NH as a reference group. ERPs were recorded at baseline and after three years. At time for the original study the children were approximately 5-8 years old and at the follow-up study 8-11 years old. ERP recordings and data processing were identical in both sessions. A standard stimulus alternated with five different deviants (gap, intensity, pitch, location and duration), presented in a pseudorandom sequence, thus following the multi-feature paradigm, Optimum-1. MMN was calculated from the average ERP of each deviant minus the standard stimuli. Repeated measures ANOVA was used for the statistical analyses and the results were based on samples within a specific time interval; 80-224 ms.Results: There was a statistically significant difference in the obligatory responses between the NH and HA groups at baseline, but this difference disappeared after three years in our follow-up study. The children with HA also showed a significant difference in mean ERP at baseline compared to follow-up, and significant differences between the deviants at follow-up but not at baseline. This suggests an improvement over time among the children with HAs. On the other hand, the children with CIs did not differ from the NH children at baseline, but after three years their mean ERP was significantly lower compared to both the children with HA and NH, indicating a reduced development of the central auditory system in this age span among the children with CIs. Regarding MMN, there was an interaction between the duration deviant and time for the children with HA, also indicating a possible improvement over time among the HA children.Conclusions: This three-year follow-up study shows neurophysiological differences between children with HL and children with NH. The results suggest a delay in the central auditory processing among the HA children compared to children with NH, but a possible catch-up, over time, and this potential may be worth to be utilized. Regarding the CI children, similar improvement in this age span is missing, meaning there are differences between the subgroups of children with HL, i.e. the children with HAs vs. CIs. The results highlight the importance of distinguishing between subgroups of children with HL in further research.
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| 41. |
- Engström, Elisabet, et al.
(author)
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Computer-assisted reading intervention for children with hearing impairment using cochlear implants : Effects on auditory event-related potentials and mismatch negativity
- 2020
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier. - 0165-5876 .- 1872-8464. ; 137
-
Journal article (peer-reviewed)abstract
- OBJECTIVES: The primary aim was to find out whether a computer-assisted reading intervention program with a phonic approach can affect event-related (ERPs) and mismatch negativity (MMN) in hearing impaired (HI) children using cochlear implants (CIs).METHODS: This study involved a test group of 15 HI children with CIs and a control group of 14 normal hearing (NH) children. The children were 4 years and 10 months to 8 years and 1 month old. ERPs were recorded immediately before and after 4 weeks of training with a computer-assisted reading intervention, GraphoGame. A multi-feature paradigm, Optimum-1, was used, i.e. a standard stimulus alternated with five different deviants: gap intensity, pitch, location and duration. MMN was calculated from the mean amplitude ERP of each deviant minus the standard stimulus response in a specific time interval, 80 - 224 ms. Repeated measures ANOVA was used for the statistical analysis.RESULTS: The results did not show any significant changes with the computerassisted training in the ERPs and MMNs among the HI children with CIs. The presence of both MMN and a positive mismatch response (pMMR), which might reflect an immaturity, complicates interpreting the results in this age group. Individually, there was a mix of MMNs and pMMRs among all participants, pre and post training, and the change of each deviant after intervention was not predictable.CONCLUSIONS: There are no significant changes in ERP or MMN after intervention, however lack of significances must be interpreted with caution. Besides the presence of both MMNs and pMMRs, only modest changes are to be expected on an individual basis and small samples hinder making statistical conclusions regarding the training's effects. The study contributes to some more descriptive pieces of ERPs and MMNs among the HI children with CIs. The issues of MMN and pMMR are highlighted.
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| 42. |
- Engström, Elisabet, et al.
(author)
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Computer-assisted reading intervention for children with sensorineural hearing loss using hearing aids : Effects on auditory event-related potentials and mismatch negativity
- 2019
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier. - 0165-5876 .- 1872-8464. ; 117, s. 17-25
-
Journal article (peer-reviewed)abstract
- OBJECTIVES: The primary aim was to investigate whether computer-assisted reading intervention somehow can affect event-related potentials (ERP) and mismatch negativity (MMN) in hearing impaired (HI) children with hearing aids (HAs) and normal hearing (NH) children.METHODS: The study included 15 HI children with sensorineural hearing loss (SNHL) using bilateral HAs and 14 NH children as a reference group; all children between the ages of 5 and 8. A multi-feature MMN-paradigm, Optimum-1, with a standard stimulus alternating with 5 different deviants was used. ERPs were recorded pre and post intervention, i.e. one month of repeatedly computer-assisted training (GraphoGame). MMN was calculated from the average ERP of each deviant minus standard. Data were based on samples within a specific time interval, 80-224 ms, and repeated measures ANOVA was used to analyze possible interactions.RESULTS: There was a significant difference between groups before training, though, the mean obligatory responses or MMN was not statistically significantly different before versus after training, neither among the NH nor the HI children. Further, the HI children did generally achieve lower levels in GraphoGame compared to the NH children. Altogether, our findings indicate differences between the groups and that training may affect the neurophysiological processing in the brain, gaining the HI children. Both MMN and positive mismatch response (pMMR) were seen among both the HA and NH children, irrespective to deviant type. Individually, changes of the MMN and pMMR after training seem unpredictable.CONCLUSION: There are statistically significant differences in both the obligatory responses in ERP and the MMNs between the NH and HI groups before the computer-assisted training. Though, these differences disappear after the intervention. This suggests possible training effects regarding the central auditory processing among the HI children.
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| 43. |
- Enoksson, Frida, et al.
(author)
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Subperiosteal abscesses in acute mastoiditis in 115 Swedish children.
- 2015
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 1872-8464 .- 0165-5876. ; 79:7, s. 1115-1120
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Journal article (peer-reviewed)abstract
- To study the outcome of different surgical methods of treating subperiosteal abscesses resulting from acute mastoiditis.
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| 44. |
- Ericsson, Elisabeth, 1959-, et al.
(author)
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Child Behavior and quality of life before and after tonsillotomy versus tonsillectomy
- 2009
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In: International Journal of Pediatric Otorhinolaryngology. - Clare, Ireland : Elsevier. - 0165-5876 .- 1872-8464. ; 73:9, s. 1254-1262
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Journal article (peer-reviewed)abstract
- 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
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| 45. |
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| 46. |
- Ericsson, Elisabeth, 1959-, et al.
(author)
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Pre-surgical Child Behavior Ratings and Pain Management after Two Different Techniques of Tonsil Surgery
- 2006
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 70:10, s. 1749-1758
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Journal article (peer-reviewed)abstract
- ObjectiveThe 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.MethodNinety-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.ResultsThese 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.ConclusionSDB 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.
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| 47. |
- Ericsson, Elisabeth, 1959-, et al.
(author)
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Swedish guidelines for the treatment of pain in tonsil surgery in pediatric patients up to 18 years
- 2015
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 79:4, s. 443-450
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Research review (peer-reviewed)abstract
- Background: Surgery of the tonsils often causes severe pain lasting for many days as been shown by data from the National Tonsil Surgery Register in Sweden. Tonsillotomy is associated with fewer readmissions due to bleeding, number of days requiring analgesics and health care contacts due to pain compared to tonsillectomy. The register data demonstrate the necessity of better-evidenced based pain treatment guidelines for tonsil-surgery.Objectives: To develop evidenced based pain treatment guidelines for tonsil-surgery in Sweden.Methods: The evidence based guidelines were designed by an updated literature review and from the clinical expertise in the pediatric pain field, which thereafter were reviewed by ENT-doctors and anesthetists from each ENT-clinic in Sweden.Results: A multimodal pain treatment approach is advocated, including premedication and administration during anesthesia, with paracetamol (acetaminophen), clonidine and betamethasone. If not given as a premedication the combination can be administered intravenously in the initial phase of anesthesia. At the end of surgery, if no bleeding problems, cox-inhibitors can be given.After discharge from hospital, the recommendations for pain relief are paracetamol combined with cox-inhibitors (ibuprofen, diclofenac) and if needed oral clonidine in favor of opioids. When pain intensity decreases, discontinue the analgesic treatment in the following order: opioid, clonidine, paracetamol and at last ibuprofen. The need for analgesic treatment after tonsillectomy is usually 5-8 days, after tonsillotomy only 3-5 days.Parents are recommended to contact the hospital if the child has difficulties in drinking or eating adequately and/or suffers from pain despite taking the recommended medication regularly.Conclusions: Swedish guidelines for tonsil-surgery provide practical evidence-based pain treatment recommendations.
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| 48. |
- Eriksson, Mats, 1957-, et al.
(author)
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Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy
- 2017
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier. - 0165-5876 .- 1872-8464. ; 96, s. 47-54
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Journal article (peer-reviewed)abstract
- 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.
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| 49. |
- Erixon, Elsa
(author)
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Estimated prevalence of permanent hearing loss among newborns and 6-year-olds : An evaluation of the three auditory screenings in Uppsala
- 2024
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier. - 0165-5876 .- 1872-8464. ; 176
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Journal article (peer-reviewed)abstract
- ObjectivesThis study estimated the permanent hearing loss (PHL) prevalence among newborns and 6-year-olds in the Uppsala region (Sweden), compared how different definitions affected this estimation, and evaluated the outcome of the three hearing screening occasions for children.MethodsA retrospective investigation of medical records and audiograms was conducted for children born in 2011–2012. Data extraction was performed when the children had reached 7 years of age. Hearing loss was defined as > 20 dB hearing level in at least one frequency (125–8000 Hz) in one or both ears (clinician's definition).ResultsA total of 1385 children were included, and 95 were diagnosed with PHL. The prevalence of bilateral PHL at 6 years was 5.50 per 1000 children based on the clinician's definition, 3.74 per 1000 children based on the World Health Organization (WHO) 2021 definition, and 2.64 per 1000 children based on the WHO 1991 definition. Adding unilateral PHL resulted in a total prevalence of 10.11 (clinician's definition) and 6.16 (WHO 2021) per 1000 children.ConclusionThis study demonstrates the necessity of repeated hearing testing during childhood to identify PHL and suggests a higher prevalence in 6-year-olds than previously reported. The definition of PHL greatly impacted its estimated prevalence.
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| 50. |
- Florentzson, Rut, 1957, et al.
(author)
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Transmyringeal ventilation tube treatment: A 10-year cohort study.
- 2012
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In: International journal of pediatric otorhinolaryngology. - : Elsevier BV. - 1872-8464 .- 0165-5876. ; 76:8, s. 1117-22
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Journal article (peer-reviewed)abstract
- Objective This ten-year cohort study was intended to determine the incidence and expected outcome of ventilation tube treatment at a clinic that serves a community with 300 000 inhabitants. Methods All children aged 0–10 years, who received their first ventilation tube during 1996, were followed over 10 years, at the department of Otorhinolaryngology, county hospital Ryhov, Jönköping, Sweden. All acute and planned visits were recorded and analyzed, but no extra visits were scheduled due to participation in the study. Results In 1996 the overall incidence of tube insertion in the age group 0–10 years was 1 percent. A total of 155 children were entered, and 146 (94 percent) fulfilled the study. During the 10 years’ follow up, a total of 409 acute visits and 1485 planned visits were made. In approximately 50 percent of the cases the first ventilation tube was still in place after one year. Infection occurred in 53 percent of the treated ear(s) at least once; the risk for infection was higher if the indication for ventilation tube placement was recurrent acute otitis media. In 45 percent of the children at least one more tube insertion was needed. A permanent perforation after tube treatment was seen in 2 percent of the treated ears. After 5 years, one half of the children were declared free from middle ear disease, but at the termination of the study 17 percent of the children were still in need of regular visits to an otologist due to residual ear problems. Conclusion This study shows the natural course of treatment with middle ear ventilation tubes in a cohort of children aged 0–10 years during a ten-year period. The incidence of ventilation tube treatment was 1 percent. It is evident that many children need a prolonged contact with an ear-nose and throat specialist when treated with a ventilation tube.
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