| 1. |
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| 2. |
- Alm, Fredrik, 1983-, et al.
(författare)
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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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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier. - 0165-5876 .- 1872-8464. ; 101, s. 123-131
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Tidskriftsartikel (refereegranskat)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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| 3. |
- Anmyr, Lena, et al.
(författare)
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Sense of coherence, social networks, and mental health among children with a cochlear implant
- 2015
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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 79:4, s. 610-615
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Tidskriftsartikel (refereegranskat)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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| 4. |
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| 5. |
- Engström, Elisabet, et al.
(författare)
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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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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier. - 0165-5876 .- 1872-8464. ; 117, s. 17-25
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Tidskriftsartikel (refereegranskat)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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| 6. |
- Enoksson, Frida, et al.
(författare)
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Subperiosteal abscesses in acute mastoiditis in 115 Swedish children.
- 2015
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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 1872-8464 .- 0165-5876. ; 79:7, s. 1115-1120
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Tidskriftsartikel (refereegranskat)abstract
- To study the outcome of different surgical methods of treating subperiosteal abscesses resulting from acute mastoiditis.
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| 7. |
- Ericsson, Elisabeth, 1959-, et al.
(författare)
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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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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 79:4, s. 443-450
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Forskningsöversikt (refereegranskat)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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| 8. |
- Eriksson, Mats, 1957-, et al.
(författare)
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Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy
- 2017
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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier. - 0165-5876 .- 1872-8464. ; 96, s. 47-54
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Tidskriftsartikel (refereegranskat)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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| 9. |
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| 10. |
- Gerhardsson, Hanna, et al.
(författare)
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Pediatric adenoid surgery in Sweden 2004-2013: Incidence, indications and concomitant surgical procedures
- 2016
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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 87, s. 61-66
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To describe the incidence and indications of adenoid surgery and concomitantly performed ENT surgical procedures in a nationwide cohort covering several years of practice. Methods: A retrospective study based on data from the National patient registry in Sweden. All children born from 1st of January 2004 to December 31st, 2013 who underwent adenoidectomy for the first time in Sweden during 2004-2013 were included in the study. Patient characteristics (age and gender), indications for surgery and performed ENT surgery were evaluated. Results: 40,829 children underwent adenoid surgery during the studied period. Of these, 24,537 (60%) were boys. Mean and median age at surgery in the studied population was 4 years and 3.5 years respectively for both boys and girls. The most frequently performed surgical procedure was adenotonsillar surgery 43% (n = 17,434) followed by solitary adenoid surgery 26% (n = 10,749). The most frequent registered indication was hypertrophy 60% (n = 24,422) followed by hypertrophy and otitis media 21% (n = 8425). The highest age related incidence for all types of adenoid surgery taken together was 2-4 years of age for both genders. Boys had higher incidence rates than girls for all ages and all types of surgery except at eight years of age. Conclusions: The main findings were that adenoidectomy most commonly was performed together with surgery of the tonsils on the indication hypertrophy, that adenoid- and adenoid related ENT surgery were most commonly performed between 2 and 5 years of age and that the incidence in surgical rates was higher for boys than girls. There seem to be large unwarranted variations between countries regarding incidence rates and we believe that there is a need for further studies in order to establish recommendations for best practice regarding adenoid and related ENT surgeries. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
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| 11. |
- Gisselsson-Solen, Marie, et al.
(författare)
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Individual-level effects of antibiotics on colonizing otitis pathogens in the nasopharynx
- 2016
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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 88, s. 17-21
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although there is evidence of an association between antibiotic consumption and resistant bacteria on a population level, the relationship on an individual level has been less well studied, particularly in terms of nasopharyngeal colonization. We have therefore analysed this association, using data from a closely followed cohort of children taking part in a vaccination trial. Methods: 109 children with early onset of acute otitis media (AOM) were randomised to heptavalent pneumococcal conjugate vaccine (PCV7) or no vaccination. They were followed for three years with scheduled appointments as well as sick visits. Nasopharyngeal cultures were obtained at all visits. Antibiotic treatments were recorded, as were risk factors for AOM, including siblings, short breast-feeding and parental smoking. Data were entered into a Cox regression model, and the findings of Streptococcus pneumoniae and Haemophilus influenzae with reduced susceptibility to the penicillin group were related to the number of previous courses of antibiotics. Results: There was evidence of an association between the amount of previously consumed betalactams and colonization with beta-lactamasenegative ampicillin-resistant (BLNAR) H. influenzae (RR 1.21; 95% CI 1.03-1.43; p = 0.03), and also with the most commonly prescribed drug; amoxicillin (RR 1.39; 95% CI 1.09-1.76; p = 0.01). There was no evidence for an association between antibiotic consumption and betalactamase producing H. influenzae or S. pneumoniae with reduced susceptibility to penicillin. Furthermore, there was no evidence of an association between resistant bacteria and AOM risk factors or PCV7. Conclusion: In this subgroup of children, most of whom were given several courses of antibiotics in early childhood, there was evidence of an association between betalactam/amoxicillin consumption and nasopharyngeal colonization with BLNAR strains, bacteria that have increased in prevalence during the last 10-15 years, and that are notoriously difficult to treat with oral antibiotics.
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| 12. |
- Gronseth, Torstein, et al.
(författare)
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Lugol's solution eradicates Staphylococcus aureus biofilm in vitro
- 2017
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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier. - 0165-5876 .- 1872-8464. ; 103, s. 58-64
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of the study was to evaluate the antibacterial efficacy of Lugol's solution, acetic acid, and boric acid against Staphylococcus aureus biofilm. Methods: The efficacy of Lugol's solution 1%, 0.1%, and 0.05%, acetic acid 5% or boric acid 4.7% for treatment of Staphylococcus aureus biofilm in vitro was tested using 30 clinical strains. Susceptibility in the planktonic state was assessed by disk diffusion test. Antiseptic effect on bacteria in biofilm was evaluated by using a,Biofilm-oriented antiseptic test (BOAT) based on metabolic activity, a biofilm bactericidal test based on culturing of surviving bacteria and confocal laser scanning microscopy combined with LIVE/DEAD staining. Results: In the planktonic state, all tested S. aureus strains were susceptible to Lugol's solution and acetic acid, while 27 out of 30 tested strains were susceptible to boric acid. In biofilm the metabolic activity was significantly reduced following exposure to Lugol's solution and 5% acetic acid, while boric acid exposure led to no significant changes in metabolic activities. In biofilm, biocidal activity was observed for Lugol's solution 1% (30/30), 0.1% (30/30), and 0.05% (26/30). Acetic acid and boric acid showed no bactericidal activity in this test. Confocal laser scanning microscopy, assessed in 4/30 strains, revealed significantly fewer viable biofilm bacteria with Lugol's solution (1% p < 0.001, 0.1% p = 0.001 or 0.05% p = 0.001), acetic acid 5% for 10 min (p = 0.001) or 30 min (p = 0.015), but not for acetic acid for 1 min or boric acid. Conclusion: Lugol's solution 1.0% and 0.1% effectively eradicated S. aureus in biofilm and could be an alternative to conventional topical antibiotics where S. aureus biofilm is suspected such as external otitis, pharyngitis and wounds. (C) 2017 Elsevier B.V. All rights reserved.
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| 13. |
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| 14. |
- Huttunen, Kerttu, et al.
(författare)
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The impact of permanent early-onset unilateral hearing impairment in children : A systematic review
- 2019
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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier. - 0165-5876 .- 1872-8464. ; 120, s. 173-183
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Forskningsöversikt (refereegranskat)abstract
- Background: Decision-making on treatment and (re)habilitation needs to be based on clinical expertise and scientific evidence. Research evidence for the impact of permanent unilateral hearing impairment (UHI) on children's development has been mixed and, in some of the reports, based on fairly small, heterogeneous samples. Additionally, treatment provided has been highly variable, ranging from no action taken or watchful waiting up to single-sided cochlear implantation. Published information about the effects of treatment has also been heterogeneous. Moreover, earlier reviews and meta-analyses published on the impact of UHI on children's development have generally focused on select areas of development.Objectives: This systematic review aimed to summarize the impact of children's congenital or early onset unilateral hearing impairment on listening and auditory skills, communication, speech and language development, cognitive development, educational achievements, psycho-social development, and quality of life.Methods: Literature searches were performed to identify reports published from inception to February 16th, 2018 with the main electronic bibliographic databases in medicine, psychology, education, and speech and hearing sciences as the data sources. PubMed, CINALH, ERIC, LLBA, PsychINFO, and ISI Web of Science were searched for unilateral hearing impairment with its synonyms and consequences of congenital or early onset unilateral hearing impairment. Eligible were articles written in English, German, or Swedish on permanent unilateral hearing impairments that are congenital or with onset before three years of age. Hearing impairment had to be of at least a moderate degree with PTA >= 40 dB averaged over frequencies 0.5 to 2 or 0.5-4 kHz, hearing in the contralateral ear had to have PTA(0.5-2 kHz) or PTA(0.5-4 kHz) <= 20 dB, and consequences of unilateral hearing impairment needed to be reported in an unanimously defined population in at least one of the areas the review focused on.Four researchers independently screened 1618 abstracts and 566 full-text articles for evaluation of study eligibility. Eligible full-text articles were then reviewed to summarize the results and assess the quality of evidence. Additionally, data from 13 eligible case and multi-case studies, each having less than 10 participants, were extracted to summarize their results.Quality assessment of evidence was made adapting the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) process, and reporting of the results adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards.Results: Three articles with the quality of evidence graded as very-low to low, fulfilled the eligibility criteria set. Due to the heterogeneity of the articles, only a descriptive summary could be generated from the results. Unilateral hearing impairment was reported to have a negative impact on preverbal vocalization of infants and on sound localization and speech perception both in quiet and in noise.Conclusions: No high-quality studies of consequences of early-onset UHI in children were found. Inconsistency in assessing and reporting outcomes, the relatively small number of participants, low directness of evidence, and the potential risk of confounding factors in the reviewed studies prevented any definite conclusions. Further well-designed prospective research using larger samples is warranted on this topic.
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| 15. |
- Håkansson, Axel, et al.
(författare)
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Transmyringeal ventilation tube treatment in children: Hearing outcome after 10 years.
- 2015
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Ingår i: International journal of pediatric otorhinolaryngology. - : Elsevier BV. - 1872-8464 .- 0165-5876. ; 79:2, s. 186-90
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Tidskriftsartikel (refereegranskat)abstract
- This ten-year cohort study intended to determine any hearing impairment and eardrum sequelae comparing children treated with ventilation tubes (VT) with an age- and gender-matched control group.
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| 16. |
- 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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| 17. |
- Lundberg, Thorbjörn, et al.
(författare)
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Diagnostic accuracy of a general practitioner with video-otoscopy collected by a health care facilitator compared to traditional otoscopy
- 2017
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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : ELSEVIER IRELAND LTD. - 0165-5876 .- 1872-8464. ; 99, s. 49-53
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Video-otoscopy is rapidly developing as a new method to diagnose common ear disease and can be performed by trained health care facilitators as well as by clinicians. This study aimed to compare remote asynchronous assessments of video-otoscopy with otoscopy performed by a general practitioner. Method: Children, aged 2-16 years, attending a health center in Johannesburg, South Africa, were examined. An otologist performed otomicroscopy and a general practitioner performed otoscopy. Video-otoscopy was performed by a health care facilitator and video sequences were stored on a server for assessment by the same general practitioner 4 and 8 weeks later. At all examinations, a diagnosis was set and the tympanic membrane appearance was graded using the OMgrade-scale. The otologist's otomicroscopic diagnosis was set as reference standard to compare the accuracy of the two otoscopic methods. Results: Diagnostic agreement between otologist's otomicroscopic examination and the general practitioner's otoscopic examination was substantial (kappa 0.66). Agreement between onsite otomicroscopy and the general practitioners asynchronous video assessments were also substantial (kappa 0.70 and 0.80). Conclusion: Video-otoscopy performed by a health care facilitator and assessed asynchronously by a general practitioner had similar or better accuracy compared to face-to-face otoscopy performed by a general practitioner.
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| 18. |
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| 19. |
- Stenfeldt, Karin
(författare)
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Preschool hearing screening in Sweden. An evaluation of current practices and a presentation of new national guidelines
- 2018
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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876. ; 110, s. 70-75
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: As the various regional authorities responsible for health care in Sweden operate independently, no knowledge was available on pre-school hearing screening available to children living in different parts of the country. The aim of this study was to carry out a survey to ascertain how preschool hearing screening was performed in the various regions of Sweden. An objective of the present paper was also to present the uniform national guidelines for pre-school hearing screening that were launched by health authorities and were based on this study. A follow-up investigation was performed to ascertain whether the new guidelines were well accepted and followed throughout the country. Methods: A questionnaire was sent to 25 physicians responsible for child health care centers in all 21 regions throughout the whole country. The questionnaire included detailed questions on hearing screening in preschool children. New national guidelines were introduced in cooperation with health authorities and providers of preventive child health care. After two and four years, questionnaires were sent to the same recipients to determine whether changes in practice in pre-school hearing screening had been implemented, and to obtain information about experiences with the new guidelines. Results: Sixteen of 21 regions practiced universal hearing screening of 4-yearolds. Many different protocols were used. Professionals at child health care centers expressed a need for national guidelines for pre-school hearing screening. At the two and four-year follow-ups, one more region had introduced universal hearing screening of 4-year-olds, while two regions were planning to introduce it in 2019. The new national guidelines were well accepted and used throughout the country. Conclusion: There was a great variability in how pre-school hearing screening was performed in Sweden. Efforts are being made to provide uniform pre-school hearing screening. Cooperation between professionals in hearing health and health authorities is needed in order to broaden the use of universal pre-school hearing screening and to implement the new national guidelines.
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| 20. |
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| 21. |
- 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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| 22. |
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| 23. |
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| 24. |
- Wang, Allen Y., et al.
(författare)
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Rat model of chronic tympanic membrane perforation : A longitudinal histological evaluation of underlying mechanisms
- 2017
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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 93, s. 88-96
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate histologically the progressive development and underlying mechanisms of chronic tympanic membrane perforation (TMP) in a rat model using a two-weeks ventilation tube (VT) treatment combined with topical application of mitomycin Cidexamethasone (VT-MID), compared with normal tympanic membrane and acute TMPs. Methods: Fifty male Sprague-Dawley rats were divided into three experimental groups: a normal control group (n = 5), an acute TMP group (n = 5) (i.e. 3 days post-myringotomy) and a VT-M/D group (n = 40). The TMs were regularly assessed by otoscopy. The normal control animals were sacrificed on day 0 and the acute TMP group was sacrificed 3 days post-myringotomy for histological and immunohistochemical evaluations. The VT-M/D group was sacrificed at various time points - 14 and 17 days, 3, 4, 6, 8 and 10 weeks. Results: On longitudinal histological examination, compared with normal TM and acute TMP, the perforation edges at the later time points illustrated thickened stratified squamous epithelium rimming around the edges, significant increase in keratin and collagen deposition, increased macrophage infiltration as well as reduced cellular proliferation. Three phases of TMP healing process were identified the acute healing phase (3-17 days), the transition phase (3-4 weeks) and the chronic phase (6-10 weeks). Conclusion: Based on the histological results of this study, the progressive development of chronic TMPs appeared to be associated with increased epidermal thickening, collagen and keratin deposition, macrophage infiltration and reduced cellular proliferation. After the 3-4 weeks of transition phase, the TMPs seemed to have transformed into a non-healing chronic TMP between 6 and 10 weeks. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
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| 25. |
- Wang, Allen Y., et al.
(författare)
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Rat model of chronic tympanic membrane perforation : Ventilation tube with mitomycin C and dexamethasone
- 2016
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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 80:1, s. 61-68
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Chronic tympanic membrane perforation (TMP) in a clinical setting may attract surgical intervention. With the advent of modern biomaterials, new options are available for myringoplasty but safety and efficacy need evaluation in a chronic TMP animal model. The aim of this study was to evaluate the efficacy of ventilation tube (VT) insertion in conjunction with topical application of mitomycin Cl dexamethasone (M/D) for the creation of chronic TMP in rats. Methods: Thirty male Sprague-Dawley rats underwent myringotomy of the right tympanic membrane (TM) and were divided into three experimental groups: spontaneous healing (myringotomy control), VT insertion for 2 weeks and VT insertion for 2 weeks in conjunction with topical application of M/D (VT-M/D). All TMs were regularly assessed by otoscopy for 10 weeks and then animals were sacrificed for histological evaluation. Results: In the VT-M/D group, seven out of ten (70%) perforations were patent at 10 weeks (mean patency, 57.9 days; P < 0.01). The VT group had two out of ten (20%) perforations patent at 10 weeks (mean patency, 26.5 days; P < 0.01), while all TMPs from the myringotomy control group were closed by day 9 (mean patency, 7.2 days). Histologically, the TMPs patent at week 10 had a stratified squamous epithelialized rim, keratinocyte layer thickening around the perforation edge as well as increased collagen deposition and macrophage infiltration. Conclusion: Chronic TMP in a rat model was successfully created by VT insertion and the efficacy was increased in combination with topical application of M/D.
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| 26. |
- Wang, Allen Y., et al.
(författare)
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Searching for a rat model of chronic tympanic membrane perforation : Healing delayed by mitomycin C/dexamethasone but not paper implantation or iterative myringotomy
- 2015
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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 79:8, s. 1240-1247
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Surgical intervention such as myringoplasty or tympanoplasty is an option in the current clinical management of chronic tympanic membrane perforation (TMP). Animal models of chronic TMP are needed for pre-clinical testing of new materials and to improve existing techniques. We evaluated several reported animal model techniques from the literature for the creation of chronic TMPs. The aim of this study was to evaluate production of chronic TMPs in a rat model using topical mitomycin C/dexamethasone, paper insertion into middle ear cavity (MEC) or re-myringotomy. Methods: Forty male Sprague-Dawley rats underwent myringotomy of the right tympanic membrane (TM) and were randomly divided into 3 experimental groups: application of topical mitomycin C/dexamethasone, paper insertion into middle ear cavity, or re-myringotomy. Control perforations were allowed to close spontaneously. TMs were assessed regularly with otoscopy for 8 weeks. At the end of 8 weeks, animals were sacrificed for histology. Results: The closure of TMPs was significantly delayed by mitomycin C/dexamethasone (mean patency, 18.9 days; P <= 0.01) compared with the control (mean patency, 7 days), but was not significantly delayed in the paper insertion group (mean patency, 9.4 days; P = 0.74). Repeated myringotomy of closed perforations (mean number of myringotomies, 8.9 per ear) stimulated acceleration of closure rather than delay. Histologically, the mitomycin C/dexamethasone group had almost normal TM morphology, while the paper insertion group revealed inflammatory and granulomatous responses. The re-myringotomy group had a thickened TM fibrous layer with collagen deposition. Conclusions: Mitomycin C/dexamethasone delayed TMP closure in rats but the effect was not sufficiently long-lasting to be defined as a chronic TMP. Neither paper insertion into middle ear cavity nor re-myringotomy created chronic TMP in rats. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
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