| 1. |
- Alm, Fredrik, 1983-, et al.
(författare)
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Adherence to Swedish Guidelines for Pain Treatment in Tonsil Surgery in Pediatric Patients
- 2016
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Konferensbidrag (refereegranskat)abstract
- Objective: As shown by data from the National Tonsil Surgery Register in Sweden, tonsil surgery often causes severe pain that lasts for many days. The register data demonstrate the necessity for better evidence-based pain treatment guidelines for tonsil surgery. The guidelines, introduced in 2013, consist of both pharmacological and non-pharmacological recommendations. In the guidelines, a multimodal analgesic approach and combination of analgesics are recommended to provide effective pain treatment with limited side effects. Two national multi-professional education days on pain, pharmacology and the guidelines were offered. Web-based information about pharmacological treatment (www.tonsililloperation.se) was designed for patients and next-of-kin. The current aims were to describe adherence to the Swedish guidelines for pain treatment in tonsil surgery in pediatric patients < 18 yearsMethod: An inter-professional questionnaire was developed, including questions linked to the relevant guidelines. The questions came from a national mapping before the guidelines were designed. The items were discussed by an expert group, and content validity was evaluated using the content validity index.ENT-and anesthesia physicians and nurses from all 50 ENT clinics in Sweden were enrolled.Results: Most clinics had received the guidelines, but there was a discrepancy between the professions. More than half had perused the literature review performed before the guidelines were designed, and attended themulti-professional education day. Pre- and perioperative treatment usually included paracetamol, clonidine and betamethasone. A multimodal pain approach after discharge from hospital (tonsillectomy and tonsillotomy) was used, combining paracetamol with cox-inhibitors. Most clinics used paracetamol, with a higher dose for the first 3 days (healthy children and acceptable nutrition), and a reduced dose from day 4.In case of inadequate analgesia after tonsillectomy, oral clonidine or opioids were used. Several clinics followed the recommendation to use clonidine as first choice and secondly an opioid. No respondents prescribed codeine compared to 80% at the mapping before the guidelines were designed. The guidelines were experienced as clear, safe and sufficient. The web-based information was used by most of the clinics to improve quality of care and provide facilitating tools for patients, relatives and caregivers.Conclusion: Swedish guidelines for tonsil surgery provide practical evidence-based pain treatment recommendations. To achieve a change, multi-professional education is necessary. This needs to be repeated for a wider spread.Future research should include evaluation through pain diaries and questionnaires to next-of-kin and children. There should be matching of data from the quality registers at each clinic, with pain variables such as unplanned health care contacts due to pain, number of days with analgesics, and return to normal diet
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| 2. |
- Ericsson, Elisabeth, 1959-, et al.
(författare)
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Kirurgisk behandling av barn med sömnrelaterade andningsstörningar
- 2009
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Ingår i: Kirurgisk behandling av barn med sömnrelaterade andningsstörningar.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Kirurgisk behandling av barn med sömnrelaterade andningsstörningar Moderator: Danielle Friberg, överläkare, Karolinska Huddinge I panelen: Elisabet Ericsson, disputerad sjuksköterska, Hälsohögskolan, Jönköping, Claes Hemlin, överläkare, Sophiahemmet, Anne-Charlotte Hessén Söderman, överläkare, Karolinska Danderyd, Elisabeth Hultcrantz, professor, Universitetssjukhuset, Linköping, Pia Nerfeldt, disputerad specialistläkare, Karolinska Huddinge, Joacim Stalfors, överläkare, Sahlgrenska, Göteborg. Bakgrund: Barn med sömnrelaterade andningsstörningar (SRBD) o/e obstruktivt sömnapnésyndrom (OSAS) behandlas primärt med kirurgi (adenotonsillektomi), varav cirka 80 % blir botade. Det finns flera riskfaktorer till SRBD/OSAS: kraniofaciala missbildningar, neuromuskulära sjukdomar samt övervikt/fetma, som ökar även bland barn. Cirka 1-3 % av barnen har OSAS och 12 % har SRBD och dessa barn löper ökad risk för inlärningssvårigheter, dålig viktsutveckling, hjärtkärlsjukdomar och dödlighet. Fram till nu har dessa barn blivit styvmoderligt behandlade i rutinsjukvården. Detta symposium vill belysa hur vi kan förbättra oss. Material och metod: Med mentometerknappar inbjuds auditoriet att delta i kliniska frågeställningar. Typfall demonstreras. Nya kirurgiska metoder presenteras; tonsillotomi, tonsillektomi med coblation eller radiofrekvens, vilka har utvärderats gentemot sedvanlig ”kall” tonsillektomi. Resultat från Kvalitetsregister för tonsilloperation kommer att redovisas. Likaså den nyvaliderade OSA-18, som är ett sjukdomsspecifikt hälsorelaterat livskvalitetsformulär för barn med misstänkt SRBD/OSAS. Ett polysomnografilab för barn har nyligen startats på Karolinska Huddinge, där flera studier planeras. Resultat: Panelmedlemmarna presenterar sina resultat för auditoriet, vilka sen får delta i diskussionen med eller utan mentometer. Diskussion: Hur kan vi förbättra omhändertagandet av barn med SRBD/OSAS? Hur ska vi välja ut de som ska opereras? Hur fungerar OSA-18 och hur kan vi använda formuläret i vår vardag? Vilken operationsmetod är att föredra på vilket barn? Vilka frågor kan det förnyade tonsilloperationsregistret besvara? Vilka barn ska följas upp efter kirurgi? Barn med riskfaktorer, hur ska vi hantera dem? Kan vi erbjuda de barn som inte blir bra på kirurgi alternativ behandling? Vilken ytterligare forskning behövs?
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| 3. |
- Ericsson, Elisabeth, 1959-, et al.
(författare)
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Kvalitetsregistret för tonsilloperation
- 2014
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Ingår i: Nationellt kvalitetsregister Öron- Näs och Halssjukvård - Årsrapport 2013. - : Västra Götalandsregionen. ; , s. 34-97
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 4. |
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| 5. |
- Ericsson, Elisabeth, et al.
(författare)
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Nationella riktlinjer för farmakologisk behandling av smärta och illamående i samband med tonsillotomi och tonsillektomi på barn och ungdomar (<18 år)
- 2013
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Ingår i: Svensk ÖNH-tidskrift. - Stockholm : Scandinavian University Press. - 1400-0121. ; 30:3, s. 1-5
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Tidskriftsartikel (refereegranskat)abstract
- Riktlinjerna är framtagna av referensgruppen för Tonsilloperation. Syftet med dessa riktlinjer är att optimera det perioperativa omhändertagandet (premedicinering - peroperativt - postoperativt smärtomhändertagande) i samband med tonsilloperationer på barn och ungdomar. Bakgrund och referenser till riktlinjerna finns i ett separat dokument.Riktlinjerna gäller för friska barn. Finns det riskfaktorer som ex grav sömnapné, kraftig övervikt, komplicerande sjukdomstillstånd eller organpåverkan behöver den farmakologiska behandlingen anpassas efter situationen.Tonsillkirurgi medför svår och långvarig smärta samt hög frekvens av illamående. Smärtan är ofta värst dag 3 till 5 efter tonsillektomi. Tonsillotomi ger generellt upphov till mindre smärta än tonsillektomi. För att uppnå effekt behöver den farmakologiska smärtbehandlingen påbörjas redan vid premedicineringen och fortlöpa under själva anestesin/ingreppet. En multimodal behandling ska eftersträvas och målsättningen är att uppnå en för individen acceptabel smärtnivå i det postoperativa skedet och i hemmet.Den farmakologiska behandlingen ska kombineras med preoperativ information om ingreppet till patienten och vårdnadshavare. En lugn och trygg situation före anestesistart ökar chanserna för ett lugnt postoperativt förlopp.
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| 12. |
- Hemlin, Claes, et al.
(författare)
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What factors are discriminating for tonsil surgery decision?
- 2010
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Konferensbidrag (refereegranskat)abstract
- OBJECTIVES To evaluate decisive factors related to indications for tonsillar surgery among ENT surgeons. METHODS Webbased questionnaire presenting a number of representative cases to Swedish ENT surgeons with threealternatives: Recommend surgery, recommend further examinations or recommend no surgery. By changingone factor in the case description a value regarding the importance of each single factor could be estimated. RESULTS 328 of 728 known ENT surgeons answered the questionnaire. An analysis of the answering population compared to the total population of Swedish ENT surgeons showed them to be representative. The proportion of Swedish ENT surgeons recommending surgery was 48 % higher for cases with recurrent StrepA tonsillitis compared to non Strep A tonsillitis and 53 % higher when tonsillar frequency was at least 4 episodes/year compared to 2 episodes/year. CONCLUSIONS Case presentations to practicing ENT surgeons can be used to achieve information on the national perception of best practice. This information was used in the development of a national consensus documenton indications for tonsillar surgery. An iterated use of the questionnaire can furthermore give valuable information on the changes in practice over time, e.g. to evaluate the impact of new recommendations. RESULTS Fourteen RCT’’s (2712 children) were evaluated; most were too heterogeneous to pool into a meta-analysis.Loss to follow-up varied from 0% to 63% after 2 years. Adenoidectomy in combination with a unilateral tympanostomy tube (n=3 trials) has a beneficial effect on the resolution of OME: risk difference 22% (95% CI 12% to 32%) and 29% (95% CI 19% to 39%) for the non-operated ear at 6 and 12 months, respectively. The effect of adenoidectomy on hearing is very small:<5dB compared to a unilateral tympanostomy tube only. Regarding AOM (n=8 trials), adenoidectomy appears to have no significant beneficial effect. CONCLUSIONS Our review shows a significant effect of adenoidectomy as far as the resolution of middle ear effusion inchildren with OME is concerned. However, the benefit to hearing is small. The risks of operating should beweighed against these potential benefits. The absence of a significant effect on AOM suggests that routine surgery for this indication is not warranted.
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| 13. |
- Hessen-Söderman, Anne-Charlotte, et al.
(författare)
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Blödning efter tonsilloperation : Resultat ur nya nationella kvalitetsregistret
- 2009
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Det nya kvalitetsregistret för tonsilloperation startade 090301. Uppgifter angående operationsmetod och använd utrustning registreras nu samt om mer än en operationsindikation har använts. Nytt är en postop. 30-dagarsenkät som föräldrarna/vuxna patienter får besvara via nätet. Då får man besked angående det postoperativa förloppet inkl. sekundära blödningar.Resultat: Fem månader efter start har 2341 patienter registrerats varav 2020 är opererade. 1109 har besvarat 30-dagarsenkäten och ännu ingen 6- månaders-formuläret. Det vanligaste ingreppet är Tonsillektomi (TE) med 976 operationer följt av tonsillotomi (TT)+Abrasio, 495 ingrepp, därefter TE+Abrasio 413 och TT 104. Primär blödning är ungefär lika vanligt för de tre första ingreppen, 2,6%, 1,8% resp. 2,4% och enbart TT 0%.Sekundär blödning, som rapporterats av föräldrarna/patienten efter 30 dagar visar TE 9%, TE+Abrasio 2,6% , TT 2% och TT + Abrasio 0.7%. Av metoder har kallt stål använts flitigast: 1078 operationer med 2,7% primära blödningar och 6% sekundära, följt av Radiofrekvens, 684 operationer med 1,5% primära och 1,6% sekundära blödningar. Diatermisax har använts på 131 patienter med 1,5% primära och 22% sekundärblödningar, Ultracision vid 79 operationer med 0 primär och 7,7% sekundärblödning samt Laser vid 22 operationer med 1,5% primär och 9% sekundärblödning.Diskussion: De olika prevalenser av postoperative blödning som resultaten visar är inte entydiga: Enbart TE görs nästan enbart på vuxna, oftast på infektionsindikation, vilket kan förklara en högre blödningsförekomst jämfört med TE+Abrasio, som istället enbart görs på barn med obstruktionsindikation, med mindre blödning som följd. Skillnaden i blödning, mellan TE och TT är dock klar, eftersom relativt många individer är opererade i båda grupperna och man genomgående har signifikant lägre blödning för TT. När det gäller operationsmetod visar de ”heta” metoderna lägre primärblödning men fler sekundär-blödningar än kallt stål. Radiofrekvens, som arbetar vid lägre temperatur har de lägsta blödningstalen både vad gäller primär- och sekundärblödning. En bias är att enbart hälften av de opererade har skickat in 30-dagarsenkät. De minst nöjda, dvs. de som blött efteråt, är kanske mer villiga att påtala detta, vilket i så fall generellt ger för höga blödningstal. Konklusion: TT ger färre primära och sekundära blödningar än TE. ”Heta” tekniker ger ett stort antal sekundära blödningar. Högre svarsfrekvens eftersträvas.
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| 14. |
- Hessén Söderman, Anne-Charlotte
(författare)
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Morbidity in Ménières disease : aspects on quality of life and triggering factors
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Menieres disease is an inner ear disorder of unclear origin, characterized by severe attacks of simultaneously appearing fluctuant hearing loss, vertigo, tinnitus and a feeling of aural fullness. The disease has a well-known natural course. In the early stage symptoms occur episodically, followed by complete remission, but during the course of the disease the hearing impairment progresses and becomes permanent, While the vertigo becomes less prominent with time. The sudden and unexpected attacks can cause a dramatic influence on the patient's quality of life, particularly as it is combined with increasing hearing loss and tinnitus. It is a well known clinical issue that stress might trigger the attacks, but so far the only correlation found has been a same day association between stress and attacks. AIMS OF THE PRESENT INVESTIGATION: 1. To assess which of three different surgical treatments of vertigo (Endolymphatic Sac Surgery, ELS, intratympanical gentamicin injections or vestibular neurectomy) was most beneficial to patients with Menieres disease; 2. To evaluate health-related quality of life issues from a general and disease specific perspective; 3. To find if stress can trigger attacks of Menieres disease; and 4. To propose a policy for treatment of patients with Menieres disease. MATERIAL AND METHODS: 1. 40 surgically treated patients with Menieres disease were followed up with extended clinical tests, including vestibular and audiological tests, computerized postural tests, functional balance tests and a questionnaire; 2. 112 Meniere patients, both surgically treated and untreated, answered a battery of disease specific and generic quality of life questionnaires. The sense of coherence, which measures coping ability, was also evaluated; and 3. In a case-crossover study, 46 Meniere patients answered questionnaires concerning the frequency of stress both in the period before an attack of Menieres disease and in a period without attacks. RESULTS AND CONCLUSIONS: 1. The outcomes with regard to vertigo were similar regardless of treatment modality. About 80 % of the patients in each group reported a total or substantial improvement of vestibular symptoms, but the gentamicin treated patients had more adverse effects on hearing and vestibular neurectomy resulted in some surgical complications; 2. The patients rate their quality of life as being significantly poorer than reference groups of healthy subjects, in both the physical and the psychosocial dimensions. Vertigo impairs the physical dimension of quality of life, while tinnitus and hearing loss have influence on the psychosocial dimension. Strong sense of coherence seems to be an important predictor of the patient's evaluation of disease-specific as well as general quality of life, but the impact of the sense of coherence is stronger on psychosocial than physical aspects; 3. Being subjected to emotional stress increases the risk for an attack of Menieres disease to occur one to three hours later. Mental stress has less impact on the risk for having a Meniere-attack and physical stress has not been found to trigger attacks of Menieres disease; and 4. When medical treatment has failed, ELS may be a useful first choice of treatment modality in patients with serviceable hearing. Recent treatment regime with low dose gentamicin can be used if ELS has failed or if for some reason surgery in general anesthesia not is advisable. Vestibular neurectomy should be saved for special cases and performed in a limited number of patients. Considering the role of stress as a trigger of attacks it might be fruitful to test whether different kinds of stress management techniques could be taught to patients with the effect of reducing the number of attacks.
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| 15. |
- 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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| 16. |
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| 18. |
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| 19. |
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| 20. |
- Hultcrantz, Elisabeth, 1942-, et al.
(författare)
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Paradigm shift in Sweden from tonsillectomy to tonsillotomy for children with upper airway obstructive symptoms due to tonsillar hypertrophy
- 2013
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Ingår i: European Archives of Oto-Rhino-Laryngology. - New York, USA : Springer. - 0937-4477 .- 1434-4726. ; 270:9, s. 2531-2536
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Tidskriftsartikel (refereegranskat)abstract
- Tonsillotomy (TT) is now used more often than tonsillectomy (TE) for tonsil obstructive symptoms in Sweden. Both TE and TT give high patient satisfaction although TT results in fewer postoperative bleedings and shorter time when analgesics are needed. The objective of this study is to analyze the current prevalence of different tonsil surgery procedures, the rates of early and late bleeding and other complications. Data from the National Tonsil Surgery Register in Sweden were analyzed. Patients 1–15 years operated for symptoms due to tonsil hypertrophy were included. Surgical procedure, technique and bleedings during hospital stay were registered. Thirty days after surgery, unplanned contacts due to bleeding, infection or pain were reported as were symptom relief after 6 months. 24,083 patients were registered. Of the 10,826 children 1–15 years operated for obstructive symptoms, 64 % were TT or TT+A, and 34 % TE, TE+A. 69 % answered the 30-day questionnaire and 50 % the 6 months. Bleeding in hospital occurred in 1.38 %, late bleedings in 2.06 %: 3.7 % after TE+A, 0.8 % after TT+A. Differences in readmissions due to bleeding, number of days using analgesics, health care contacts due to pain and nosocomial infections were significant between TT and TE, but not differences with regard to symptom relief after 6 months.
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| 21. |
- Knutsson, Johan, et al.
(författare)
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A randomized study of four different types of tympanostomy ventilation tubes : Full-term follow-up
- 2018
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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 107, s. 140-144
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the impact of tympanostomy ventilation tube material (silicone vs fluoroplastic) and shape (short vs long) regarding time to extrusion, occurrence of otorrhea, occlusion, tube removal and occurrence of persistent perforation.METHODS AND MATERIAL: Four different types of ventilation tubes were used; Long Armstrong tubes, Donaldson tubes, Shepard tubes and straight tubes, representing four specific combinations of VT material (silicone or fluoroplastic) and shape (short, double flanged or long, single flanged). Four hundred children scheduled for bilateral tube insertion were included in a randomized trial. The patients received one type of tube in the right ear and another type in the left ear. The incidence of tube extrusion and complications were monitored postoperatively every third month by an otolaryngologist.RESULTS: Twenty-two children were excluded during surgery. Out of the studied 378 children the mean age was 35.3 months. 63.8% were boys. Short tubes extruded earlier than long tubes; hazard ratio (HR) 4.84 (95% CI 3.50-6.69, p < 0.001). Long Armstrong tubes were least prone to extrude. Silicone tubes resulted in significantly longer time to first infection in a VT ear, HR 1.68 (95% CI 1.03-2.76, p = 0.039). Donaldson tubes rendered the longest mean time to first infection (p = 0.025). Infections did not affect tube extrusion rates significantly (p = 0.879). No significant differences were found regarding tube occlusion, tube extraction or persistent perforation.CONCLUSIONS: Long tubes are less prone to extrude early. Long Armstrong tubes have the least propensity to extrude early. Silicone tubes render significantly longer time to first infection. Donaldson tubes result in least infections. Infection does not affect extrusion rates significantly.LEVEL OF EVIDENCE: 1b.
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| 22. |
- Möller, Jette, et al.
(författare)
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Differential misclassification of exposure in case-crossover studies.
- 2004
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Ingår i: Epidemiology. - : Ovid Technologies (Wolters Kluwer Health). - 1044-3983 .- 1531-5487. ; 15:5, s. 589-96
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to examine 2 types of differential misclassification of exposure in case-crossover studies. The first is the outcome-dependent misclassification of exposure, meaning that if an event has occurred, it could affect the reporting of exposure. The second is differential misclassification of exposure as a result of fading memory over time, which arises if the length of the recall period for case and control windows differs. We use empirical data from a case-crossover study of triggers of attacks in Ménière's disease. The study applied the matched-pair interval control window sampling approach. We examined misclassification in relation to 2 different types of exposures: emotional stress and salty food intake. The study covered repeated events reported by the same patients and involved the sampling of many control windows. Because some of these windows were related to case events and some unrelated, we were able to conduct both case-crossover and control-crossover analyses. Although this group of Ménière patients are well aware of their disease, and many of them have definite ideas regarding what triggers attacks, neither outcome-dependent misclassification nor differential misclassification of exposure resulting from fading memory over time seemed to be a major problem.
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| 23. |
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| 24. |
- Odhagen, Erik, et al.
(författare)
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Readmission Rates Due to Post-Tonsillectomy Haemorrhage in Sweden: SIGNIFICANT DIFFERENCES BETWEEN SURGICAL CENTRES : Significant Differences Between Surgical Centres
- 2016
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Konferensbidrag (refereegranskat)abstract
- Objectives: Post-surgical haemorrhage is the major complication of tonsil surgery. Post-tonsillectomy haemorrhage often results in readmission to hospital, sometimes demands return to theatre and can be a life-threatening occurrence. There are large differences in previously reported rates of post-tonsillectomy haemorrhage. The aim of this study is to determine readmission rates due to post-tonsillectomy haemorrhage in Sweden 2012-2014.Method: This is a population-based cohort study based on matched data from two healthcare registries in Sweden; the Swedish National Patient Register (NPR) and the National Tonsil Surgery Register in Sweden (NTSRS). All patients who underwent tonsillectomy, with or without simultaneous adenoidectomy, on benign indications from 2012 to 2014 were included in the study. The unique Personal Identity numbers were used to follow patients over time in NPR and identify readmission due to haemorrhage within 30 days from surgery. In NTSRS, readmission was reported by the patient in a questionnaire 30 days after surgery.Results: By matching the two registries a total of 22 800 unique patients were identified and included in the study. A total of 1726 patients (7.6%) were readmitted to hospital due to post-surgical haemorrhage. Tonsil surgery was conducted at 56 different surgical centres. Readmission rates due to post-tonsillectomy haemorrhage ranged from 0% to 22.4% at different surgical centres. 11 of 56 surgical centres had significant lower readmission rates compared to the average in Sweden. 12 of 56 surgical centres had significant higher readmission rates than the average.Conclusions: The rate of hospital readmissions due to post-surgical haemorrhage following tonsillectomy in Sweden 2012-2014 was 7.6%. There were significant differences in readmission rates between different surgical centres. This suggests that quality improvement interventions should be explored in units with high readmission rates to decrease post-tonsillectomy morbidity.
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| 25. |
- Odhagen, Erik, 1977, et al.
(författare)
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Reducing post-tonsillectomy haemorrhage rates through a quality improvement project using a Swedish National quality register : a case study
- 2018
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Ingår i: European Archives of Oto-Rhino-Laryngology. - : Springer. - 0937-4477 .- 1434-4726. ; 275:6, s. 1631-1639
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Tidskriftsartikel (refereegranskat)abstract
- PurposeTonsillectomy (TE) is one of the most frequently performed ENT surgical procedures. Post-tonsillectomy haemorrhage (PTH) is a potentially life-threatening complication of TE. The National Tonsil Surgery Register in Sweden (NTSRS) has revealed wide variations in PTH rates among Swedish ENT centres. In 2013, the steering committee of the NTSRS, therefore, initiated a quality improvement project (QIP) to decrease the PTH incidence. The aim of the present study was to describe and evaluate the multicentre QIP initiated to decrease PTH rates.MethodsSix ENT centres, all with PTH rates above the Swedish average, participated in the 7-month quality improvement project. Each centre developed improvement plans describing the intended changes in clinical practice. The project’s primary outcome variable was the PTH rate. Process indicators, such as surgical technique, were also documented. Data from the QIP centres were compared with a control group of 15 surgical centres in Sweden with similarly high PTH rates. Data from both groups for the 12 months prior to the start of the QIP were compared with data for the 12 months after the QIP.ResultsThe QIP centres reduced the PTH rate from 12.7 to 7.1% from pre-QIP to follow-up; in the control group, the PTH rate remained unchanged. The QIP centres also exhibited positive changes in related key process indicators, i.e., increasing the use of cold techniques for dissection and haemostasis.ConclusionsThe rates of PTH can be reduced with a QIP. A national quality register can be used not only to identify areas for improvement but also to evaluate the impact of subsequent improvement efforts and thereby guide professional development and enhance patient outcomes.
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| 26. |
- Odhagen, Erik, 1977, et al.
(författare)
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Risk of reoperation after tonsillotomy versus tonsillectomy : a population-based cohort study
- 2016
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Ingår i: European Archives of Oto-Rhino-Laryngology. - : Springer. - 0937-4477 .- 1434-4726. ; 273, s. 3263-3268
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Tidskriftsartikel (refereegranskat)abstract
- Tonsil surgery to address upper airway obstruction in children can be performed either as a tonsillectomy (TE) or as a tonsillotomy/intracapsular/partial tonsillectomy (TT). The advantage of TT is a decreased risk of postoperative morbidity. The disadvantage is the risk of tonsil regrowth with recurrence of symptoms and/or problems with future tonsil infections, which may demand a reoperation of the tonsils. The aim of this study is to compare the risk of reoperation of the tonsils following TE and TT in children with tonsil-related upper airway obstruction. This is a retrospective register-based cohort study of the Swedish National Patient Register. All children aged 1–12 years who underwent TE or TT from 2007 to 2012 for the main indication of upper airway obstruction were included in the study. The unique Personal Identity numbers were used to follow patients over time in the register and identify additional tonsil surgery. A total of 27,535 patients were included in the study, contributing 76,054 person-years of follow-up. A total of 684 patients (2.5 %) underwent a second tonsil surgery during follow-up. The incidences of reoperation were 1.94 per 1000 person-years in the TE group and 16.34 per 1000 person-years in the TT group. The risk for reoperation was seven times higher (HR 7.16) after TT compared to TE. Younger age was significantly associated with reoperation for both TE and TT and the difference in risk between TE and TT gradually decreased with time. The most common indication for reoperation after both TE and TT was ‘‘Upper airway obstruction’’.
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| 27. |
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| 28. |
- Stahlfors, Joacim, et al.
(författare)
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Symptom relief after tonsil surgery, comparison between tonsillectomy andtonsillotomy Results from the National Tonsil Surgery Register in SwedenAuthors
- 2010
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Konferensbidrag (refereegranskat)abstract
- OBJECTIVES To compare tonsillotomy (TT) and tonsillectomy (TE) with regard to relief of symptoms six months postoperatively. METHODS Register study and analysis of data from the National Tonsil Surgery Register in Sweden covering the period 1997-2008. A total of 54 696 tonsil surgery procedures were registered whereof 23 339 (42.7%) were performed on children (1-15 years) due to obstructive symptoms and tonsil hypertrophy. Data were collected from patients six months postoperatively from questionnaires. RESULTS 17 903 children were operated with TE and 5 436 with TT. The ratio TT/TE was increasing after 2004. More than 96 % reported total or partial symptom relief six months CONCLUSIONS Both TT and TE are highly effective in relieving obstructive symptoms in children.short
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| 37. |
- Stalfors, Joacim, et al.
(författare)
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Registerdata från tonsillregistret
- 2015
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Ingår i: Svensk ÖNH-tidskrift. - Örebro : Svensk förening för Otorhinolaryngologi, Huvud- och Halskirurgi. - 1400-0121. ; 22:3, s. 34-93
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Tidskriftsartikel (populärvet., debatt m.m.)
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| 38. |
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| 40. |
- Stalfors, Joacim, 1966, et al.
(författare)
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Tonsil surgery efficiently relieves symptoms, Analysis of 54 696 paqtients in The National Tonsil Surgery Register in Sweden
- 2012
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Ingår i: Acta Oto-Laryngologica. - London, United Kingdom : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 132:5, s. 533-539
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Tidskriftsartikel (refereegranskat)abstract
- CONCLUSION:Patients operated with tonsillar surgery report a high degree of symptom relief 6 months after surgery.OBJECTIVE:The purpose of this study was to analyze symptom relief 6 months after tonsil surgery in relation to age, indication, surgical procedure, primary bleeding and unplanned postoperative visits. The National Tonsil Surgery Register in Sweden offers data from 54,696 patients registered during 1997-2008.METHODS:This was a prospective assessment by questionnaire. Data were collected using three questionnaires, two completed by professionals and one 6 months postoperatively by the parents/patients.RESULTS:Among 54,696 patients, the most common surgical indications were obstruction (49.7%), followed by recurrent tonsillitis (35.2%). Symptom relief 6 months after surgery was high in all indication groups (>92%), and highest for patients operated on the indication peritonsillitis (>98%). The indications obstruction, recurrent tonsillitis or chronic tonsillitis reported a high degree (>96%) of symptom relief. Of the patients who underwent tonsillectomy with adenoidectomy, 97.5% were symptom-free compared to 96% of patients who had tonsillectomy alone and 96.1% who underwent tonsillotomy (p < 0.0001). In all, 13.9% of patients required an unplanned visit to the clinic postoperatively. Only 148 of 54,696 patients reported worsening of symptoms after surgery.
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| 43. |
- Sunnergren, Ola, et al.
(författare)
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Nytta med tonsilloperation
- 2015
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Ingår i: Svensk ÖNH-tidskrift. - Örebro : Svensk förening för Otorhinolaryngologi, Huvud- och Halskirurgi. - 1400-0121. ; 22:S1, s. 30-32
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 44. |
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| 45. |
- Sunnergren, Ola, 1971-, et al.
(författare)
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Radiofrequency tonsillotomy in Sweden 2009-2012
- 2014
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Ingår i: European Archives of Oto-Rhino-Laryngology. - New York, USA : Springer Berlin/Heidelberg. - 0937-4477 .- 1434-4726. ; 271:6, s. 1823-1827
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Tidskriftsartikel (refereegranskat)abstract
- The Swedish National Registry for TonsilSurgery has been operational since 1997. All ENT clinicsin Sweden are encouraged to submit data for all patientsscheduled for tonsil surgery. Preoperatively, age, genderand indication are recorded. Postoperatively, method(tonsillectomy or tonsillotomy), technique, and perioperativecomplications are recorded. Postoperative bleedings,pain, infections, and symptom relief are assessed throughquestionnaires. An earlier report from this registry showedthat tonsillotomy had become more common than tonsillectomyin children with tonsil-related upper airwayobstruction. The aim of this study was to categorize whichinstruments were used for tonsillotomy in Sweden and tocompare their outcome and complication rate. All children2–18 years, reported to the registry from March 2009 untilSeptember 2012, who underwent tonsillotomy on theindication upper airway obstruction, were included in thestudy. 1,676 patients were identified. In 1,602 cases(96 %), a radiofrequency instrument was used. The postoperativebleeding rate was low (1.2 %) and the degree ofsymptom relief was high (95.1 %). Three different radiofrequencyinstruments (ArthroCare Coblation, EllmanSurgitron, and Sutter CURIS) were used in 96 % of thepatients. There were no significant differences in thenumber of postoperative bleedings, postoperative infectionsor symptom relief between the instruments. The onlydifference found was in the number of days on analgesics,where more days were registered after use of Coblation.In Sweden, radiofrequency tonsillotomy is the dominantsurgical technique used for tonsil hypertrophy causingupper airway obstruction in children. There are no significantdifferences in outcome between the different radiofrequencyinstruments except for number of days onanalgesics after surgery.
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| 46. |
- Söderman, Anne-Charlotte Hessén, et al.
(författare)
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A randomized study of four different types of tympanostomy ventilation tubes - One-year follow-up
- 2016
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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 89, s. 159-163
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare four different types of tympanostomy ventilation tubes (VT); long-shaft and short-shaft silicone tubes and long-shaft and short-shaft fluoroplastic tubes, regarding time to extrusion and events of otorrhea. Methods: A prospective randomized controlled trial in children with bilateral recurrent acute otitis media or secretory otitis media; four hundred children were randomized to receive one type of VT in the right ear and another type in the left ear. Postoperatively the children were assessed every third month by an otolaryngologist to monitor the incidence of otorrhea and tube extrusion. Results: Out of the 400 children, 22 were excluded during surgery. Mean age was 35.3 months. A majority (63.8%) were boys. Forty-eight children were lost to follow up during the first year. Significantly more short-shaft VTs were extruded after 12 months compared to long-shaft VTs, regardless of material. Significantly higher incidence of otorrhea was found in the fluoroplastic VT ears compared to the silicone ones, regardless of length of tube. Conclusion: Long-shaft VTs last longer in the eardrum during the first year of treatment. Silicone tubes render a reduced risk of otorrhea during the first year of treatment.
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| 47. |
- Söderman, Anne-Charlotte Hessén, et al.
(författare)
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Stress as a trigger of attacks in Menière's disease. A case-crossover study.
- 2004
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Ingår i: The Laryngoscope. - : Wiley. - 0023-852X .- 1531-4995. ; 114:10, s. 1843-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Menière's disease is defined as the presence of recurrent, spontaneous episodic vertigo, hearing loss (HL), aural fullness, and tinnitus. The occurrence of attacks is unpredictable. The etiology is still unknown, but the disease has a pathologic correlate in hydropic distension of the endolymphatic system. Earlier studies have shown increased incidence of stress on the same day as vertigo attacks, but it has not been determined whether stress occurring on the day of the vertiginous episode came before or after the onset of the vertigo. METHODS: A case-crossover study including 46 patients with active Menière's disease. MAIN OUTCOME MEASURE: Relative risks with 95% confidence intervals (CI). FINDINGS: During the study period, 153 Menière's attacks were reported. Twenty-four (52%) of the 46 patients reported attacks. Twelve of the 153 (8%) attacks occurred within 3 hours after exposure to emotional stress. The relative risk of having an attack was 5.10 (95% CI 2.37-10.98) during 3 hours after being exposed to emotional stress. Twenty-nine percent of the patients with attacks had at least one attack after exposure to emotional stress. For mental stress, the relative risk was 4.16 (95% CI 1.46-11.83) and the hazard period 1 hour, but only five attacks were exposed. No excess risk was found after physical stress. INTERPRETATION: Being exposed to emotional stress increases the risk of getting an attack of Menière's disease during the next hour, and the hazard period is possibly extended up to 3 hours.
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