| 1. |
- Bagger-Sjoback, Dan, et al.
(författare)
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High-frequency hearing, tinnitus, and patient satisfaction with stapedotomy: A randomized prospective study
- 2015
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Ingår i: Scientific Reports. - : Nature Publishing Group: Open Access Journals - Option C / Nature Publishing Group. - 2045-2322. ; 5:13341
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Tidskriftsartikel (refereegranskat)abstract
- Otosclerosis is a common disorder that leads to conductive hearing loss. Most patients with otosclerosis also have tinnitus, and surgical treatment is known to improve hearing as well as tinnitus. Some patients however experience worsening of tinnitus after the operation, but there are no known factors that allow surgeons to predict who will be at risk. In this prospective observational study on 133 patients undergoing stapedotomy, we show that postoperative air conduction thresholds at very high stimulus frequencies predict improvement of tinnitus, as assessed with proportional odds logistic regression models. Young patients were significantly more likely to experience reduction of tinnitus and patients whose tinnitus became better were also more satisfied with the outcome of the operation. These findings have practical importance for patients and their surgeons. Young patients can be advised that surgery is likely to be beneficial for their tinnitus, but a less positive message should be conveyed to older patients.
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| 2. |
- Bagger-Sjöbäck, Dan, et al.
(författare)
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A Randomised, Double Blind Trial of N-Acetylcysteine for Hearing Protection during Stapes Surgery
- 2015
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:3
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Tidskriftsartikel (refereegranskat)abstract
- Background Otosclerosis is a disorder that impairs middle ear function, leading to conductive hearing loss. Surgical treatment results in large improvement of hearing at low sound frequencies, but high-frequency hearing often suffers. A likely reason for this is that inner ear sensory cells are damaged by surgical trauma and loud sounds generated during the operation. Animal studies have shown that antioxidants such as N-Acetylcysteine can protect the inner ear from noise, surgical trauma, and some ototoxic substances, but it is not known if this works in humans. This trial was performed to determine whether antioxidants improve surgical results at high frequencies. Methods We performed a randomized, double-blind and placebo-controlled parallel group clinical trial at three Swedish university clinics. Using block-stratified randomization, 156 adult patients undergoing stapedotomy were assigned to intravenous N-Acetylcysteine (150 mg/kg body weight) or matching placebo (1:1 ratio), starting one hour before surgery. The primary outcome was the hearing threshold at 6 and 8 kHz; secondary outcomes included the severity of tinnitus and vertigo. Findings One year after surgery, high-frequency hearing had improved 2.7 +/- 3.8 dB in the placebo group (67 patients analysed) and 2.4 +/- 3.7 dB in the treated group (72 patients; means +/- 95% confidence interval, p = 0.54; linear mixed model). Surgery improved tinnitus, but there was no significant intergroup difference. Post-operative balance disturbance was common but improved during the first year, without significant difference between groups. Four patients receiving N-Acetylcysteine experienced mild side effects such as nausea and vomiting. Conclusions N-Acetylcysteine has no effect on hearing thresholds, tinnitus, or balance disturbance after stapedotomy.
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| 3. |
- Berling Holm, Katarina, et al.
(författare)
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Taste disturbance after stapes surgery : an evaluation of frequency, severity, duration, and quality-of-life
- 2017
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Ingår i: Acta Oto-Laryngologica. - : Taylor & Francis Group. - 0001-6489 .- 1651-2251. ; 37:1, s. 39-43
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Tidskriftsartikel (refereegranskat)abstract
- Conclusion: The incidence of taste disturbance after stapes surgery is high (61.9 %), whereas the majority (94.8 %) recovers within 1 year. More severe surgical nerve trauma caused more disturbance, implying that the nerve should be handled carefully during surgery. Objectives: Patients operated on for otosclerosis seem more often to complain about post-operative taste disturbance than those operated on for chronic otitis media, although the chorda tympani nerve more seldom becomes maltreated in stapedotomy. These observations seem paradoxical. It is unclear to what extent a post-operative taste disturbance affects the quality-of-life. This study aims to shed light on the occurrence of post-operative taste disturbances, on possible prognostic factors, and to what extent post-operative taste disturbance impairs the quality-of-life. Methods: One hundred and thirty-four adults undergoing primary stapedotomy were included. Questionnaires on taste disturbance and quality-of-life (SF-36) were answered before and after surgery, until 1 year post-operatively. Results: Eighty-three (61.9%) study persons reported post-operative taste disturbance. Seven (5.2%) reported persisting disturbance at 1 year. Surgically more traumatized chorda tympani nerves correlated with more severe taste disturbance post-operatively than less traumatized. Taste disturbance at 1 year post-operatively correlate with a decrease of the physical function domain in the SF-36.
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| 4. |
- Ejnell, Hasse, et al.
(författare)
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Nationella rekommendationer för trakeotomi och trakeostomivård : [National recommendations for tracheotomy and tracheostomy care. Consensus for safe tracheostomy care of adult patients]
- 2020
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Ingår i: Läkartidningen. - : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 117
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Tidskriftsartikel (refereegranskat)abstract
- This article describes new Swedish guidelines for the care of adult patients having a tracheostomy. A national expert panel of ENT and anaesthesiology specialists appointed by each national specialist association reviewed fatal patient cases involving tracheostomy failure as well as national and international guidelines to produce a "best of practice" document. The main recommendation is that the health care provider has the full responsibility to ensure that the combined surgical competence at the hospital can handle acute airway problems also under difficult anatomical conditions. The distribution of percutaneous and surgical tracheotomy should be weighted to ensure the competence in both.
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| 5. |
- Mylavarapu, Goutham, et al.
(författare)
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Importance of paranasal sinuses in computational modeling of nasal airflow
- 2009
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Ingår i: 47th AIAA Aerospace Sciences Meeting including the New Horizons Forum and Aerospace Exposition. - : AIAA. - 9781563479694 ; , s. 2009-0772-
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Konferensbidrag (refereegranskat)abstract
- This paper investigates the importance of including paranasal sinuses in the computational modeling of the nasal airflow. Three dimensional models of human nasal airway with and without including paranasal sinuses were reconstructed from Computed Tomography (CT) axial images of a subject with healthy nasal airway. The reconstruction process was performed using MIMICS® software program. The airway volume was discretized using TGRID® mesh generator. Steady Reynolds-Averaged Navier-Stokes (RANS) simulations were carried in both inspiratory and expiratory phases of respiratory cycle at a peak flow rate of 15 L/min in FLUENT®. The results show that the left and right nasal resistances change with less than 11% when paranasal sinuses are included in the computational model of the nasal airway. The flow into the sinuses is characterized by very low velocities during both inspiration and expiration conditions. The velocity distributions in the main nasal passage show small change predominantly in regions closer to the paranasal sinuses when compared to the model where sinuses were not included.
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| 6. |
- Mylavarapu, Goutham, et al.
(författare)
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Planning human upper airway surgery using Computational Fluid Dynamics
- 2013
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Ingår i: Journal of Biomechanics. - : Elsevier. - 0021-9290 .- 1873-2380. ; 46:12, s. 1979-1986
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Tidskriftsartikel (refereegranskat)abstract
- The study advances the idea of using computational fluid dynamics in the process of planning surgical treatment modalities for patients with obstructive airway disorders. It is hypothesized that the a priori knowledge of the functional outcome of surgical intervention on the flow and airway resistance can guide the surgeon in choosing an effective surgical strategy. Computed tomography images spanning the respiratory tract of an adult patient with a combined glottic and subglottic stenosis are used to reconstruct three-dimensional geometrical models of the airway. Computational fluid dynamics is used to obtain airway flow patterns during inspiration and expiration in these models. Numerical predictions about flow velocity, pressure distribution on the airway lumen, wall shear stress, and airway resistance are obtained so that the relevance of each individual stenotic level is quantified. Four different virtual surgeries in different combinations are assessed in order to remedy the constricted airway. The virtual surgery based airway models are evaluated by comparisons with the pre-treatment flow modeling results. The predicted numerical data revealed that the removal of the constriction at the level of the vocal folds will have the most significant effect on the airway resistance. The flow simulations offer a quantitative method of evaluating the airway resistance in patients with combined glottic and subglottic stenoses. Predictions of airway resistances and other numerical calculations from different virtual surgeries give additional inputs for the surgeon, in deciding the most appropriate surgery on a case-by-case basis.
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| 7. |
- Mylavarapu, Goutham, et al.
(författare)
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Virtual Surgery : a Computational Engineering Approach to a Medical Problem
- 2010
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Ingår i: proceedings of International Conference on Jets, Wakes and Separated Flows ICJWSF-2010.
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Konferensbidrag (refereegranskat)abstract
- The aim of the study is to utilize Computational Fluid Dynamics in the process of planning surgical treatment modalities for patients with obstructive airway disorders. It is hypothesized that the a-priori knowledge of the functional outcome of surgical intervention on the flow and airway resistance can guide the surgeon in choosing an effective surgical strategy. Computed Tomography images spanning the respiratory tract of an adult patient with a combined glottic and subglottic stenosis are used to reconstruct three-dimensional geometrical models of the airway. Computational Fluid Dynamics is used to obtain airway flow patterns during inspiration and expiration in these models. Numerical predictions about flow velocity, pressure distribution on the airway lumen, wall shear stress, and airway resistance are obtained so that the relevance of each individual stenotic level is quantified. Four different virtual surgeries in different combinations are assessed in order to remedy the constricted airway. The virtual surgery based airway models are evaluated by comparisons with the pre-treatment flow modeling results. The predicted numerical data revealed that the removal of the constriction at the level of the vocal folds will have the most significant effect on the airway resistance. The flow simulations offer a quantitative method of evaluating the airway resistance in patients with combined glottic and subglottic stenosis. Predictions of airway resistances and other numerical calculations from different virtual surgeries give additional inputs for the surgeon, in deciding the most appropriate surgery on a case-by-case basis.
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| 8. |
- Nellgård, Per, et al.
(författare)
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National recommendations for tracheotomy and for tracheostomy care
- 2017
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Ingår i: Abstracts from the Scandinavian Society of Anesthesiology and Intensive Care Medicine 34th Congress. - : John Wiley & Sons. ; , s. 1034-1035
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Konferensbidrag (refereegranskat)abstract
- Background: Every year 2000 tracheotomies are performed in Sweden. Severe or lethal complications and shortcomings in the valuation of risks pre-, per- and postoperatively occurs. This work intends, based on best available evidence, to reduce injuries related to tracheotomy.Material and Method: Anaesthesiologists and otorhinolaryngologists from University Hospitals compiled a document with guidelines to reduce risks to cause severe complications and death at tracheotomy operations. Landstingens Omse- € sidiga Fors € €akringsbolag (LOF, Swedish insur- € ance company for publicly funded health care providers) also took part.Results: Surgical tracheotomy is recommended for children and adults with known or expected difficult intubation such as Cormack-Lehane IIIIV, short/thick neck, distance between cricoid cartilage and jugulum<15 mm, neck circumference >45 cm, tumors in head and neck area, BMI >35, rheumatoid arthritis, severe obstructive sleep apnea syndrome, high intracranial pressure, unstable neck fracture and coagulopathies. Acta Anaesthesiologica Scandinavica 61 (2017) 962–1062 1034 ª 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd SSAI ABSTRACTS Percutaneous tracheostomy (PCT) could be performed in intensive care patients. A tracheotomy cannula with an inner cannula should be used. Common complications include acute obstruction of tracheal cannula, dislocation, emphysema of the neck, trauma to dorsal tracheal wall. Some deaths have occurred due to lack of education to perform a surgical tracheotomy in patients where percutaneous tracheostomy were not possible to perform.Conclusion: Tracheotomy should be performed at hospitals where competence exist for surgical tracheotomy, including patients with difficult anatomy, regardless of the tracheotomy technique. At each hospitals the distribution between percutaneous and surgical tracheostomies must be weighted as to preserve overall competence for both techniques. A guideline of acute tracheal cannula occlusion is presented (Figure).
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