Jørgen Lous

Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population‐based cross‐sectional study

Bowel dysfunction was assessed after low anterior resection with and without neoadjuvant therapy (NT) for rectal cancer using a novel symptom‐based scoring system correlated with quality of life.

Epidemiology of middle ear effusion and tubal dysfunction. A one-year prospective study comprising monthly tympanometry in 387 non-selected 7-year-old children

Abstract In a Danish school district comprising 387 7-year-old pupils 10 electroacoustic otoadmittance tests showed in the course of one year a 31% total morbidity of middle ear effusion (MEE), while 30% constantly had normal tympanograms on both sides. The point prevalence of MEE ranged from 9 to 3%, highest during the winter and spring months. In most cases MEE was present only at one examination, but in one-quarter of the cases it persisted for 3 months or longer. Spontaneous recovery occurred in a mean of about 2 months. MEE setting in during the period September to February lasted longer than cases setting in at other times of the year. The middle ear status was extremely dynamic, about one-quarter of the children changing status (type of tympanogram) between consecutive tests and 17% 5 or more times. Spontaneous improvement was frequent (90%) and so was complete recovery (76%), but in about one-third of the cases there was recurrences. It is emphasized that an indication for treatment cannot as a rule be based on one test and should await observation for about 3 or 4 months.

Secretory otitis media and language development: a six-year follow-up study with case-control

The 2nd Hjørring Cohort Study, a prospective cohort study, comprised 94% of the 463 three-year-old children residing in the municipality. Among this cohort we found 40 children (9%) who had constant signs of secretory otitis media (SOM), in one or both ears, at 4 examinations in the course of 6 months. Five years later, 12 of the children who had previously had long-lasting SOM had left the municipality. At the age of 8 years the entire cohort had a Silent Reading Word Test (OS-400). Six months later, the 26 children with long-lasting SOM who were still residing in the municipality and 26 control children were tested with the Revised Peabody Picture Vocabulary Test and the verbal part of the Wechsler Intelligence Scale for Children (WISC) test. The controls were matched by sex, age, school, grade level, and controlled for classroom and social stratum. The children with long-lasting SOM did not score lower than the control children on the 3 tests. In a separate analysis children with long-lasting bilateral SOM did not score lower than their controls. On the WISC and PPVT-R tests the variability in the case group was greater than in the control group. More comprehensive and varied studies seem needed to elucidate the relationship between language development and SOM.

Incidence of Otitis Media in a Contemporary Danish National Birth Cohort

Objectives In recent years welfare in Denmark has increased which might be expected to reduce otitis media (OM) incidence. We examined the age-specific incidence of OM in a nation-wide cohort of children aged 0–7 years born in 1996–2003 (Danish National Birth Cohort, DNBC). Only selection was ability to understand and speak Danish. Methods Information of OM and ventilation tubes (VT) was collected through three maternal interviews at 6-month, 18-month and 7-years of age and based on this age-specific and cumulative incidence of OM was calculated. As different numbers of the total population answered the different interviews, the calculations are done with different denominators. The information in DNBC was validated against two population based registries containing information of VT insertions. Results Cumulative incidence of OM at 7 years was 60.6% (31,982/52,755). For children with OM, 16.2% (7143/44194) had their first OM episodes between 0–6 months of age, 44.3% (19579/44194) between 7–18 months, and 39.5% (17472/44194) between 19 months and 7 years. Four or more OM episodes before 7 years were reported by 39.5% (12620/31982) and by 64.0% (2482/3881) of those who had their OM debut between 0–6 months; by 48.2% (4998/10378) with debut between 7–18 months; and by 28.7% (4996/17344) with debut between 19 months and 7 years. These figures are essentially unchanged from earlier figures from Denmark. VT insertion at least once was reported by 26,1% in the 7-year interview. Assuming recordings in the Danish National Patient Registry to be gold standard, maternal self-reportings in DNBC of insertion of VT showed high sensitivity (96.4%), specificity (98.2%), and positive (94.8%) and negative predictive values (98.8%). Conclusion OM affects nearly 2/3 of preschool children in Denmark despite reduction in known OM risk factors.

A systematic review of the effect of tympanostomy tubes in children with recurrent acute otitis media.

OBJECTIVE Documentation of the effect of tympanostomy tubes in children with recurrent acute otitis media (RAOM) is limited. A recently published Cochrane review on the effect of tympanostomy tubes in children with RAOM was based on only two studies. Could the documentation be increased by including other randomized studies? METHODS A MEDLINE and EMBASE search for randomized controlled trials was performed and 143 eligible papers were found. Only five studies could be included. All five were randomized studies with a total of 519 children, four randomized by children and one by ears. All five studies had different designs and control groups, making a proper meta-analysis impossible. Three studies had an antibiotic treated group, two studies a placebo group, and two studies a no treatment group as comparison group. Outcome measures were rates of AOM or fraction free of AOM in six or 12 months. RESULTS Between two and five children have to be treated with tympanostomy tubes to prevent one child from attacks of acute otitis media (AOM) in six months. Tube treatment could reduce AOM with about one attack in six months after operation. Six months treatment with antibiotics was not different from treatment with tubes. No study reported quality of life for child and family or parental absence from day care or work. CONCLUSION Insertion of tympanostomy tubes or long-term treatment with antibiotics seems to prevent one attack of AOM or keep one child out of three free from AOM in six months.

A 5-year prospective case-control study of the influence of early otitis media with effusion on reading achievement

In a still ongoing prospective longitudinal study, more than 500 children--a total birth-cohort in a Danish municipality--were followed from their 3rd to their 9th year of life by multiple impedance tests in order to investigate a number of factors concerning epidemiology and long-term impacts of otitis media with effusion. This is a report on the influence of otitis media with effusion early in life on reading achievement. The study revealed no difference in school-class level between the 9% of the children (n = 46) who constantly had abnormal tympanometry during a 6-month period at the age of 3, and the other pupils in the municipality. At the Silent Reading Test (OS-400), done on 40 of the 46 case-pupils the results did not differ from (1) the other pupils in the municipality, (2) from other pupils of the same sex in the same classroom, or (3) from individual control-pupils matched by sex, social group and classroom.

Which children would benefit most from tympanostomy tubes (grommets)? A personal evidence-based review

UNLABELLED Otitis media with effusion (OME) is a common condition in young children. OME causes some hearing loss, and can cause permanent changes in the tympanic membrane as well as other symptoms. In most cases OME is of short duration. As long-lasting bilateral OME for decades has been associated with delayed cognitive and language development, parents and ENT specialists have a positive attitude towards treatment with tympanostomy tubes (TT). METHOD This personal evidence-based review is build on own observations and research combined with newer studies and guidelines. RESULTS The review argues for a relatively restrictive treatment policy concerning the use of TT in children with OME without signs or symptoms of impaired social or linguistic function. CONCLUSION Six months with bilateral OME and significant hearing loss should be present before treatment with TT in otherwise healthy children. At the moment we have no evidence for the subgroups of children excluded from the RCTs, i.e. children with speech/language delays, behaviour and learning problems, or syndromes. Clinicians will need to make their own decisions regarding treatment of such children. The situation just now is that some children are over-treated and some are under-treated. There is an urgent need for prospective cohort studies and randomised studies on children with long-lasting OME in an attempt to characterise the children who would benefit most from TT.

Danish guidelines on management of otitis media in preschool children.

INTRODUCTION Otitis media is one of the most common diseases in small children. This underlines the importance of optimizing diagnostics and treatment of the condition. Recent literature points toward a stricter approach to diagnosing acute otitis media (AOM). Moreover, ventilating tube treatment for recurrent AOM (RAOM) and chronic otitis media with effusion (COME) has become the most frequently performed surgical procedure in pre-school children. Therefore, the Danish Health and Medicines Authority and the Danish Society of Otorhinolaryngology, Head and Neck Surgery deemed it necessary to update the Danish guidelines regarding the diagnostic criteria for acute otitis media and surgical treatment of RAOM and COME. METHODS The GRADE system (The Grading of Recommendations Assessment, Development and Evaluation) was used in order to comply with current standards of evidence assessment in formulation of recommendations. An extensive literature search was conducted between July and December 2014. The quality of the existing literature was assessed using AGREE II (Appraisal of Guidelines for Research & Evaluation), AMSTAR (assessing the Methodological Quality of Systematic Reviews), QUADAS-2 (Quality of Diagnostic Accuracy Studies), Cochrane Risk of Bias Tool for randomized trials and ACROBAT-NRSI (A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies). The working group consisted of otolaryngologists, general practitioners, pediatricians, microbiologists and epidemiologists. CONCLUSION Recommendations for AOM diagnosis, surgical management for RAOM and COME, including the role of adenoidectomy and treatment of ventilating tube otorrhea, are proposed in the guideline.

Risk Factors of Early Otitis Media in the Danish National Birth Cohort

Objective To assess risk factors of otitis media (OM) in six-months-old children. Method The sample consisted of 69,105 mothers and their children from the Danish National Birth Cohort. The women were interviewed twice during pregnancy and again 6 months after birth. The outcome “one or more” maternal reported episodes of OM at age six months. In total 37 factors were assessed, covering prenatal, maternal, perinatal and postnatal factors. Results At age six months 5.3% (95% CI 5.1–5.5) of the children had experienced one or more episodes of OM. From the regression analysis, 11 variables were associated with a risk of OM. When a Bonferroni correction was introduced, gender, prematurity, parity, maternal age, maternal self-estimated health, taking penicillin during pregnancy, and terminating breastfeeding before age six months, was associated with a risk of early OM. The adjusted ORs of OM for boys versus girls was 1.30 (95% CI 1.18–1.44). The OR having one sibling versus no siblings was 3.0 (95% CI 2.64–3.41). If the woman had been taking penicillin during pregnancy, the OR was 1.35 (95% CI 1.15–1.58). Children born before 38th gestational week had an increased OR for early OM of 1.49 (95% CI 1.21–1.82). Children of young women had an increased OR of early OM compared to children of older women. Additionally, children of women who rated their own health low compared to those rating their health as high, had an increased OR of 1.38 (95% CI 1.10–1.74). Finally, children being breastfeed less than 6 months, had an increased OR of 1.42 (95% CI 1.28–1.58) compared to children being breastfeed beyond 6 months. Conclusion These findings indicate that prenatal factors are of less importance regarding early OM before the age of six months. Postnatal risk factors seem to pose the main risk of early OM.

Use of tympanometry in general practice in Denmark.

OBJECTIVES Otitis media has been a serious disease and can be that even today. The diagnosis of otitis media is often difficult. Pneumatic otoscopy, otomicroscopy, and tympanometry can improve the diagnostic quality by indication of fluid in the middle ear and thereby improve the quality of treatment. The aim of this ongoing study is to analyze the use of tympanometry in Denmark after reimbursement for doing tympanometry (November 2006) when clinically indicated. Our research questions were: How many clinics were using tympanometry? How frequent was it used? Is the use increasing? Has the number of GPs in the clinic any relation to the use of tympanometry? METHOD We used information in The Danish National Health Service in three Regions to analyze the use of tympanometry in general practice during the years 2007-2009. The coverage of the GPs is 100% in the regions. RESULTS The three regions counted about half of Danish population. In 2009 the material was 902 different clinics with more than 1700 GPs. In 2007 55% of the clinics did tympanometry, in 2009 the figure was 60%. In the clinics doing tympanometry the median value was 28 tympanometries per year (inter-quartile range 13-53) per GP. The variation in the use of tympanometry was surprisingly high, from none or a few per GP per year to a maximum of more than 500 tympanometric examinations per GP a year. This huge variation has to be discussed. DISCUSSION Many answers can be given. Some of the explanation was problems in doing correct tympanometry, and problems understand the clinical implications of curves and the figures.