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  • 1. Ahlberg, Alexander
    et al.
    Engström, Therese
    Nikolaidis, Polymnia
    Gunnarsson, Karin
    Johansson, Hemming
    Sharp, Lena
    Laurell, Göran
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Early self-care rehabilitation of head and neck cancer patients2011In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 131, no 5, p. 552-61Article in journal (Refereed)
    Abstract [en]

    CONCLUSIONS: No positive effects of early preventive rehabilitation could be identified. The results do not contradict the proposition that rehabilitation based on self-care can be effective but it is important to establish evidence-based training programs and identify proper instruments for selection of patients and evaluation of intervention.

    OBJECTIVES: Patients with head and neck cancer suffer from functional impairments due to intense treatment. In this study, we investigated the effectiveness of an experimental early preventive rehabilitation using hard, objective end points in a nonselective, longitudinal, prospective cohort study.

    METHODS: In all, 190 patients were included in the program and received instructions for training before the start of treatment with the aim of reducing swallowing problems and reducing mouth opening and stiffness in the neck. A control group of 184 patients was recruited.

    RESULTS: There was no difference in weight loss and 2-year survival between the two groups. No positive effects concerning functional impairments were found in patient-reported outcome measures.

  • 2.
    Bodin, Ingrid
    et al.
    Umeå University, Faculty of Medicine, Odontology.
    Lind, Magnus
    Henningsson, Gunilla
    Isberg, Annika
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Deterioration of intraoral hole size identification after treatment of oral and pharyngeal cancer.1999In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 119, no 5, p. 609-616Article in journal (Refereed)
    Abstract [en]

    Thirty-one patients with a diagnosed malignant tumour of the oral cavity or pharynx were tested in hole size identification on four test occasions: before all treatment, after radiotherapy and 6 months and 1 year after surgical treatment. They were compared within groups as well as with a group of healthy reference individuals of the same age who underwent the same test procedure at a 2 months' interval. The oral group did not decline in hole size identification after radiotherapy, but did after surgery. The deterioration was persistent 1 year after surgery. The pharyngeal group did not change performance in hole size identification after radiotherapy, nor after surgery. It is obvious that surgery of the oral structures causes the deterioration. No correlation with damage to the lingual nerve could be registered. The oral cavity reacts as one unit, despite sensory input from two sides. The non-operated side does not compensate for the operated side. It is plausible that decreased oral sensory acuity, in recognizing hole size of the bolus, contributes to postoperative swallowing problems.

  • 3.
    Brämerson, Annika
    et al.
    Department of Otorhinolaryngology, Central Hospital, Skövde.
    Millqvist, Eva
    Asthma and Allergy Research Group, Sahlgrenska University Hospital, Göteborg.
    Ydse, Bo
    Department of Biomedical Engineering, Central Hospital, Skövde.
    Larsson, Christel
    Department of Otorhinolaryngology, Central Hospital, Skövde.
    Olofsson, Jonas K
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Bende, Mats
    Department of Otorhinolaryngology, Central Hospital, Skövde.
    Event-related potentials in patients with olfactory loss2008In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 128, no 10, p. 1126-1131Article in journal (Refereed)
    Abstract [en]

    Conclusion. The olfactory event-related potential (OERP) method provides a means of objectively assessing olfactory function. However, further validation is needed before OERPs can be routinely applied in clinical assessment of olfactory dysfunction. Objective. To assess OERPs in patients with olfactory impairment and in healthy controls to investigate possible dose-response effects of odor concentration on OERP parameters in these groups, thereby exploring possibilities and limitations regarding the clinical utility of the OERP method. Subjects and methods. Twenty-three patients with a history of impaired olfactory function and 24 controls participated in the study. Olfactory function was assessed with psychophysical tests, i.e. assessment of the odor threshold, and odor identification. OERPs were obtained in response to the olfactory stimulant butanol at two different concentrations, presented via an olfactometer. Results. The OERP amplitudes increased and the latencies shortened with increasing stimulus concentration. Furthermore, a difference between the groups was found, with higher OERP amplitudes and shorter latencies in healthy subjects compared with patients.

  • 4. Dahlqvist, A
    et al.
    Diamant, H
    Dahlqvist, Solbritt Rantapää
    Cedergren, B
    HLA antigens in patients with otosclerosis1985In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 100, p. 33-35Article in journal (Refereed)
  • 5.
    Dahlqvist, Johanna
    et al.
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Dahlqvist, Åke
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Marklund, Marie
    Umeå University, Faculty of Medicine, Odontology, Ortodontics.
    Berggren, Diana
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Franklin, Karl
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Pulmonary Medicine.
    Physical findings in the upper airways related to obstructive sleep apnea in men and women2007In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 127, no 6, p. 623-630Article in journal (Refereed)
    Abstract [en]

    CONCLUSIONS:There are gender differences when it comes to the risk factors for sleep apnea. Large tonsils, a high tongue and a wide uvula are risk factors for sleep apnea in men, while large tonsils and a retrognathic mandible are risk factors in women. Upper airway abnormalities including mandibular retrognathia are, however, unable to predict sleep apnea among snorers being investigated for suspected sleep apnea.

    OBJECTIVES: To identify gender-specific risk factors for obstructive sleep apnea and the diagnostic performance from physical upper airway examinations among snoring men and women investigated because of suspected sleep apnea.

    PATIENTS AND METHODS: The dimensions of the uvula, tonsils, velopharynx and tongue, and nasal septal deviation, mandibular position, neck circumference, weight, and height were systematically scored in 801 consecutive snoring patients (596 men and 205 women), who had been referred for a primary sleep apnea recording.

    RESULTS: In men, large tonsils, a high tongue, and a wide uvula were independent factors associated with an apnea-hyopnea index of > 15. In women, large tonsils and mandibular retrognathia were independent factors associated with an apnea-hypopnea index of > 15. The positive predictive values for upper airway abnormalities ranged between 0.20 and 0.25 in men and between 0.09 and 0.15 in women.

  • 6.
    Dapefrid, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Lundström, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Tano, Krister
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Prevalence of Fusobacterium necrophorum in tonsils from patients with chronic tonsillitis2017In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 137, no 3, p. 297-301Article in journal (Refereed)
    Abstract [en]

    Conclusion: There was a high prevalence of Fusobacterium necrophorum (FN) in patients with chronic tonsillitis in the age group 15-23 years. This indicates that FN might play an important role in the pathogenesis of chronic tonsillitis in this age group, which is also the age group in which chronic or recurrent tonsillitis is most common.

    Objectives: The role of FN in patients with acute and chronic tonsillitis is unclear. Thus, this study investigated the occurrence of FN in tonsils of patients with chronic tonsillitis. The aim of the study was to determine the prevalence of FN in patients that underwent tonsillectomy due to chronic tonsillitis. This study also investigated if FN was found at different areas in the tonsils.

    Method: One hundred and twenty-six consecutive patients undergoing tonsillectomy due to chronic tonsillitis were included from the ENT clinics at Sunderby Hospital and Gallivare Hospital, Sweden. Both children and adults were included to encompass various age groups (age =2-57 years). Culture swabs were taken from three different levels of the tonsils - the surface, the crypts, and the inner core of the tonsils. Selective agar plates for detecting FN were used for culture. Culture was also made for detecting -hemolytic streptococci, Haemophilus influenzae, and Arcanobacterium.

    Results: FN was the most common pathogen (19%). The highest prevalence of FN was found in the age group 15-23 years (in 34% of the patients). FN was detected both at the surface and in the core of the tonsils. Furthermore, in the few patients where FN was not detected in all three areas, FN was always detected at the tonsillar surface, in spite of being an anaerobic bacterium. Streptococci group G and C also occurred most frequently (30%) in the same age group as FN (15-23 years), whereas Streptococci group A was more evenly spread among the age groups.

  • 7. Duan, Maoli
    et al.
    Chen, Zhiqiang
    Qiu, Jianxin
    Ulfendahl, Mats
    Laurell, Göran
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Borg, Erik
    Ruan, Runsheng
    Low-dose, long-term caroverine administration attenuates impulse noise-induced hearing loss in the rat2006In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Acta Otolaryngol, Vol. 126, no 11, p. 1140-7Article in journal (Refereed)
  • 8. Duan, Maoli
    et al.
    Laurell, Göran
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Qiu, Jianxin
    Borg, Erik
    Susceptibility to impulse noise trauma in different species: guinea pig, rat and mouse.2007In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 128, no 3, p. 277-283Article in journal (Refereed)
  • 9. Edfeldt, Lennart
    et al.
    Stromback, Karin
    Grendin, Joakim
    Umeå University, Faculty of Medicine. ENT Clinic.
    Bunne, Marie
    Harder, Henrik
    Peebo, Markus
    Eeg-Olofsson, Mans
    Petersson, Carl-Magnus
    Konradsson, Konrad
    Evaluation of cost-utility in middle ear implantation in the 'Nordic School': a multicenter study in Sweden and Norway2014In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 134, no 1, p. 19-25Article in journal (Refereed)
    Abstract [en]

    Conclusion: Hearing restoration using an active middle ear implant (AMEI) is a highly cost-effective treatment for a selected group of patients with no other possibilities for auditory rehabilitation. Objectives: To evaluate the cost-utility of using an AMEI for hearing rehabilitation. Methods: This was a prospective, multicenter, single-subject repeated study in six tertiary referral centers. Twenty-four patients with sensorineural (SNHL), conductive (CHL), and mixed hearing loss (MHL) were implanted with the AMEI Vibrant Soundbridge (R) (VSB) for medical reasons. All patients were previously rehabilitated with conventional hearing aids. Multiple validated quality of life patient questionnaires, Health Utilities Index (HUI 2 and 3), and Glasgow Hearing Aid Benefit Profile (GHABP) were used to determine the utility gain and quality adjusted life years (QALY). Directly related treatment costs for the implantation were calculated and related to utility gain and QALY. Results: The cost/QALY for patients with SNHL was estimated at (sic)7260/QALY, and for patients with C/MHL at (sic)12 503/QALY.

  • 10.
    Emgård, Per
    et al.
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Hellström, Sten
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Holm, Stig
    External otitis caused by infection with Pseudomonas aeruginosa or Candida albicans cured by use of a topical group III steroid, without any antibiotics2005In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 125, no 4, p. 346-352Article in journal (Refereed)
    Abstract [en]

    CONCLUSIONS: Irrespective of the microbial agent, group III steroid solution cured external otitis efficiently in a rat model. The addition of antibiotic components to steroid solutions for the treatment of external otitis is of questionable validity. OBJECTIVE: External otitis, caused by infection with either Pseudomonas aeruginosa or Candida albicans, was established in a rat model and the treatment efficacy of a group III steroid solution was studied. MATERIAL AND METHODS: Three treatments were studied: (i) a group III steroid solution; (ii) a group I steroid combined with two antibiotic components; and (iii) a saline solution. A scoring scale was used to evaluate the characteristics of the ear canal skin. Bacteriological and fungal samples were collected for culturing and ear canal skin biopsies were taken for structural analyses. RESULTS: It was possible to cause P. aeruginosa and C. albicans infections in an animal model. In the P. aeruginosa-infected animals, only the group III steroid treatment cured all the animals. In the C. albicans-infected animals, group III steroid treatment resolved external otitis faster than the other treatment modalities.

  • 11.
    Franklin, Karl A.
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Haglund, Bengt
    Axelsson, Susanna
    Holmlund, Thorbjörn
    Rehnqvist, Nina
    Rosen, Måns
    Frequency of serious complications after surgery for snoring and sleep apnea2011In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 131, no 3, p. 298-302Article in journal (Refereed)
    Abstract [en]

    Conclusion: No case of death related to surgery in the form of uvulopalatopharyngoplasty, uvulopalatoplasty or nasal surgery for snoring or sleep apnea has been recorded in Sweden among 4876 patients treated between 1997 and 2005. Severe complications of surgery in the peri-and postoperative period, especially in the form of bleedings and infections, were most common after uvulopalatopharyngoplasty, occurring in 3.7%. Objective: To investigate the frequency of serious complications, including death, of surgery for treatment of snoring and sleep apnea. Methods: All Swedish adults who were treated surgically because of snoring or sleep apnea from January 1997 to December 2005 were identified in the National Patient Register. Mortality and serious complications within 30 days from surgery were obtained from the National Cause of Death Register and the National Patient Register. Results: A total of 4876 patients were treated surgically. Uvulopalatopharyngoplasty was performed in 3572 patients, uvulopalatoplasty in 929 patients, and nasal surgery in 375 patients. None of the surgically treated patients died in the peri-and postoperative period. Severe complications, mainly bleedings and infections, were recorded in 37.1 per 1000 patients treated with uvulopalatopharyngoplasty, in 5.6 per 1000 patients after uvulopalatoplasty, and in 8.8 per 1000 patients after nasal surgery.

  • 12. Hallenstål, Niclas
    et al.
    Sunnergren, Ola
    Ericsson, Elisabeth
    Hemlin, Claes
    Sodermane, Anne-Charlotte Hessen
    Nerfeldt, Pia
    Odhagen, Erik
    Ryding, Marie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology. Department of Otorhinolaryngology, Östersund Hospital, Östersund, Sweden.
    Stalfors, Joacim
    Tonsil surgery in Sweden 2013-2015. Indications, surgical methods and patient-reported outcomes from the National Tonsil Surgery Register2017In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 137, no 10, p. 1096-1103Article in journal (Refereed)
    Abstract [en]

    Aim: To describes how tonsil surgery was performed in Sweden from 2013 to 2015 with data from the National Tonsil Surgery Registry in Sweden (NTSRS).

    Method: The registry collects data from both professionals and patients through questionnaires. A total of 33,870 tonsil surgeries were analysed, comprising approximately 80% of all tonsil surgeries in Sweden from 2013 to 2015.

    Results: The two most common procedures were tonsillectomy (41%) and tonsillotomy with adenoidectomy (38%). Tonsillectomy was most commonly performed to treat frequent tonsillitis, while the main indication for tonsil surgery with combined adenoidectomy and for tonsillotomy alone was upper airway obstruction. The most commonly used techniques were cold steel (70%) for tonsillectomy/adenotonsillectomy and radiofrequency (79%) for tonsillotomy/adenotonsillotomy. Ninety-five percent of patients reported symptom relief after 180 d. Day surgery was utilised in 70% of the surgeries. The rate of readmission due to post-tonsillectomy haemorrhage was 5.1%. Male patients more often underwent tonsil surgery at preschool ages due to upper airway obstruction; in comparison, female patients to a larger extent underwent surgery in their early teens because of previous infections.

    Conclusions: The NTSRS provides an opportunity to survey tonsil surgery in Sweden and to launch and follow up improvement programmes as desired.

  • 13. Hammarstedt, Lalle
    et al.
    Dahlstrand, Hanna
    Lindquist, David
    Karolinska Instituet, Institutionen för Onkologi-Patologi.
    Onelöv, Liselotte
    Ryott, Michael
    Luo, Juhua
    Dalianis, Tina
    Ye, Weimin
    Munck-Wikland, Eva
    The incidence of tonsillar cancer in Sweden is increasing.2007In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 127, no 9, p. 988-92Article in journal (Refereed)
    Abstract [en]

    CONCLUSIONS: The incidence of tonsillar cancer in Sweden is increasing, particularly among men. Risk factors other than smoking may have contributed to the observed secular trend in men. In women, however, smoking can be a part of the explanation. Further studies to look at changes in other environmental factors, such as human papilloma virus (HPV) infection, are clearly warranted.

    OBJECTIVES: Head and neck cancer is related to smoking habits and smoking has decreased substantially during the last 30 years in Sweden. However, there is suspicion that the incidence of tonsillar cancer has increased in the last 30 years as it has in the USA and Finland, in spite of reduced prevalence of known risk factors. The time trends of oral and oropharygeal cancer have been studied in Sweden, but not tonsillar cancer specifically.

    SUBJECTS AND METHODS: We used the Swedish Cancer Registry to assess the secular trend of incidence of tonsillar cancer in Sweden since 1960. For comparison we investigated the incidence of other oral cancers and lung cancer, which are also smoking-related. The prevalence of smoking was investigated for reference. Age-standardized incidence rates were calculated and linear regression was used to evaluate secular trends.

    RESULTS: The incidence of tonsillar cancer increased by 2.6% per year in men and 1.1% in women. No similar increase was seen in the other oral cancers. For lung cancer there was a decrease in the incidence in men, but in women the incidence is still increasing.

  • 14. Hertegård, S
    et al.
    Dahlqvist, A
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Goodyer, E
    Viscoelastic measurements after vocal fold scarring in rabbits: short-term results after hyaluronan injection2006In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 126, no 7, p. 758-763Article in journal (Refereed)
  • 15. Hertegård, Stellan
    et al.
    Hallén, Lars
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Laurent, Claude
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Lindström, Elisabeth
    Olofsson, Katarina
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Testad, Per
    Dahlqvist, Ake
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Cross-linked hyaluronan versus collagen for injection treatment of glottal insufficiency: 2-year follow-up.2004In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 124, no 10, p. 1208-1214Article in journal (Refereed)
  • 16.
    Holm, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Hellman, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Laurent, Claude
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology. Department of Speech and Language Pathology and Audiology, University of Pretoria, South Africa.
    Laurell, Göran
    Nylander, Karin
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Olofsson, Katarina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Hyaluronan in vocal folds and false vocal folds in patients with recurrent respiratory papillomatosis2018In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 138, no 11, p. 1020-1027Article in journal (Refereed)
    Abstract [en]

    Background: Hyaluronan (HA) is a glycosaminoglycan with viscoelastic properties necessary for vocal fold (VF) vibration and voice production. Changes in HAs molecular mass, possibly related to human papilloma virus, could affect formation/persistence of recurrent respiratory papillomatosis (RRP).

    Aims/Objective: Describing mass and localization of HA and localization of HA receptor CD44 in VF and false vocal folds (FVF) in RRP.

    Materials and Methods: Biopsies from VF and FVF from 24 RRP patients. Twelve were studied with histo-/immunohistochemistry for HA and CD44 in epithelium, stroma and RRP lesions. Twelve samples were analyzed for HA molecular mass distribution with gas-phase-electrophoretic-molecular-mobility-analyzer (GEMMA).

    Results: Three of 23 stains (VF and FVF combined) showed faint HA staining in the epithelium; there was more extensive staining in the stroma. CD44 was present throughout all areas in FVF and VF, it did not concur with HA. GEMMA analysis revealed very high mass HA (vHMHA) with more varying amounts in VF.

    Conclusions/Significance: HA was mainly distributed in the stroma. CD44 not binding to HA might explain the non-inflammatory response described in RRP. Possibly crosslinked vHMHA was seen in VF and FVF, with more variable amounts in VF samples. Counteracting HA crosslinking could become a treatment option in RRP.

  • 17.
    Hulterström, Anna Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Technology/Dental Materials Science.
    Sellin, Mats
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Monsen, Tor
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Widerström, Micael
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Gurram, Bharath Kumar
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Berggren, Diana
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Bacterial flora and the epidemiology of staphylococcus aureus in the nose among patients with symptomatic nasal septal perforations2016In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 136, no 6, p. 620-625Article in journal (Refereed)
    Abstract [en]

    Conclusions Patients with symptomatic perforations of the nasal septum had a high prevalence of S. aureus in the nasal mucosa. Pulsed field gel electrophoresis (PFGE) analysis revealed a high genetic heterogeneity of S. aureus among both patients and controls. This indicates that presence of different strains of S. aureus can maintain a chronic inflammation in symptomatic nasal septal perforations. Objective The purpose of this study was to investigate the microbial flora around nasal septal perforations in patients having severe symptoms regarding bleeding, obstruction, and crustation associated with their perforation. Methods Twenty-five patients with untreated symptomatic nasal septal perforations were included. For culture, swabs around the perforations were collected. Bacteria were identified with standard laboratory techniques including a MALDI-TOF mass spectrometer. Epidemiological analysis was done using PFGE protocols. Bacteriological data were compared with data from a healthy control group. Results Staphylococcus aureus was present in the mucosa surrounding the nasal perforation significantly more often (p < 0.0001) in the patients (88%) compared to a control group (13%). Corynebacterium spp. and Propionibacterium spp. were significantly more frequently identified in the control group. The PFGE analysis of S. aureus strains revealed a high genetic heterogeneity and no specific S. aureus genotypes were associated with septal perforation.

  • 18.
    Isberg, A
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Levring-Jäghagen, E
    Umeå University, Faculty of Medicine, Department of Odontology.
    Dahlström, M
    Dahlqvist, A
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Persistent dysphagia after laser uvulopalatoplasty: a videoradiographic study of pharyngeal function.1998In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 118, no 6, p. 870-874Article in journal (Refereed)
    Abstract [en]

    In a follow-up study of 79 patients two years after laser uvulopalatoplasty 21 (27%) reported persistent postoperative dysphagia, with aspiration symptoms in 22%. None of the patients had suffered from recurrent pneumonia. A total of 4% of the patients regretted the treatment because of their dysphagia problems. The objective of this study was to examine oral and pharyngeal function videoradiographically during swallowing in the patients with persistent dysphagia, to determine whether the subjective symptoms of dysphagia correlated with objective signs of pharyngeal dysfunction. Pharyngeal function during swallowing was deviant in 76% of the dysphagic patients. In 52% of the dysphagic patients premature leakage of bolus down to different levels of the pharynx, from the tongue base to sinus piriformis, was observed before the swallowing reflex was elicited. In the dysphagic patients substantial bolus retention was observed on the epiglottis or in the valleculae alter the propagation wave had passed (43%) as well as epiglottal dysmotility (24%). Of the dysphagic patients, 10% could not avoid aspiration during the examination. These findings could explain the symptoms reported by the patients.

  • 19.
    Jäghagen, Eva Levring
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Berggren, Diana
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Dahlqvist, Ake
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Isberg, Annika
    Prediction and risk of dysphagia after uvulopalatopharyngoplasty and uvulopalatoplasty.2004In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 124, no 10, p. 1197-1203Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To test the hypothesis that preoperative asymptomatic pharyngeal swallowing dysfunction predisposes for the development of symptoms of dysphagia after uvulopalatopharyngoplasty (UPPP) and uvulopalatoplasty (UPP). MATERIAL AND METHODS: A total of 42 patients who snored were scheduled to undergo UPPP (n = 20) or UPP (n = 22). UPP was performed using either a CO2 laser or a conventional steel scalpel. Preoperatively and 1 year postoperatively all patients were examined videoradiographically to assess pharyngeal swallowing function. They also completed a questionnaire pre- and postoperatively concerning their snoring problems and swallowing function as well as the outcome of surgery. RESULTS: Preoperatively, 7 (17%) patients reported dysphagia. Pharyngeal swallowing dysfunction was demonstrated in 6/7 patients with preoperative dysphagia while pharyngeal swallowing dysfunction was evident preoperatively in 18/35 non-dysphagic patients. Of the 35 patients without preoperative dysphagia, 10 (29%/) developed dysphagia after surgery. There was no significant risk of development of postoperative dysphagia for patients with compared to patients without preoperative pharyngeal swallowing dysfunction. Only one of the seven patients with preoperative dysphagia experienced worsening of the problem. A total of 93% of the patients reported a decrease in snoring and 95% reported a decrease in daytime sleepiness. CONCLUSIONS: Preoperative pharyngeal swallowing dysfunction was not proven to predict the development of dysphagia after UPPP or UPP. The surgical method did not influence the frequency of postoperatively acquired dysphagia. The results do not indicate that patients with preoperative dysphagia should be excluded from treatment with UPPP or UPP.

  • 20.
    Kobayashi, Masamichi
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology. Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Japan.
    Sone, Michihiko
    Umemura, Masayuki
    Nabeshima, Toshitaka
    Nakashima, Tsutomu
    Hellström, Sten
    Comparisons of cochleotoxicity among three gentamicin compounds following intratympanic application2008In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 128, no 3, p. 245-249Article in journal (Refereed)
    Abstract [en]

    CONCLUSION: Among the three main gentamicin (GM) compounds following intratympanic application, the cochleotoxicity of C2 was the most severe, whereas that of C1a was the weakest. Understanding of the different cochleotoxicity characteristics of each compound may be of use in future custom-made intratympanic therapy for Ménière's disease.

    OBJECTIVE: To investigate differences in cochleotoxicity among three major GM compounds following intratympanic application.

    MATERIALS AND METHODS: Three GM compounds (C1, C2, and C1a) were isolated. Sprague-Dawley rats were treated every 2 days for 2 weeks with intratympanic application of saline, GM complex, C1, C2, and C1a. The cochleotoxicity of each compound was assessed by measuring auditory brainstem response (ABR) and through morphological analyses using scanning electron microscopy.

    RESULTS: The ABR threshold of the C2 group was found to be more impaired than those of the other groups. The C1a group showed the mildest elevation of the ABR thresholds. Morphological analyses revealed that the proportion of remaining outer hair cells (OHCs) was the lowest in animals treated with C2. Morphologically, the C1 and C1a groups showed the least damage to OHCs.

  • 21.
    Laurell, Göran
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology. Institut National de la Santé et de la Recherche Médicale, Department of Physiology, Faculté Xavier Bichat, Université Paris, Center for Hearing and Communication.
    Teixeira, Marie
    Duan, Maoli
    Sterkers, Olivier
    Ferrary, Evelyne
    Intact blood-perilymph barrier in the rat after impulse noise trauma2008In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 128, no 6, p. 608-612Article in journal (Refereed)
    Abstract [en]

    CONCLUSION: The permeability of the blood-labyrinth barrier for radioactive mannitol was unchanged after impulse noise trauma. The present findings are contradictory to the theory of an increased permeability in the blood-labyrinth barrier as a result of extensive noise exposure.

    OBJECTIVE: Noise trauma is reported to cause multiple effects on the cochlea including mechanical and metabolic damage. The aim of the study was to observe the effects of impulse noise on cochlear homeostasis.

    MATERIALS AND METHODS: A well-established rat model was used for evaluation of the early effects of impulse noise trauma on the integrity of the blood-perilymph barrier. To evaluate whether a blood-perilymph barrier disruption contributes to cochlear injury after impulse noise, the paracellular transport of radioactive mannitol into scala vestibuli perilymph (PLV) and electrolyte concentration in perilymph were estimated. Thirteen animals exposed to synthesized impulses of 160 dB SPL peak value, at a rate of 100 pulses, were designed as the study group and 15 rats not exposed to noise were designed as the control group. After mannitol infusion each ear of the animal in the study group was separately exposed to impulse noise and PLV samples were taken during 2 h post-infusion. In the control group, corresponding PLV samples were taken after mannitol injection.

    RESULTS: At 2 h after mannitol infusion there was no difference in PLV mannitol concentration in the study group and control group (21.5%+/-2.2 and 20.5%+/-2.1, respectively). Impulse noise had no effect on the electrochemical composition of PLV.

  • 22.
    Levring Jäghagen, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Berggren, D
    Isberg, A
    Swallowing dysfunction related to snoring: a videoradiographic study.2000In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 120, no 3, p. 438-43Article in journal (Refereed)
    Abstract [en]

    Biopsy studies of the soft palatal and oropharyngeal tissues in habitual snorers and patients suffering from obstructive sleep apnoea have shown signs of neurogenic lesions. These lesions might affect the pharyngeal swallowing function, which is dependent on adequate sensitivity. The objective of the present study was to test the hypothesis that snoring is associated with aberrant pharyngeal swallowing function. Forty-one consecutive patients without dysphagia, seeking medical attention because of heavy snoring and various degrees of daytime sleepiness, were prospectively selected. Fifteen non-snoring volunteers without dysphagia served as controls. Patients and volunteers were videoradiographically examined in lateral and posteroanterior views during the oral and pharyngeal phases of swallowing. The hypothesis was verified. Snoring patients demonstrated deviant pharyngeal swallowing function seven times more frequently than did the non-snoring volunteers. Deviant pharyngeal swallowing function was observed in 22 (54%) of the snorers compared with 1 (7%) of the non-snoring volunteers. Impaired bolus control with premature leakage of bolus into the pharynx and a delayed evocation of the swallowing reflex was the most common finding, followed by bolus residual in the pharynx and laryngeal penetration. The conclusion was that snoring is associated with subclinical pharyngeal swallowing dysfunction.

  • 23. Lindblom, Ulrika
    et al.
    Nilsson, Per
    Gärskog, Ola
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Kjellen, Elisabeth
    Laurell, Göran
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Wahlberg, Peter
    Zackrisson, Björn
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Aspiration as a late complication after accelerated versus conventional radiotherapy in patients with head and neck cancer2016In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 136, no 3, p. 304-311Article in journal (Refereed)
    Abstract [en]

    Conclusion Neck dissection after radiotherapy increased the risk of aspiration as a late effect in a sub-sample of patients treated for head and neck cancer in the ARTSCAN study. Patients treated with accelerated fractionation (AF) developed aspiration, with or without coughing, more frequently than patients treated with conventional fractionation (CF). Objectives A long-term follow-up study was conducted to determine the frequency of aspiration as a late effect in patients with head and neck cancer treated with AF or CF. Method One-hundred and eight patients were recruited from two centres of the Swedish multi-centre study, ARTSCAN, where AF and CF were compared. Patients with positive lymph nodes were treated with neck dissection after completing radiotherapy. The follow-up was performed at a median of 65 months after initiation of radiotherapy and included an ENT and a videofluoroscopic examination. Results Aspiration was found in 51/108 (47%) and silent aspiration in 34/96 (35%) patients. Neck dissection (n = 47 patients) was significantly associated with both aspiration and silent aspiration. Aspiration was more common among patients treated with AF (34/61; 56%) compared to CF (17/47; 36%; p = 0.053). Silent aspiration was also more common after AF (24/54; 44%) than after CF (10/42; 24%; p = 0.052).

  • 24. Lindell Jonsson, Eva
    et al.
    Nylander, Karin
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Hallen, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Laurell, Goran
    Immunohistochemical analysis of EGFR and hyaluronan in tongue cancer and the development of regional recurrence in patients initially diagnosed N02017In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 137, no 8, p. 877-882Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate whether the extent of expression of hyaluronan (HA) and epidermal growth factor receptor (EGFR) in squamous cell carcinoma of the mobile tongue can predict the risk of cervical metastasis and survival.

    Study design: Retrospective histopathologic study.

    Methods: Surgical specimens from 64 patients who had undergone surgery for squamous cell carcinoma of the mobile tongue were assessed using immunohistochemistry to investigate the expression of HA and EGFR in the primary tumours, and the data were then correlated to cervical metastasis and survival.

    Results: There was a significant correlation between the intensity of HA staining and patient survival (p .024), and a weak correlation between the staining proportion of EGFR and the risk for regional recurrence (AUC 66).

    Conclusions: This study indicates that immunoscoring using HA could be used to provide prognostic tools for tongue cancer, and that it might be of interest to study the prognostic properties of EGFR further concerning the risk for regional recurrence after the primary treatment.

  • 25.
    Loizou, Christos
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Laurell, Göran
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Arvidsson, Andreas
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Lindquist, David
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Nylander, Karin
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Olofsson, Katarina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Recurrent respiratory papillomatosis in northern Sweden: Clinical characteristics and practical guidance2015In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 135, no 10, p. 1058-1064Article in journal (Refereed)
    Abstract [en]

    Conclusion: Recurrent respiratory papillomatosis (RRP) patients with high surgical treatment frequency (>= 1/year, HF) were significantly younger and had a more widespread laryngeal disease compared to a low frequency treated group (< 1 treatment/year, LF). This study confirms the existence of a clinical RRP group, not primarily related to HPV sub-type, but more care-intensive and in need of more vigilant follow-up. Objectives: RRP is associated with high morbidity due to its influence on breathing and voice. The purpose of this study was to characterize RRP patients in northern Sweden and investigate possible predictor factors affecting therapeutic needs. Method: Patients from the regional referral area (northern Sweden) were categorized for age, disease duration, juvenile or adult onset, profile of disease development, number of surgical sessions in relation to disease duration, laryngeal deposition of papilloma, gender, and HPV sub-types, in order to identify patients with increased need for frequent surgical treatment. Results: The median age of the RRP patients (n = 48) was 44.5 years; 34 (71%) were males and 14 (29%) females, most were infected with HPV 6. Patients with high surgical treatment frequency/year were significantly younger and showed more widespread papillomatous vegetation in the larynx, compared to the low frequency treated group.

  • 26.
    Loizou, Christos
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Laurell, Göran
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology. Department of Surgical Sciences, Division of Otorhinolaryngology, Uppsala University.
    Lindquist, David
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Olofsson, Katarina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Voice and quality of life in patients with recurrent respiratory papillomatosis in a northern Sweden cohort2014In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, ISSN 1651-2251 (online), Vol. 134, no 4, p. 401-406Article in journal (Refereed)
    Abstract [en]

    Abstract Conclusion:

    The frequency of operations, age at onset, gender and subtype of the human papilloma virus (HPV) may be used as factors to predict voice disability.

    Objectives:

    Patients with recurrent respiratory papillomatosis (RRP) are characterized by morbid consequences due to a lifelong repetitive influence on voice and breathing ability and the need for recurrent surgical treatments. The aim of the study was to measure the quality of voice and life using evaluated and validated questionnaires in a northern Sweden RRP population.

    Methods:

    A total of 27 consecutive patients with RRP (age 21-71 years, median 47 years) were evaluated 3 months postoperatively (CO2 laser treatment) using the voice handicap index (VHI) and SF-36 questionnaires to assess the impact on life and voice in an RRP population. The values were compared to historical normative data, VHI ≤ 20.

    Results:

    Patients that underwent more than one operation per year were younger (p = 0.028) than those treated less frequently. The mean VHItotal score in patients with RRP was 39.3, indicating a statistically significant impairment of voice quality (p < 0.001) as compared with normal subjects. Voice dysfunction was observed in 21 patients (78%). Significantly lower values than the normal population regarding the quality of life in patients with RRP were obtained in the domain of social functioning (p = 0.029). Females, patients with frequent surgical treatment sessions and patients with the high-risk HPV types scored significantly lower in several domains of the quality of life assessment as compared with normal subjects. The results should be interpreted with caution due to the limited number of subjects.

  • 27.
    Mattsson, Cecilia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Berggren, Diana
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Hellström, Sten
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Myringotomized tympanic membranes cultured in vitro do not develop myringosclerosis2002In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 122, no 2, p. 168-172Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate the development of myringosclerosis in in vitro-cultured tympanic membranes. Sprague-Dawley rats were myringotomized bilaterally and the tympanic membranes were excised after sacrifice. The explants were placed in inserts in wells filled with a nutrient medium. Every second day the tympanic membranes were photodocumented and after 9 days the explants were prepared for histology. On the 4th day the explants had attached to the bottom of the inserts and the specimens had thickened. From the perforation borders and the dissection edges a thin outgrowth was extending across the surface. By Day 9 the perforation had clearly diminished in size when examined in a stereomicroscope. In a light microscope the keratin layer was seen to protrude towards the centre of the perforation and, at the borders, epithelial cells were bridging the gap. Neither the pars tensa nor the pars flaccida showed any sclerotic lesions. The pars flaccida had thickened and the basal cells of the outer keratinized epithelium had invaded the connective tissue. Inflammatory cells were sparse in both the pars tensa and pars flaccida. The in vitro-cultured myringotomized tympanic membrane therefore shows a similar healing pattern to that in vivo. However, inflammatory reactions are sparse and there is no development of myringosclerosis.

  • 28. Niklasson, Anders
    et al.
    Tano, Krister
    Self-inflicted negative pressure of the external ear canal: a common cause of isolated malleus fractures2010In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 130, no 3, p. 410-416Article in journal (Refereed)
    Abstract [en]

    We report the investigation of the cause of isolated malleus fractures based on four recent patients at our clinic and five patients reported to us by Swedish otosurgeons. In recent years we have treated four patients with isolated malleus fractures. Colleagues in the Swedish Society of Otosurgeons were encouraged to send us reports on patients with diagnosed isolated malleus fractures, resulting in five more cases. A literature review focusing on the cause and management of this injury was also conducted. Eight of nine patients in the Swedish material had the same history. The patients had inserted a finger into the external auditory canal (most often after a bath) and then pulled it out. Immediately afterwards they experienced a short pain and a hearing loss. An audiogram revealed a conductive hearing loss. After exploration of the middle ear, the most common operation performed was ossiculoplasty. In the present material the most common cause of isolated malleus fractures was a sudden negative pressure in the external auditory canal created by a quick outward movement of a finger in the external ear canal. Since this fracture appears to be infrequent, it can easily be missed at otomicroscopic examination. Tympanometry and pneumatic otomicroscopy are helpful diagnostic tools.

  • 29.
    Nordin, Steven
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Brämerson, Annika
    Department of Otorhinolaryngology, Central Hospital, Skövde, Sweden.
    Bende, Mats
    Department of Otorhinolaryngology, Central Hospital, Skövde, Sweden.
    Prevalence of self-reported poor odor detection sensitivity: The Skövde population-based study2004In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 124, no 10, p. 1171-1173Article in journal (Refereed)
    Abstract [en]

    Objective: To enable adequate planning of ENT healthcare it is important to know the prevalence of olfactory dysfunction in the general population. Whether an individual will actually seek medical attention for olfactory dysfunction is likely to depend predominantly on his/her self-evaluation of the sense of smell. This motivated an investigation of the prevalences of self-reported poorer- and better-than-normal odor detection sensitivity in the general population.

    Material and Methods: A random sample of 1900 adult inhabitants, stratified for age and gender, was drawn from the municipal population register of Skövde, Sweden. Subjects were asked to attend a structured interview concerning their self-evaluation of their odor detection sensitivity.

    Results: In total, 1387 volunteers (73% of the sample) were investigated. The overall prevalences of self-reported poorer- and better-than normal odor detection sensitivity were 15.3% and 17.4%, respectively. The prevalence of poorer sensitivity was found to increase with age, and the prevalence of better sensitivity was lower in men than women.

    Conclusions: Considering the fairly high participation rate in this study and the fact that the population of Skövde is representative of the general Swedish population, the obtained prevalences can be considered representative of the general Swedish adult population.

  • 30.
    Nordin, Steven
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Hedén Blomqvist, Ebba
    Department of Clinical Science, Intervention and Technology,.
    Olsson, Petter
    Department of Clinical Science, Intervention and Technology,.
    Stjärne, Pär
    Department of Clinical Science, Intervention and Technology,.
    Ehnhage, Anders
    Department of Clinical Science, Intervention and Technology,.
    Effects of smell loss on daily life and adopted coping strategies in patients with nasal polyposis with asthma2011In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 131, no 8, p. 826-832Article in journal (Refereed)
    Abstract [en]

    CONCLUSIONS: Results from prior studies of quality of life (QoL) in heterogeneous patient groups (regarding disorder type and etiology) with olfactory disorders may be useful also for understanding QoL in homogeneous patient groups. Diagnosis and treatment of smell loss should be given high priority in polyposis with asthma, and coping strategies can be suggested to these patients.

    OBJECTIVES: To investigate the effects of smell loss on daily life and coping strategies in patients with smell loss without dysosmia and with nasal polyposis with asthma as the only primary etiology, and to compare these results with those from a prior study of a patient group with heterogeneous olfactory disorders and etiology.

    METHODS: Fifty patients with smell loss and with nasal polyposis and asthma responded to questions about consequences of smell loss, QoL, psychological well-being and distress, and coping strategies.

    RESULTS: Negative consequences of smell loss, associated risks, and diminished food enjoyment were commonly reported, and various aspects of QoL were rated as being deteriorated. Psychological well-being was found to be poorer than normal, and use of both problem- and emotion-focused strategies was common. The results from this homogeneous patient group are very similar to those previously obtained from a heterogeneous group.

  • 31.
    Nordin, Steven
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nyroos, Mikaela
    Umeå University, Faculty of Social Sciences, Department of applied educational science. Umeå University, Faculty of Social Sciences, Department of Education.
    Maunuksela, E.
    Department of Food Technology, University of Helsinki, Helsinki, Finland.
    Niskanen, T.
    Department of Food Technology, University of Helsinki, Helsinki, Finland.
    Tuorila, H.
    Department of Food Technology, University of Helsinki, Helsinki, Finland.
    Applicability of the Scandinavian odor identification test: a Finnish–Swedish comparison2002In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 122, no 3, p. 294-297Article in journal (Refereed)
    Abstract [en]

    The possibility of using the Scandinavian Odor Identification Test (SOIT), developed for clinical purposes for use with Swedish subjects, for assessment of another northern European population was studied by comparing test performance between 127 Finnish and 127 Swedish participants, who were matched for age (19-85 years) and gender. The results showed very similar performance between countries and demonstrated, as expected, age- and gender-related differences in performance. Test-retest reliability was as good in Finnish as in Swedish subgroups of participants and no significant difference between countries in terms of diagnostic distribution (normosmia, hyposmia and anosmia) was found when using existing cut-off scores. The findings suggest that the SOIT, with its diagnostic cut-off scores, is reliable and valid for use with Finnish populations.

  • 32.
    Nordin, Steven
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Olsson, Petter
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Hedén Blomqvist, Ebba
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Stjärne, Pär
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Ehnhage, Anders
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Effects of FESS and additional fluticasone propionate nasal drops on psychological well-being in nasal polyposis with asthma2013In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 133, no 9, p. 939-943Article in journal (Refereed)
    Abstract [en]

    Conclusion: A combined therapy of fluticasone propionate nasal drops (FPND) and functional endoscopic sinus surgery (FESS) can improve quality of life (QoL). When compared with prior data, the results imply that a generic measure of psychological aspects of QoL may be better than measures of respiratory symptoms and clinical parameters to capture a patient's perception of the disease and its treatment. Objective: To better understand effects of FPND and FESS on generic QoL. Methods: Sixty nasal polyposis patients with concomitant asthma completed participation in a randomized, double-blind, placebo-controlled, 14-week study in which they responded to the General Well-Being Schedule (GWBS). Results: GWBS scores (i) increased significantly after administration of FPND, independent of FESS (from lower than normal to normal), (ii) increased after FESS independent of FPND (from lower than normal to normal), and (iii) increased additively after FPND and FESS.

  • 33.
    Olofsson, Katarina
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Mattsson, C
    Hammarström, Marie-Louise
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry.
    Hellström, S
    Structure of the human uvula1999In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 119, no 6, p. 712-717Article in journal (Refereed)
    Abstract [en]

    Eleven uvular biopsies were investigated for their morphology, the presence of mast cells and the distribution of hyaluronan and its major ligand CD44. Three microanatomical sites--surface epithelium, subepithelial area and area of glands--were examined. The oral side of the uvula was covered by a 15-20 cell thick layer of keratinized/parakeratinized surface epithelium, firmly anchored to the underlying connective tissue by connective tissue papillae. The width of the intercellular spaces in the epithelium increased toward the basal lamina, a location that exhibited intense hyaluronan and anti-CD44 staining. Most mast cells were located in the vicinity of blood vessels, at which sites there was high staining intensity of hyaluronan. Tissue mast cells could also be observed in the connective tissue septa enclosing the acini. Glands and muscle fibres became more sparse from the proximal part of the uvula to the distal end, while the amount of connective tissue increased. The localization and architecture of connective tissue elements and mast cells are consistent with the ability of the uvula to resist mechanical stresses and to develop oedema and fibrosis, respectively.

  • 34.
    Prestwich, Annika Hansson
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Li, Jinan
    Umeå University, Faculty of Medicine, Department of Medical Biochemistry and Biophysics.
    Eriksson, P O
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Ny, Tor
    Umeå University, Faculty of Medicine, Department of Medical Biochemistry and Biophysics.
    Berggren, Diana
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Hellström, Sten
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Lack of plasminogen does not alter the early inflammatory response following a tympanic membrane perforation: a study in plasminogen-deficient mice.2008In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 128, no 12, p. 1294-1302Article in journal (Refereed)
    Abstract [en]

    CONCLUSIONS: The results of the present study show that the early inflammatory response in plasminogen (plg)-deficient mice is not altered compared to that in wild-type (wt) mice. Therefore the chronicity of the perforation in the long-term healing experiment cannot be explained by an impairment of the early inflammatory response, but rather by an impairment in activation of the inflammatory cells. These findings give further insight into the mechanisms resulting in a clinically seen chronic tympanic membrane (TM) perforation and thus possible therapeutic strategies to replace today's conventional surgical treatment of these perforations. OBJECTIVES: Plg has been shown to play an essential role in the healing of TM perforations. In plg-deficient mice a completely arrested healing reaction was seen, resulting in a chronic TM perforation. The mechanisms involved seem to be an abundant neutrophil recruitment, an accumulation of macrophages, an arrested keratinocyte migration, and a massive deposition of fibrin along the TM tissue. However, the exact functional role of plg in the early inflammatory response during healing of TM perforation remains unclear. This study aimed to evaluate the early inflammatory response, mainly the occurrence of macrophages and neutrophils, during the first 48 h following a perforation in the pars tensa (PT) of the TM, in mice lacking the plasminogen gene compared to the corresponding response in wt mice. MATERIALS AND METHODS: The TMs were perforated in 45 plg-deficient and 39 wt mice. Otomicroscopic evaluation was performed at 3, 6, 9, 12, 18, 24, and 48 h after the perforation was made. Mice were harvested at all time points and prepared for morphology including immunohistochemistry (IHC). IHC was performed with antibodies targeting macrophages, neutrophils, T and B cells, cytokeratin, and fibrin(ogen). Morphometry was performed regarding the volume percentage of TM tissue occupied by the different inflammatory cells. RESULTS: Perforation of the TM resulted in early otomicroscopic changes of the pars flaccida (PF) in both genotypes. Infiltration of inflammatory cells to PF and the presence of edema occurred as early as 6 h after the perforation was made, in both plg-deficient and wt mice. Morphometry did not reveal any significant differences between the genotypes concerning the occurrence of inflammatory cells. In contrast to the PF, the PT showed only sparse reactions during the experimental period. Furthermore, the migration pattern of keratinocytes did not differ between the genotypes throughout the experimental period.

  • 35.
    Spratley, Jorge
    et al.
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Hellström, Sten
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Eriksson, Per Olof
    Umeå University, Faculty of Medicine, Clinical Sciences.
    Pais-Clemente, Manuel
    Early structural tympanic membrane ractions to myringotomy: A study in an acute otitis media model.2002In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 122, no 5, p. 479-487Article in journal (Refereed)
    Abstract [en]

    Myringotomy (Myr) is one of the most frequently performed surgical procedures in children. However, events occurring in the early phases, i.e. a matter of hours, following Myr in the acute otitis media (AOM) model have not been described. The aim of the present study was to evaluate the early otomicroscopic and histopathologic reactions of the tympanic membrane (TM) after Myr during the course of AOM (AOM-Myr). The left tympanic bulla from 36 healthy Sprague-Dawley rats was inoculated with Streptococcus pneumoniae type 3. Forty-eight h later, at Day 0, 4 randomized animals were immediately sacrificed and the remaining animals were treated with bilateral Myr. Otomicroscopy and sacrifices were performed in series of 4 animals at 3, 6, 9, 12, 24 and 48 h, and 4 and 7 days. The AOM-Myr TMs were compared to non-infected Myr TMs (non-AOM-Myr). The TMs were then dissected free and routinely processed for light and electron microscopy. AOM developed in all inoculated ears at Day 0. In the pars tensa of the AOM-Myr TMs the reaction of the keratinocyte layer of the perforation border was already evident at 6 h. The lamina propria exhibited a strong inflammatory reaction, which became more organized from 12 h onwards. At Day 4 the perforations were closed in three-quarters of cases. At Day 7 all perforations were healed with a distorted scar. In the non-AOM Myr TMs a strong degranulation of mast cells and edema were found in the pars flaccida at 6 h. A keratin spur at the perforation border was not seen until 24 h. All perforations were patent on Day 7 and myringosclerotic deposits were abundant in these TMs. The infected TMs regenerated faster and closed their perforations at an earlier stage. These findings favor the hypothesis that there is a low risk of chronic perforations when myringotomizing AOM TMs.

  • 36.
    Stepanidis, Karen
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Kessel, Marie
    Caye-Thomasen, Per
    Stangerup, Sven-Eric
    Socio-demographic distribution of vestibular schwannomas in Denmark2014In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 134, no 6, p. 551-556Article in journal (Refereed)
    Abstract [en]

    Conclusion: Vestibular schwannomas (VSs) are diagnosed less frequently in the remote parts of Denmark, whereas the diagnostic age and tumor size is the same across the different socio-demographic areas of Denmark. Objective: To determine whether VSs are diagnosed equally often in different socio-demographic areas of Denmark and whether a change has occurred during the period 1976-2012. In addition, differences in diagnostic age and tumor size between areas were explored. Methods: Since 1976, all patients diagnosed with a VS in Denmark have been registered in a national database, in which information on, for example, the size of the tumor and the age and address of the patient has been registered. Up to 2012, 2739 patients were diagnosed with a VS. Patient distribution according to area of habitat was determined by subgrouping into urban, suburban, rural, and remote municipalities, using the definitions of socio-demographic areas elaborated by Demarks Statistic. Results: The mean national incidence increased almost linearly over the time period from 6.1 per million per year in the first period from 1976 to 1984, to 22.1 per million per year in the last period from 2003 to 2012. There was a lower incidence at the end of the period in the remote areas compared with the other socio-demographic areas (1976-1984, p = 0.05 and 2003-2011, p = 0.001). The mean age at diagnosis increased during the period, from 52.6 years in the first period to 58.6 years in the last period. There was no significant difference in the age distribution between socio-demographic areas. The mean diagnostic tumor size decreased during the period, from 28.6 mm in the first period to about 10 mm in the last period. There was no significant difference in the size of the tumor between socio-demographic areas.

  • 37. Tano, Liselott
    et al.
    Tano, Krister
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology. Department of Otolaryngology, Sunderby Hospital, Luleå, Sweden.
    A daily nasal spray with saline prevents symptoms of rhinitis2004In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 124, no 9, p. 1059-1062Article in journal (Refereed)
    Abstract [en]

    Objective: To ascertain whether a daily nasal spray with physiological saline could prevent symptoms of common cold in a population of otherwise healthy adults.

    Material and Methods: This was study involving 10 weeks of daily use of a nasal saline spray and 10 weeks of only recording symptoms. Young adults eligible for military service at an army barrack in Boden, Sweden were invited to participate in the study and 108 healthy conscripts aged approximate to 20 years agreed to do so. Data were recorded by the participants in a diary at home. In the diary the participants noted symptoms such as rhinitis, blocked nose, cough, fever and sore throat (pharyngeal pain). They also recorded inability to perform their duties due to the symptoms, and any medication or antibiotics necessitated by upper respiratory tract infection.

    Results: A total of 69 subjects completed the 20-week diary period. For 60 of them, compliance during the spray period exceeded 60% and their data were used in the statistical calculations. During the spray period the number of days with nasal secretion and/or blocked nose (mean 6.4 days) was significantly (p= 0.027) lower than that during the observation period (mean 11 days). Furthermore, the participants had a mean of 0.7 episodes of upper respiratory tract infection during the spray period, compared with 1.0 episodes during the observation period (p= 0.05).

    Conclusion: A daily nasal spray with saline can prevent nasal symptoms of common cold in a population of otherwise healthy adults.

  • 38. Videhult Pierre, Pernilla
    et al.
    Engmér, Cecilia
    Wallin, Inger
    Laurell, Göran
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Ehrsson, Hans
    High concentrations of thiosulfate in scala tympani perilymph after systemic administration in the guinea pig2009In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 129, no 2, p. 132-137Article in journal (Refereed)
    Abstract [en]

    CONCLUSION: High concentrations of the antioxidant thiosulfate reach scala tympani perilymph after i.v. administration in the guinea pig. Thiosulfate concentrations in perilymph remain elevated longer than in blood. This warrants further studies on the possibility of obtaining otoprotection by thiosulfate administration several hours before that of cisplatin without compromising the anticancer effect caused by cisplatin inactivation in the blood compartment.

    OBJECTIVE: Thiosulfate may reduce cisplatin-induced ototoxicity, presumably by oxidative stress relief and formation of inactivate platinum complexes. This study aimed to explore to what extent thiosulfate reaches scala tympani perilymph after systemic administration in the guinea pig.

    MATERIALS AND METHODS: Scala tympani perilymph (1 microl) was aspirated from the basal turn of each cochlea up to 3 h after thiosulfate administration (103 mg/kg b.w., i.v.). Blood samples were also taken. Thiosulfate was quantified by HPLC and fluorescence detection.

    RESULTS: Substantial thiosulfate concentrations were found in perilymph. The area under the concentration-time curve for thiosulfate in perilymph and blood was 3100 microMxmin and 6300 microMxmin, respectively. The highest thiosulfate concentrations in perilymph were found at the first sampling at about 10 min. Due to a more rapid elimination from blood, perilymph concentrations exceeded those of blood towards the end of the experiment.

  • 39.
    Wagner, Niels
    et al.
    Departments of Otorhinolaryngology, Head and Neck Surgery, Gentofte University Hospital of Copenhagen, Hellerup, Denmark.
    Cayé-Thomasen, Per
    Departments of Otorhinolaryngology, Head and Neck Surgery, Gentofte University Hospital of Copenhagen, Hellerup, Denmark.
    Laurell, Göran
    Departments of Otorhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Bagger-Sjöbäck, Dan
    Departments of Otorhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Thomsen, Jens
    Departments of Otorhinolaryngology, Head and Neck Surgery, Gentofte University Hospital of Copenhagen, Hellerup, Denmark.
    Cochlear hair cell loss in single-dose versus continuous round window administration of gentamicin2005In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 125, no 4, p. 340-345Article in journal (Refereed)
    Abstract [en]

    CONCLUSIONS: Gentamicin-induced cochlear hair cell loss depends on local middle ear administration kinetics and the total drug dose. Single-dose gentamicin instillation in the middle ear is associated with a high variation in hair cell loss.

    OBJECTIVE: To compare the effects of single-dose and continuous round window administration of gentamicin on cochlear hair cell loss in a guinea pig model.

    MATERIAL AND METHODS: Two methods for drug administration to the inner ear were used. In groups of five animals, a total dose of 0.8 or 3.2 mg of gentamicin was either instilled as a single dose directly into the round window niche or administered continuously over a 1-week period using a pump-catheter system. Continuous administration was achieved by means of a posterior tympanotomy and subcutaneous placement of an osmotic pump fitted with a catheter. The tip of the catheter was fixed in the round window niche. One group of five animals served as controls and received a saline infusion. The animals were sacrificed after 1 week and hair cell loss was determined microscopically after dissection and phalloidin labelling of the basilar membrane and organ of Corti.

    RESULTS: Quantitation of cochlear hair cell loss revealed a dose-dependent effect of gentamicin. With both treatment modalities the higher dose induced a higher percentage of hair cell loss. There was inner and outer hair cell loss in all four groups that received gentamicin. With the single-dose instillation, hair cell loss was distributed irregularly from the round window membrane towards the cochlear apex, whereas continuous administration induced hair cell loss close to the round window membrane. Single-dose instillation induced greater hair cell loss than continuous administration at the same dose. The inter-individual variation in hair cell loss was highest following single-dose instillation.

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