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| 2. |
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| 3. |
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| 4. |
- Emilsson, Össur Ingi, et al.
(author)
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Definition of nocturnal gastroesophageal reflux for studies on respiratory diseases
- 2016
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In: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 51:5, s. 524-530
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Journal article (peer-reviewed)abstract
- Objective Nocturnal gastroesophageal reflux (nGER) has been associated with respiratory diseases. Our aim was to study a questionnaire method to identify nGER subjects with respiratory involvement in a general population. Material and methods A subgroup of Icelandic participants in the European Community Respiratory Health Survey III (ECRHS III) reporting symptoms of nGER (n =48) as well as age and gender paired controls (n =42) were studied further by a structured interview, questionnaires, laryngeal fibrescopy, and exhaled breath condensate. A subgroup underwent 24-h oesophageal pH impedance (24-h MII-pH) measurements. Symptoms of nGER were assessed with a modified version of the reflux disease questionnaire (RDQ), where symptoms were divided into daytime and nocturnal. A report of nGER both at baseline and at follow-up was defined as persistent nGER. Results Participants reporting persistent nGER had significantly more signs of laryngopharyngeal reflux according to the reflux finding score than those without nGER (Mean +/- SD: 5.1 +/- 2.3 vs. 3.9 +/- 2.2, p =0.02). Of the 16 persistent nGER subjects that underwent 24-h MII-pH, 11 had abnormal gastroesophageal reflux, but none of three control subjects (69% vs. 0%). Pepsin was more commonly found in exhaled breath condensate in the nGER group (67% vs. 45%, p =0.04). Conclusions Participants with nGER symptoms at least once a month, reported on two occasions, had a high level of positive 24-h MII-pH measurements, laryngeal inflammation and pepsin in exhaled breath condensate. This nGER definition identified a representable group for studies on nGER and respiratory diseases in a general population.
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| 5. |
- Ersson, Karin, et al.
(author)
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A longitudinal study of exercise-induced bronchoconstriction and laryngeal obstruction in high school athletes
- 2023
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In: Scandinavian Journal of Medicine and Science in Sports. - : John Wiley & Sons. - 0905-7188 .- 1600-0838. ; 33:8, s. 1509-1518
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Journal article (peer-reviewed)abstract
- BACKGROUND: Exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (EILO) are common in elite athletes. Knowledge of which factors are related to incident EIB and EILO is limited. The aim of this study was to explore the course of EIB and EILO in adolescent athletes over a 2 years period and baseline characteristics related to incident EIB.METHODS: Questionnaire data on respiratory symptoms, asthma, and aeroallergy and results of objective EIB and EILO tests were collected from 58 participants (27 tested for EILO) at baseline and after 2 years (follow-up). Associations between incident EIB and baseline asthma-like symptoms, exercise-induced symptoms, fractional exhaled nitric oxide (FeNO), aeroallergy, and sex were assessed using logistic regression models.RESULTS: Ten participants had incident EIB, and eight participants had persistent EIB. Five were EIB positive at baseline but negative at follow-up, while 35 participants were EIB negative at both time points. Having incident EIB was associated with reporting waking up with chest tightness (OR = 4.38; 95% CI: 1.06, 22.09). Reporting an increased number of asthma-like symptoms increased the likelihood of incident EIB (OR = 2.78; 95% CI: 1.16, 6.58). No associations were found between exercise-induced symptoms, FeNO, aeroallergy, or sex and incident EIB. Incident EILO was found in three and persistent EILO in two of the 27 participants tested.CONCLUSION: Two in nine had incident EIB and one eighth had incident EILO, suggesting that recurrent testing for EIB and EILO may be relevant in young athletes. Particularly, EIB-negative athletes reporting multiple asthma-like symptoms could benefit from recurrent EIB testing.
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| 6. |
- Ersson, Karin, et al.
(author)
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Exercise-induced airway symptoms in young athletes; a follow-up from first to third year in sports high school
- 2020
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In: European Respiratory Journal. - : European Respiratory Society. ; 56:suppl 64
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Journal article (peer-reviewed)abstract
- Adult elite athletes have a higher prevalence of exercise-induced airway symptoms than the general population and it is more common among female athletes than male. Studies on the prevalence of these symptoms in early-career athletes are scarce.We studied the prevalence of exercise-induced wheeze and dyspnoea in high school athletes, over a two year period, by inviting a cohort (n=272) to answer a questionnaire at age 16 and again at age 18.At age 16 the prevalence of wheeze was 20.5% and dyspnoea 30.1%, and at age 18 the corresponding figures were; wheeze 18.2% and dyspnoea 21.8%. In comparison with 18-year-olds from the general population (1), the high school athletes reported more wheeze (18.2% vs 12.4% p=0.02).At age 16, more female athletes reported wheeze and dyspnea compared with males (29.5 vs 12.4% p=0.001 and 43.2 vs 16.8% p<0.001). Two years later, no gender difference was found regarding wheeze, but more females reported dyspnoea, compared with males (28.3 vs 16.5% p=0.02). The prevalence of dyspnoea among females did however decrease with age (43.2 vs 28.3% p=0.005). This was mainly due to less reported dyspnoea, over the two year period, in females with current asthma (86.4 vs 54.5% p=0.008). In male athletes, the prevalence of both symptoms was similar over time.High school athletes have a higher prevalence of exercise-induced wheeze compared with the general population. A larger proportion of female athletes report exercise-induced symptoms compared with their male peers but this difference seems to decrease with age.1. Johansson H, et al. Respir Med. 2019;154:76-81.FootnotesCite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 1391.This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
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| 7. |
- Ersson, Karin, et al.
(author)
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Prevalence of exercise-induced bronchoconstriction and laryngeal obstruction in adolescent athletes
- 2020
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In: Pediatric Pulmonology. - : Wiley. - 8755-6863 .- 1099-0496. ; 55:12, s. 3509-3516
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To study the prevalence of exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (EILO) in adolescent athletes.METHODS: All adolescents (n = 549) attending first year at a sports high school in 2016 and 2017, were invited to answer a questionnaire on respiratory symptoms. The 367 responding participants were divided into two groups based on whether they reported exercise-induced dyspnea (dyspnea group) or not (non-dyspnea group). Randomly selected participants in each group were invited to undergo two standardized exercise tests, an EIB test and a continuous laryngoscopy exercise (CLE) test, to investigate EILO.RESULTS: In total, 98 participants completed an EIB test, 75 of whom also completed a CLE test. Positive EIB tests: eight of 41 in the dyspnea group and 16 of 57 in the non-dyspnea group. Positive CLE tests: five of 34 in the dyspnea group and three of 41 in the non-dyspnea group. The estimated prevalence of EIB was 23.1 % (95 % CI 14.5 - 33.8) and of EILO 8.1 % (95 % CI 2.5 - 18.5) in the whole study population. No differences in prevalence of EIB or EILO were found between the dyspnea and the non-dyspnea groups.CONCLUSION: EIB was highly prevalent in this cohort of adolescent athletes. EILO was less prevalent, but represents an important differential diagnosis to EIB. Self-reported exercise-induced dyspnea is a weak indicator for both EIB and EILO and standardized testing should be provided.
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| 8. |
- Hallberg, Pär, et al.
(author)
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Comparison of Clinical Factors Between Patients With Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema and Cough
- 2017
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In: The Annals of Pharmacotherapy. - Thousand Oaks, USA : Sage Publications. - 1060-0280 .- 1542-6270. ; 51:4, s. 293-300
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Journal article (peer-reviewed)abstract
- Background: Angioedema is a rare and serious adverse drug reaction (ADR) to angiotensin-converting enzyme (ACE) inhibitor treatment. Dry cough is a common side effect of ACE inhibitors and has been identified as a possible risk factor for angioedema.Objective: We compared characteristics between patients with ACE inhibitor-induced angioedema and cough with the aim of identifying risk factors that differ between these adverse events.Methods: Data on patients with angioedema or cough induced by ACE inhibitors were collected from the Swedish database of spontaneously reported ADRs or from collaborating clinicians. Wilcoxon rank sum test, Fisher's exact test, and odds ratios (ORs) with 95% CIs were used to test for between-group differences. The significance threshold was set to P <0.00128 to correct for multiple comparisons.Results: Clinical characteristics were compared between 168 patients with angioedema and 121 with cough only. Smoking and concomitant selective calcium channel blocker treatment were more frequent among patients with angioedema than cough: OR = 4.3, 95% CI = 2.1-8.9, P = 2.2 × 10(-5), and OR = 3.7, 95% CI = 2.0-7.0, P = 1.7 × 10(-5) Angioedema cases were seen more often in male patients (OR = 2.2, 95% CI = 1.4-3.6, P = 1.3 × 10(-4)) and had longer time to onset and higher doses than those with cough (P = 3.2 × 10(-10) and P = 2.6 × 10(-4)). A multiple model containing the variables smoking, concurrent calcium channel blocker treatment, male sex, and time to onset accounted for 26% of the variance between the groups.Conclusion: Smoking, comedication with selective calcium channel blockers, male sex, and longer treatment time were associated with ACE inhibitor-induced angioedema rather than cough.
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| 9. |
- Halvorsen, Thomas, et al.
(author)
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Inducible laryngeal obstruction : an official joint European Respiratory Society and European Laryngological Society statement
- 2017
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In: European Respiratory Journal. - : EUROPEAN RESPIRATORY SOC JOURNALS LTD. - 0903-1936 .- 1399-3003. ; 50:3
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Journal article (peer-reviewed)abstract
- Inducible laryngeal obstruction (ILO) describes an inappropriate, transient, reversible narrowing of the larynx in response to external triggers. ILO is an important cause of a variety of respiratory symptoms and can mimic asthma. Current understanding of ILO has been hampered by imprecise nomenclature and variable approaches to assessment and management. A task force of the European Respiratory Society (ERS) and European Laryngological Society (ELS) was thus set up to address this, and to identify research priorities. A literature search identified relevant articles published until June 2016, using all identifiable terms for ILO, although including only articles using laryngoscopy. In total, 172 out of 252 articles met the inclusion criteria, summarised in sections on diagnostic approach, aetiology, comorbidities, epidemiology and treatment. The consensus taxonomy published by ERS, ELS and the American College of Chest Physicians (ACCP) in 2015 is used throughout this statement. We highlight the high prevalence of ILO and the clinical impact for those affected. Despite recent advances, most aspects of this condition unfortunately remain incompletely understood, precluding firm guidance. Specifically, validated diagnostic and treatment algorithms are yet to be established, and no randomised control studies were identified in this search; hence we also make recommendations for future research.
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| 10. |
- Heimdal, John-Helge, et al.
(author)
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Surgical Intervention for Exercise-Induced Laryngeal Obstruction
- 2018
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In: Immunology and allergy clinics of North America. - : Saunders Elsevier. - 0889-8561 .- 1557-8607. ; 38:2, s. 317-324
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Journal article (peer-reviewed)abstract
- Respiratory distress during exercise can be caused by exercise-induced laryngeal obstruction (EILO). The obstruction may appear at the level of the laryngeal inlet (supraglottic), similar to supraglottic collapse observed in infants with congenital laryngomalacia (CLM). This observation has encouraged surgeons to treat supraglottic EILO with procedures proven efficient for severe CLM. This article summarizes key features of the published experience related to surgical treatment of EILO. Supraglottoplasty is an irreversible procedure with potential complications. Surgery should be restricted to cases where the supraglottic laryngeal obstruction significantly affects the quality of life in patients for whom conservative treatment modalities have failed.
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| 11. |
- Irewall, Tommie, et al.
(author)
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High Prevalence of Exercise-induced Laryngeal Obstruction in a Cohort of Elite Cross-country Skiers
- 2021
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In: Medicine & Science in Sports & Exercise. - : American College of Sports Medicine. - 0195-9131 .- 1530-0315. ; 53:6, s. 1134-1141
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Journal article (peer-reviewed)abstract
- Introduction: Exercise-induced laryngeal obstruction (EILO) is a differential diagnosis for asthma and prevalent in athletes referred for exercise-induced dyspnoea. The aim of this study was to estimate the prevalence of EILO in elite cross-country skiers, known for a high prevalence of asthma.Method: Elite cross-country skiers were invited for screening of EILO. Screening consisted of clinical assessment, questionnaires, skin prick test, spirometry, eucapnic voluntary hyperventilation test, and continuous laryngoscopy during exercise test. Current asthma was defined as physician-diagnosed asthma and use of asthma medication during the last 12 months. EILO was defined as ≥2 points at the supraglottic or glottic level during exercise at maximal effort, using a visual grade score system.Result: A total of 89 (51% female) cross-country skiers completed the study. EILO was identified in 27% of the skiers, 83% of whom were female. All skiers with EILO had supraglottic EILO, there was no glottic EILO. Current asthma was present in 34 (38%) of the skiers, 10 (29%) of whom had concomitant EILO. In the skiers with EILO, a higher proportion reported wheeze or shortness of breath following exercise, compared to skiers without EILO. In skiers with EILO and current asthma, compared to skiers with asthma only, a higher proportion reported wheeze or shortness of breath following exercise. Asthma medication usage did not differ between these groups.Conclusion: EILO is common in elite cross-country skiers, especially females. Asthma and EILO may co-exist, and the prevalence of respiratory symptoms is higher in skiers with both. Testing for EILO should be considered in cross-country skiers with respiratory symptoms.
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| 12. |
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| 13. |
- Johansson, Henrik, et al.
(author)
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Exercise-induced dyspnea is a problem among the general adolescent population
- 2014
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In: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 108:6, s. 852-858
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Journal article (peer-reviewed)abstract
- Rationale: Respiratory symptoms during exercise are common and might limit adolescents' ability to take part in physical activity. Objective: To estimate the prevalence, determinants and consequences of exercise-induced dyspnea (EID) on daily life in a general population of 12-13 year old adolescents. Methods: A letter was sent to the parents of all 12-13 year old adolescents in the city of Uppsala (n = 3838). Parents were asked to complete a questionnaire together with their child on EID, asthma and allergy, consequences for daily life (wheeze, day time- and nocturnal dyspnea) and physical activity. The response rate was 60% (n = 2309). Results: Fourteen percent (n = 330) reported EID, i.e. had experienced an attack of shortness of breath that occurred after strenuous activity within the last 12 months. Female gender, ever-asthma and rhinitis were independently associated with an increased risk of EID. Ever-asthma was reported by 14.6% (n = 338), and 5.4% (n = 128) had both EID and ever-asthma. Sixty-one percent (n = 202) of the participants with EID did not have a diagnosis of asthma. In addition to rhinitis, participants with EID reported current wheeze and day-time as well as nocturnal dyspnea more often. than the group without EID. No difference was found in the level of physical activity between participants with and without EID. Conclusion: Adolescents with undiagnosed exercise-induced dyspnea have respiratory symptoms and are affected in daily life but have the same level of physical activity as adolescents without exercise-induced respiratory symptoms.
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| 14. |
- Johansson, Henrik, 1965-, et al.
(author)
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Exercise test using dry air in random adolescents: temporal profile and predictors of bronchoconstriction
- 2016
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In: Respirology (Carlton South. Print). - : Wiley. - 1323-7799 .- 1440-1843. ; 21:2, s. 289-296
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Journal article (peer-reviewed)abstract
- Background and objectiveGuidelines recommend exercise tests using dry air to diagnose exercise-induced bronchoconstriction (EIB). Lung function changes subsequent to these tests have not been investigated in a general adolescent population, and it remains unknown whether signs of airway inflammation, measured using exhaled nitric oxide (FeNO), can predict a positive response. The aim of this study was to investigate the temporal aspect of decline in forced expiratory volume in 1 s (FEV1) after an exercise test using dry air, and to investigate predictors of EIB.MethodsFrom a cross-sectional study on adolescents aged 13–15 years (n = 3838), a random subsample of 146 adolescents (99 with and 47 without self-reported exercise-induced dyspnoea) underwent standardized treadmill exercise tests for EIB while breathing dry air.ResultsOf the adolescents, 34% had a positive EIB test (decline of ≥10% in FEV1 from baseline) within 30 min. Of the subjects with EIB, 53% showed the greatest decline in FEV1 at 5 to 10 min (mean decline 18.5%), and the remaining 47% of the subjects showed the greatest decline at 15 to 30 min (mean decline 18.9%) after exercise. Increased FeNO (>20 ppb), female gender and self-reported exercise-induced dyspnoea were independently associated with a positive EIB test.ConclusionWhen assessing general adolescents for EIB with exercise test using dry air, there is a temporal variation in the greatest FEV1 decline after exercise. Therefore, lung function should be measured for at least 30 min after the exercise. Increased FeNO, female gender and self-reported exercise-induced dyspnoea can be predictors of a positive EIB test.
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| 15. |
- Johansson, Henrik, et al.
(author)
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Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population
- 2015
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In: Thorax. - : BMJ. - 0040-6376 .- 1468-3296. ; 70:1, s. 57-63
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Journal article (peer-reviewed)abstract
- Background Exercise-induced respiratory symptoms are common among adolescents. Exercise is a known stimulus for transient narrowing of the airways, such as exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (EILO). Our aim was to investigate the prevalence of EIB and EILO in a general population of adolescents. Methods In this cross-sectional study, a questionnaire on exercise-induced dyspnoea was sent to all adolescents born in 1997 and 1998 in Uppsala, Sweden (n=3838). A random subsample of 146 adolescents (99 with self-reported exercise-induced dyspnoea and 47 without this condition) underwent standardised treadmill exercise tests for EIB and EILO. The exercise test for EIB was performed while breathing dry air; a positive test was defined as a decrease of >= 10% in FEV1 from baseline. EILO was investigated using continuous laryngoscopy during exercise. Results The estimated prevalence of EIB and EILO in the total population was 19.2% and 5.7%, respectively. No gender differences were found. In adolescents with exercise-induced dyspnoea, 39.8% had EIB, 6% had EILO and 4.8% had both conditions. In this group, significantly more boys than girls had neither EIB nor EILO (64.7% vs 38.8%; p=0.026). There were no significant differences in body mass index, lung function, diagnosed asthma or medication between the participants with exercise-induced dyspnoea who had or did not have a positive EIB or EILO test result. Conclusions Both EIB and EILO are common causes of exercise-induced dyspnoea in adolescents. EILO is equally common among girls and boys and can coexist with EIB.
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| 16. |
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| 17. |
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| 18. |
- Johansson, Henrik, 1965-, et al.
(author)
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The relationship between exercise induced bronchial obstruction and health related quality of life in female and male adolescents from a general population
- 2016
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In: BMC Pulmonary Medicine. - : Springer Science and Business Media LLC. - 1471-2466. ; 16
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Journal article (other academic/artistic)abstract
- Background: Previous studies have observed that exercise-induced bronchoconstriction (EIB) is more common and more strongly related to exercise related breathing problems in female adolescents than male adolescents. However, few studies have investigated the association between EIB and health related quality of life (HRQoL) from a gender perspective. The aim of this study was to examine the association between EIB and HRQoL and physical activity level in female and male adolescents with and without EIB. Methods: From a population based study on exercise-induced breathing problems among adolescents (13-15 years, n = 3838) a cross sectional study with prospective data collection was carried out in a random subsample of 140 adolescents. The subjects in the sample were tested for EIB with a standardised exercise test, of which 49 adolescents were tested positive. HRQoL was assessed with the Pediatric Quality of Life Inventory (PedsQL) and the adolescents' physical activity levels were measured objectively with accelerometer. Results: The female subjects with EIB reported a lower HRQoL, both in total score (p = 0.03) and physical functioning score (p = 0.009) and had a lower baseline FEV1 compared to females without EIB (88 vs. 94 % predicted, p = 0.001). No differences were found in HRQoL or baseline lung function between males with or without EIB. There were no differences in minutes of moderate to vigorous physical activity per day between females or males with and without EIB. Conclusion: In a general population, the female adolescents with EIB had lower HRQoL and poorer baseline lung function compared to counterparts without EIB. These differences were not observed in males. EIB does not appear to affect the level of daily physical activity neither in females nor males.
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| 19. |
- Lidian, Adnan, et al.
(author)
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BDNF as otoprotectant in toxin-induced hearing loss
- 2013
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In: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 133:1, s. 4-11
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Journal article (peer-reviewed)abstract
- Conclusion: Brain-derived neurotrophic factor (BDNF) can prevent auditory brainstem response (ABR) threshold shift changes caused by Pseudomonas aeruginosa exotoxin A (PaExoA). Objective: Peptides of the neurotrophin family are known to prevent neuronal death during embryonic development by interacting with specific membrane receptors. The purpose of this study was to investigate whether a single dose of BDNF is an effective protectant against toxic effects of PaExoA-induced ABR threshold shifts. Materials and Methods: Eight groups of Sprague-Dawley rats were used. There were five control groups (n = 20) as follows. Group A (n = 4) received NaCl solution; group B (n = 3) received 4 mu g BDNF; group C (n = 4) received 1 mu g/20 mu l PaExoA; group D (n = 4) received 2 mu g/20 mu l PaExoA; groupE (n = 5) received 10 mu g/20 mu l PaExoA injected into the round window niche. Three treatment groups (n = 13) received a single dose of PaExoA and 4 mu g of BDNF simultaneously. Group 1 (n = 3) received 1 mu g/20 mu l PaExoA + 4 mu g of BDNF; group 2 (n = 5) received 2 mu g/20 mu l PaExoA + 4 mg BDNF; group 3 (n = 5) received 10 mu g/20 mu l PaExoA+ 4 mu g BDNF. ABR was used to measure efficacy by analyzing threshold shifts before and after injections. Results: A single dose of BDNF prevented changes in ABR thresholds following exposure to increasing concentrations of PaExoA injected into the middle ear.
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| 20. |
- Lidian, Adnan, et al.
(author)
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Early hearing protection by brain-derived neurotrophic factor
- 2013
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In: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 133:1, s. 12-21
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Journal article (peer-reviewed)abstract
- Conclusion: Brain-derived neurotrophic factor (BDNF) protects the inner ear from PaExoA (exotoxin A from Pseudomonas aeruginosa)-induced sensory neural hearing loss when administered 12 h after exotoxin, but not after 72 h. Objective: BDNF is a peptide in the neurotrophin family with protective effects against noise-induced hair cell loss and toxic inner ear damage following exposure to cisplatin. The exotoxin A (PaExoA) from P. aeruginosa, the most common microorganism in chronic suppurative otitis media, induces sensorineural hearing loss in rats. Previous study showed that, when given simultaneously with the exotoxin, BDNF protected the inner ear from damage. The aim of this study was to determine if BDNF has a protective effect when given 12-72 h after PaExoA. Materials and Methods : Five groups of Sprague-Dawley rats were used. The three control groups (n = 16) were as follows. Group 1 (n = 8) received 15 mu g/20 mu l PaExoA; group 2 (n = 5) received 20 mu g/20 mu l PaExoA; and group 3 (n = 3) received 25 mu g/20 mu l PaExoA injected into the round window niche. There were two treatment groups (n = 12): group A (n = 6) received 15 mu g/20 mu l PaExoA and 4 mu g/20 mu l BDNF 12 h later; group B (n = 6) received 15 mu g/20 mu l PaExoA and 4 mu g/20 mu l BDNF 72 h later. Brainstem response audiometry (ABR) was performed on day 0 (control), and repeated on days 7, 14, 21, 28, and 35 to analyze the thresholds shifts. Results: Exposure to 15 mu g/20 mu l PaExoA caused persistent and significant ABR impairment in controls when measured after 35 days. A single dose of BDNF given 12 h after PaExoA reduced hearing loss significantly, but when BDNF was given 72 h after PaExoA no protective effect was evident.
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| 21. |
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| 22. |
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| 23. |
- Nordang, Leif, et al.
(author)
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Complement activation in sudden deafness.
- 1998
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In: Archives of Otolaryngology - Head & Neck Surgery. - 0886-4470 .- 1538-361X. ; 124:6, s. 633-6
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To test whether complement activation is associated with sudden deafness.DESIGN: Plasma samples obtained from patients in the acute phase of sudden deafness were analyzed for complement activation measured by C3bc levels and terminal complement complex. Comparisons were made with plasma samples from healthy controls.PATIENTS: Twenty-five adult patients with unilateral sudden deafness. The criteria for inclusion were symptoms of hearing loss for not longer than 14 days and a hearing loss of 35 dB or more measured at entry.RESULTS: Levels of C3bc were higher in patients compared with controls (P<.001). There were no differences in the formation of terminal complement complex in patients and controls.CONCLUSIONS: The elevated levels of C3bc in patients with sudden deafness indicate an activation of the first part of the complement cascade and therefore suspected inflammatory causes. Measurements of C3bc levels might identify patients with sudden deafness who would benefit from treatment with anti-inflammatory drugs.
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| 24. |
- Nordang, Leif, et al.
(author)
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Early laryngeal outcome of prolonged intubation using an anatomical tube : a double blind, randomised study
- 2016
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In: European Archives of Oto-Rhino-Laryngology. - : Springer Science and Business Media LLC. - 0937-4477 .- 1434-4726. ; 273:3, s. 703-708
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Journal article (peer-reviewed)abstract
- The objective of this study was to study the short-term impact on larynx by a newly designed anatomical tube. A prospective randomised trial of a newly designed anatomical tube versus a standard endotracheal tube in patients operated under general anaesthesia for at least 12 h. Seventy adults were included and randomised to either type of tube. The patients were evaluated by means of fibre-optic laryngoscopy and VAS-rating of symptoms on two occasions in the first post-operative week. The evaluating investigators and the patients were blinded to the type of tube used. 27 cases and 23 controls had complete data for evaluation. Age, gender and intubation times were comparable. Symptoms such as hoarseness, coughing, and pain were rated above 30 % of maximum during at least one of the first post-operative days by 21 and 19 patients, respectively. At the first examination (within 24 h), 38 % of patients in the anatomical tube group stated no hoarseness; compared to 13 % of the controls (p = 0.057). Fibre-optic laryngoscopy showed some kind of pathology in all the patients examined within 24 h of extubation. After 3-6 days, seven patients with the anatomical tube and four patients in the control group showed complete resolution of the lesions, and the changes were limited to redness in the vocal process area in another seven and four, respectively. The differences between the groups did not attain statistical significance. The study shows considerable short-term laryngeal morbidity after prolonged intubation, and the anatomical tube only showed an advantage concerning hoarseness. Further improvement of the endotracheal tubes and intubation routines are still needed.
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| 25. |
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| 26. |
- Nordang, Leif, et al.
(author)
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Exercise-Induced Laryngeal Obstruction-An Overview
- 2018
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In: Immunology and allergy clinics of North America. - : Saunders Elsevier. - 0889-8561 .- 1557-8607. ; 38:2, s. 271-280
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Journal article (peer-reviewed)abstract
- Exertional dyspnea is common in health and disease. Despite having known for centuries that breathlessness can arise from the larynx, exercise-induced laryngeal obstruction is a more prevalent condition than previously assumed. This article provides a brief overview of the history, epidemiology, and pathophysiology of exercise-induced laryngeal obstruction.
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| 27. |
- Nordang, Leif, et al.
(author)
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Glutamate is the afferent neurotransmitter in the human cochlea
- 2000
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In: Acta Oto-Laryngologica. - 0001-6489 .- 1651-2251. ; 120:3, s. 359-362
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Journal article (peer-reviewed)abstract
- Glutamate, the most important afferent neurotransmitter in the auditory system, is thought to be the afferent transmitter between the cochlear inner hair cells and afferent neurons, hitherto visualized only in the cochlea of animal species. It has been identified for the first time in sections from the human inner ear. L-glutamate, NMDAR2B and the enzyme glutamine synthetase were identified by using monoclonal antibodies. The distribution pattern of the transmitter L-glutamate in the human cochlea is similar to that observed in other mammals. L-glutamate was identified adjacent to outer and inner hair cells and in the spiral ganglion. Similar distributions were found for glutamine synthetase and the ionotropic NMDA receptor subunit NMDAR2. The identification of neurotransmitters and their receptors in the human cochlea has implications for the pharmacotherapy of inner ear diseases.
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| 28. |
- Nordang, Leif, et al.
(author)
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Hearing loss in relation to round window membrane morphology in experimental chronic otitis media
- 2001
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In: Journal for Oto-Rhino-Laryngology. - : S. Karger AG. - 0301-1569 .- 1423-0275. ; 63:6, s. 333-340
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Journal article (peer-reviewed)abstract
- The present study was performed to test the effect of single and repeated Pseudomonas aeruginosa exotoxin A (PaExoA) instillations in the middle ear of the rat. The hearing level was examined by the ABR technique, round window membrane (RWM) thickness was measured and morphology was studied by light microscopy. The results showed both reversible and permanent hearing loss (HL). In animals that received a single dose of PaExoA, the RWM thickness doubled initially and remained thickened during the observation period. When PaExoA was instilled on several occasions, RWM thickness doubled, before decreasing to near-control levels. This study confirms the toxicity of PaExoA and the partially reversible HL occurring after a single application of the toxin. The diminished effect of repeated toxin instillations--despite the decreasing thickness of the RWM--is discussed.
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| 29. |
- Nordang, Leif, et al.
(author)
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Morphological changes in round window membrane following topical hydrocortisone and dexamethasone treatment
- 2003
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In: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 24:2, s. 339-43
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Journal article (peer-reviewed)abstract
- HYPOTHESIS: Are all glucocorticoids supposed to have the same effect on the round window membrane? BACKGROUND: Interest in glucocorticoids for topical treatment of inner ear diseases is increasing. The safety of such treatment should therefore be an important consideration before clinical use. METHODS: In this study the authors investigated the morphology of the round window membrane after topical instillation of dexamethasone or hydrocortisone into the middle ear. Twenty Sprague-Dawley rats were used. Five rats received 5 doses, and five rats 10 doses, of 1 microg (20 microl) dexamethasone in the right ear, and five others were given 5 doses, and five rats 10 doses, of 2% (20 microl) hydrocortisone solution, also in the right ear. Membrane morphology was studied in both light microscopy and transmission electron microscopy. The thickness of exposed membranes was measured and compared with that of control membranes. RESULTS: Thickening and microscopically signs of inflammation were observed in hydrocortisone-exposed membranes but not in dexamethasone-exposed membranes, which did not differ morphologically from those in control ears. CONCLUSION: Although hydrocortisone has anti-inflammatory properties, it seems to provoke inflammation in the round window membrane after topical instillation. Dexamethasone had no such effects, however.
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| 30. |
- Nordang, Leif, et al.
(author)
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Nitro-L-arginine methyl ester : a potential protector against gentamicin ototoxicity
- 2005
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In: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 125:10, s. 1033-8
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Journal article (peer-reviewed)abstract
- The nitric oxide (NO) inhibitor nitro-L-arginine methyl ester (L-NAME) may act as an otoprotectant against high-frequency hearing loss caused by gentamicin, but further studies are needed to confirm this.Aminoglycoside antibiotics are still widely used by virtue of their efficacy and low cost. Their ototoxicity is a serious health problem and, as their ototoxic mechanism involves the production of NO, we need to assess the use of NO inhibitors for the prevention of aminoglycoside-induced sensorineural hearing loss. In this experimental study we used 30 Sprague-Dawley rats, 27 of which had gentamicin instilled into the middle ear. The otoprotectant L-NAME was administered topically to 12/27 animals. Its effect was determined in terms of attenuation of hearing loss, measured by shifts in the auditory brainstem response threshold. L-NAME reduced gentamicin-induced hearing loss in the high-frequency range, but gave no protection in the middle or low frequencies.
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| 31. |
- Nordang, Leif, et al.
(author)
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Passage through the round window membrane and inner ear function
- 2004
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In: Audiological Medicine. - : Informa UK Limited. - 1651-386X .- 1651-3835. ; 2:3, s. 165-168
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Journal article (pop. science, debate, etc.)abstract
- The round window membrane (RWM) is an anatomical barrier between the aerated middle ear and the fluid (perilymph) compartments of the cochlea. Permeability of the RWM is regarded as an accident and not as a function of the membrane because of its anatomical characteristics, location and the high prevalence of middle ear disease. This paper provides a review of the effects on cochlear function following experimental exposure of bacterial toxins into the round window niche. Hearing loss is correlated with RWM morphology in experimental chronic otitis media. Following exposure to bacterial toxins there is a time‐dependent response of both the middle ear mucosal changes and the morphological alterations in the epithelium of the endolymphatic duct and sac. Otoprotectants, such as nitric oxide inhibitors, dexamethasone and neurotrophic factors, prevent toxic effects of Pseudomonas aeruginosa exotoxin A. In spite of a limited knowledge on the permeability of the RWM the application of therapeutic substances into the round window niche seems still the most suitable clinical approach to treat inner ear disorders.
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| 32. |
- Nordang, Leif, 1954-
(author)
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The Round Window Membrane - Gateway to the Cochlea : A Morphological and Electrophysiological study
- 2002
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Doctoral thesis (other academic/artistic)abstract
- Topical treatment of several inner ear diseases through the round window membrane (RWM) might be feasible in the near future. Bacteria toxins, ototoxic drugs and noise trauma seem to harm the inner ear by a common pathway which involves, excessive outflow of the afferent neurotransmitter glutamate and formation of nitric oxide (NO), which can severely damage cells/nerve endings and lead to cell death.In this study we used 98 Sprague-Dawley rats and seven human temporal bones. Various substances were instilled into the middle ear of the rat, such as Pseudomonas Aeruginosa Exotoxin (PaExoA), gentamicin, NO-inhibitor N-Omega-Nitro-L-Arginine Methyl Ester (L-NAME), and glucocorticoids. The effects of the substances were studied by morphological analysis of RWM and the endolymphatic sac (ES) by light and electron microscopic. Hearing level was measured in the rats by ABR technique. The human temporal bones were studied immunomorphologically to search for glutamate.In the human inner ear, glutamate receptors and glutamine synthetase, were identified. In the rat, we found, following PaExoA exposure, reversible and permanent hearing loss and morphological changes in the RWM. The ES showed increased numbers of macrophages and thickening of the epithelia. When L-NAME was used as an otoprotector from gentamicin ototoxicity a therapeutic effect in the high frequency area was found. Hydrocortisone (but not dexamethasone) exposure of the RWM resulted in membrane thickening, and adjacent to the membrane, inflammatory cells.The importance of the RWM as a portal for toxic substances and topical treatment of inner ear diseases was highlighted in this study. The difficulties of applying drugs in the round window niche were exposed. The results of this study add important knowledge concerning certain mechanisms of inner ear injury and help us to understand possibilities and problems of local treatment of inner ear diseases in patients.
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| 33. |
- Norlander, Katarina, et al.
(author)
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Comparison between two assessment methods for exercise-induced laryngeal obstructions
- 2016
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In: European Archives of Oto-Rhino-Laryngology. - : Springer Science and Business Media LLC. - 0937-4477 .- 1434-4726. ; 273:2, s. 425-430
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Journal article (peer-reviewed)abstract
- Exercise-induced laryngeal obstructions (E-ILOs) are important differential diagnoses to exercise-induced asthma and are diagnosed by the continuous laryngoscopy exercise (CLE) test. There are two different methods for evaluating the severity of E-ILOs using recordings from the CLE test; the CLE score and EILOMEA. The aim of this study was to investigate the consistency between these methods. Using their respective method, the developers of each method evaluated 60 laryngoscopic recordings from patients with different subtypes and various levels of severity of E-ILOs. The CLE score evaluates glottic and supraglottic obstructions on a 4-grade scale. EILOMEA uses software to calculate the obstruction severity on continuous scales from a still frame of the larynx during maximal obstruction giving three parameters reflecting glottic and supraglottic obstruction. The means of the EILOMEA measures differed significantly for CLE score 1 vs. 2 and 2 vs. 3, but not for 0 vs. 1 for glottic as well as supraglottic obstructions. The EILOMEA method does not distinguish between CLE score 0 and 1, but otherwise the methods correlate. Since previous studies have suggested that only CLE scores of 2 and 3 reflect a severity of E-ILOs of clinical importance, this lack of the EILOMEA method is not crucial for a correct medical evaluation.
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| 34. |
- Norlander, Katarina, et al.
(author)
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Differences in laryngeal movements during exercise in healthy and dyspnoeic adolescents
- 2020
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In: International Journal of Pediatric Otorhinolaryngology. - : Elsevier. - 0165-5876 .- 1872-8464. ; 129
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To compare glottic and supraglottic movements in healthy adolescents and adolescents experiencing dyspnoea during strenuous exercise.METHODS: Using the continuous laryngoscopy exercise (CLE)-test laryngeal movements during exercise were analysed in healthy controls (n = 28) and compared to subjects with exercise induced bronchoconstriction (EIB) (n = 10), exercise induced laryngeal obstruction (EILO) (n = 10) and subjects experiencing exercise-induced dyspnoea without having any of these diagnoses (n = 31). Images from the video recordings were assessed regarding glottic angle, glottic area and supraglottic area using the software measuring tool EILOMEA.RESULTS: No significant differences were detected between controls, the dyspnoea group without a diagnosis of EIB or EILO and the EIB group regarding glottis angle, glottis area or supraglottic area at maximum effort. All three parameters differed significantly in the EILO group compared to the other groups (p=<0.001). In the group with EILO all but one had supraglottic obstruction (corresponding to a CLE-test score ≥2). Movement of the laryngeal structures, corresponding to a CLE-test score of 1, at glottic and/or supraglottic level was seen in 26 of 35 (74%) of controls, 34 out of 41 (83%) of patients in the dyspnoea group, and in 25 of 38 (66%) of EIB-subjects.CONCLUSION: Minor movements at both glottic and supraglottic level are equally common in healthy controls as among adolescents with exercise induced dyspnoea without EIB or EILO and adolescents with EIB. Adolescents with EILO had a statistically significant more pronounced supraglottic obstruction than the other groups.
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| 35. |
- Norlander, Katarina, 1969-
(author)
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Exercise-induced laryngeal obstruction : Prevalence, laryngeal findings and evaluation of treatment
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Exercise-induced laryngeal obstruction (EILO) is one of many different causes for adolescents to experience dyspnoea during exercise. Objective exercise-testing with continuous video laryngoscopy is crucial for a correct diagnosis since it is difficult to differentiate EILO from other exercise related conditions in the airways only on the symptomatology. The main symptom in EILO is inspiratory stridor arising from an obstruction at the laryngeal level during ongoing exercise which quickly resolves after the exercise has stopped. EILO is often misdiagnosed as exercise-induced bronchoconstriction (EIB), which is obstruction in the peripheral airways that typically arises after cessation of exercise.From a previous survey investigating self-reported exercise-induced dyspnoea in all 12-13-year-old adolescents in Uppsala (n=3,838, response rate 60.2%) a subset of 150 randomly selected adolescents (103 with dyspnoea and 47 controls) performed standardized treadmill exercise-tests for EIB and EILO.During the exercise-test for EIB the subjects breathed dry air according to the current recommended guidelines. EIB was defined as a decrease in FEV1 ≥10% from baseline. EILO was diagnosed during a continuous laryngoscopy exercise (CLE) test by use of the CLE-score method and was defined as an obstruction of grade 2 at either glottic or/and supraglottic laryngeal level. The estimated prevalence of EIB in the general population was 19.2% and the estimated prevalence of EILO was 5.7%. No gender differences were detected.A diagnostic software program for EILO, EILOMEA, was compared with the CLE-score and the methods were found to be compatible. EILOMEA was used to map and compare laryngeal response patterns in adolescents with exercise-induced dyspnoea (EIB and/or EILO), in adolescents with dyspnoea but without a diagnosis of EIB or EILO, and in healthy controls, all of whom had performed the CLE-test. No differences were seen between the healthy controls and the adolescents with dyspnoea without a diagnosis. Only adolescents diagnosed with EILO showed a significant different laryngeal response pattern which strongly suggests that the diagnostic procedure is reliable.In a follow-up study of patients referred for investigation of exercise-induced dyspnoea, we investigated the outcome of surgical vs. conservative treatment of EILO-positive subjects and subjects tested negative for the diagnosis, regarding the level of exercise-induced dyspnoea and physical activity. Surgically treated patients had less breathing problems and were more physically active than both conservatively treated patients and patients who were tested negative.
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| 36. |
- Norlander, Katarina, et al.
(author)
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Surgical treatment is effective in severe cases of exercise-induced laryngeal obstruction : A follow-up study
- 2015
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In: Acta Oto-Laryngologica. - 0001-6489 .- 1651-2251. ; 135:11, s. 1152-1159
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Journal article (peer-reviewed)abstract
- Conclusions: Surgery is an effective treatment in severe cases of supraglottic exercise-induced laryngeal obstruction (E-ILO). Conservatively treated subjects and subjects tested negative for E-ILO, who still experience breathing problems 1–3 years after diagnosis, tend to adjust their physical activity to a greater extent than surgically treated subjects. Objective: To investigate how symptoms and level of physical activity change over time in patients with E-ILO who have undergone surgery, patients with E-ILO treated conservatively and patients who tested negative for laryngeal obstruction at continuous laryngoscopy exercise-test (CLE-test). Methods: Patients referred for exercise-induced breathing difficulties answered questionnaires at diagnostic CLE-test and at follow-up. Questions regarded exercise-induced breathing problems, current physical activity level, and medical history of asthma and perennial allergy. Results: Out of 84 invited subjects, 59 (70%) answered both questionnaires. Surgically treated subjects had less breathing problems at follow-up compared with conservatively treated subjects and subjects who tested negative (p < 0.001). None of the surgically treated subjects were less physically active or had changed sport due to exercise-induced dyspnoea, whereas 41.7% of the conservatively treated subjects had made such adjustments (p < 0.001).
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| 37. |
- Veneroni, Chiara, et al.
(author)
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Self‐reported exercise‐induced dyspnea and airways obstruction assessed by oscillometry and spirometry in adolescents
- 2022
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In: Pediatric Allergy and Immunology. - : John Wiley & Sons. - 0905-6157 .- 1399-3038. ; 33:1
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Journal article (peer-reviewed)abstract
- Background Self-reported exercise-induced dyspnea (EID) is common among adolescents. Possible underlying pathologies are exercise-induced bronchoconstriction (EIB) and laryngeal obstruction (EILO). The forced oscillation technique (FOT) may evaluate exercise-induced changes in airway caliber. Aim To investigate in adolescents the relationship between EID, EIB (post-exercise fall in forced expiratory volume in 1s (FEV1)>= 10%), EILO, and post-exercise challenge changes in FOT parameters. Methods One hundred and forty-three subjects (97 with EID) of 13-15 years old underwent a standardized exercise challenge with FOT measurement and spirometry repeatedly performed between 2 and 30 min post-exercise. EILO was studied in a subset of 123 adolescents. Subjects showing greater changes than the healthy subgroup in the modulus of the inspiratory impedance were considered FOT responders. Results EID-nonEIB subjects presented similar post-exercise changes in all FOT parameters to nonEID-nonEIB adolescents. Changes in all FOT parameters correlated with FEV1 fall. 45 of 97 EID subjects responded neither by FEV1 nor FOT to exercise. 19 and 18 subjects responded only by FEV1 (onlyFEV(1)responders) or FOT (onlyFOTresponders), respectively. Only a lower baseline forced vital capacity (FVC)%predicted and a higher FEV1/FVC distinguished the onlyFEV(1)responders from onlyFOTresponders. FOT parameters did not present specific post-exercise patterns in EILO subjects. Conclusion FOT can be used to identify post-exercise changes in lower airway function. However, EID has a modest relation with both FEV1 and FOT responses, highlighting the need for objective testing. More research is needed to understand whether onlyFEV(1)responders and onlyFOTresponders represent different endotypes.
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| 38. |
- Wadelius, Mia, et al.
(author)
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Phenotype Standardization of Angioedema in the Head and Neck Region Caused by Agents Acting on the Angiotensin System
- 2014
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In: Clinical Pharmacology and Therapeutics. - : Nature Publishing Group. - 0009-9236 .- 1532-6535. ; 96:4, s. 477-481
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Research review (peer-reviewed)abstract
- Angioedema is a potentially life-threatening adverse reaction to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. To study the genetic etiology of this rare adverse event, international consortia and multicenter recruitment of patients are needed. To reduce patient heterogeneity, we have standardized the phenotype. In brief, it comprises swelling in the head and neck region that first occurs during treatment. It should not coincide with urticaria or have another likely cause such as hereditary angioedema.
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