Juhani Nuutinen

Prevalence of meniere disease in finland

Objectives: To assess the prevalence of Meniere disease in the population of 5 million in Finland according to the criteria of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS) recommendation. Study Design: Retrospective investigation based on patient records of 306 patients treated for Meniere disease and recognized as such according to the International Statistical Classification of Diseases and Related Health Problems (ICD‐9 or ICD‐10) in seven Finnish hospitals serving a population of 1.5 million people. Methods: Patients were selected from the computerized patient registers of outpatients and inpatients having received an appropriate diagnosis during the period from 1992 to 1996 and re‐evaluated. Definite cases according to AAO‐HNS guidelines were identified to calculate the prevalence of Meniere disease in Finland at the end of 1996. ReRults: A total of 131 definite cases of Meniere disease were identified. The prevalence of at least 43 per 100,000 and an average annual incidence of 4.3 per 100,000 were obtained. The prevalence turned out to be higher (P < .001) in Northern areas (49/100,000) than in the south (38/100,000). The prevalence did not differ in the areas of university hospitals (44/100,000) from those of central hospitals (42/100,000). Conclusions: The prevalence and incidence in Finland is lower than could be expected from previous international surveys, most of which provide inadequate data for forming a real picture of the epidemiology of Meniere disease. Uniform diagnostic criteria are indispensable for further research.

MUCOCILlARY FUNCTlON IN CHILDREN WITH SECRETORY OTITIS MEDIA

Mucociliary clearance of the nasal meatus and the middle ear cavity was measured by a radioisotopic method using 99mTc-labelled human serum albumin as a tracer substance. In the patients with secretory otitis me dia the tracer did not move in either ear indicating a lack of mucociliary clearance. Lowered nasal mucociliary transport velocity was found in 31 of the 46 child patients with recurrent or chronic respiratory infections. 11 from 31 patients (35 %) suffered from recurrent otitis media and 19 (62%) from secretory otitis media. Only one patient of the 15 cases with normal transport velocity had secretory otitis media. It seems that primarily or secondarily im paired mucociliary function plays an important role in the pathophyaiology of secretory otitis media.

Recovery After Tonsillectomy in Adults: A Three-Week Follow-up Study

Objective To evaluate recovery after tonsillectomy and safety and efficacy of ketoprofen in pain treatment after discharge.

High stromal versican expression predicts unfavourable outcome in oral squamous cell carcinoma

Background: Versican, an extracellular matrix proteoglycan, has been noted to be expressed in several malignant tumours and has been suggested to play an important role in cancer development and tumour growth. Aims: To investigate whether the versican expression level in the peritumoural stromal tissue of primary oral squamous cell carcinoma (OSCC) predicts relapse-free or disease-specific survival. Also, to study the associations between versican expression and several other clinicopathological variables, as well as tumour cell proliferation. Methods: Immunohistochemistry was used to study the expression of versican and tumour cell proliferative activity in 139 OSCCs. All pertinent clinical data were collected retrospectively from the hospital records. Results: In this cohort, versican expression did not correlate with the clinicopathological factors or tumour cell proliferation. In univariate analyses, higher risk for disease recurrence was associated with higher stromal versican expression score (p = 0.02), positive neck node status (p = 0.02), lower Karnofsky performance status (p = 0.03) and higher tumour cell proliferation index (p = 0.04). Increased disease-specific risk of death was associated with high stromal versican expression score (p = 0.005) higher T class (p = 0.002), positive neck node status (p<0.001), higher stage (p<0.001), poorer histological differentiation (p = 0.005), worse general condition of the patient (p = 0.049) and increased tumour cell proliferative index (p = 0.02). In multivariate disease-specific survival analysis, high stromal versican expression score (p = 0.048), poorer histological differentiation (p = 0.047) and higher stage (p = 0.002) independently predicted poorer disease outcome. Conclusions: In this cohort, increased stromal versican expression correlated with both increased risk for disease recurrence and shortened survival. High stromal versican expression may thus be considered an independent and adverse prognostic marker in OSCC.

The effect of ketoprofen on recovery after tonsillectomy in children: a 3-week follow-up study

OBJECTIVE To evaluate recovery after tonsillectomy in children, and to determine the safety and efficacy of ketoprofen in pain treatment after discharge. STUDY DESIGN A prospective, longitudinal study in 102 children undergoing tonsillectomy. METHODS All children underwent tonsillectomy under a same general anesthesia. At discharge, all patients were prescribed ketoprofen capsules at a dose of 3-5 mg(-1) kg(-1) per 24 h for postoperative pain control at home, with paracetamol or paracetamol-codeine tablets for rescue analgesia. At home, the patients recorded pain and analgesic consumption each day for the first week after surgery. At 3 weeks, patients recorded the total analgesic requirement, duration of pain, and all adverse events during recovery and return to normal daily activities. RESULTS The median of pain cessation was 9 days (range 1-20 days) and the median duration of analgesic treatment was 10 days (4-19 days). More than 50% of the patients needed rescue analgesic daily during the first week after tonsillectomy. Ketoprofen combined with paracetamol or paracetamol-codeine provided sufficient analgesia for most children. However, the analgesic action of drugs was too short to achieve pain relief, which allow undisturbed sleep during the first postoperative nights. A return back to normal daily activities took place after 9 days (2-26 days). The influence of age for pain pattern was negligible. Five patients needed electrocautery to stop postoperative bleeding. No other serious adverse-events occurred. CONCLUSIONS The main problem after tonsillectomy is significant pain that may last 9 days or longer after surgery. Ketoprofen combined with paracetamol-codeine seems to provide a sufficient analgesia, but before ketoprofen may be recommended for children during tonsillectomy a larger study is needed to show whether or not ketoprofen increases the hemorrhage rate.

Bilateral vocal cord paralysis following general anesthesia

A rare case of bilateral vocal cord paralysis after orotracheal intubation and inhalation anesthesia, in surgery not in relation to the neck, is presented. There was no obvious cause for the paralysis and possible etiological factors are discussed. Overextension of the neck during intubation is suspected of being the etiological agent causing stretching of both the vagus nerves. Normal laryngeal function returned after two months.

Silicone tubing after endoscopic dacryocystorhinostomy: is it necessary?

Background Endoscopic dacryocystorhinostomy (EN-DCR) is increasing in popularity as a treatment of nasolacrimal obstructions because it has proven to be an effective and safe procedure. In this study the success of EN-DCR combined with or without bicanalicular silicone stents was evaluated in patients with nasolacrimal obstructions. Methods Forty-two consecutive EN-DCR procedures were performed in 36 patients during 2000–2004. The surgery was primary in 23 cases and revision in 19 cases. Bicanalicular silicone stents were inserted in 18 cases and in 24 cases stenting was avoided. Results The overall success rate after EN-DCR was 81%. The success rate of EN-DCR was 89% with silicone tubing and 75% without silicone tubing. The mean duration of postoperative follow-up was 4 months. Conclusion In our retrospective study no significant statistical differences were seen between the patients with stenting compared with patients without stenting. However, prospective, randomized studies are clearly needed to answer the question of whether the use of stents is advisable.

Correlation Between Ciliary Beat Frequency and the Structure of Ciliated Epithelia in Pathologic Human Nasal Mucosa

The structure and function of ciliated epithelium were studied in 44 human nasal mucosa samples using a photoelectric method and scanning electron microscopy (SEM). The ciliary beat frequency (CBF) of cases with recurrent or chronic sinusitis was 9.1 ± 5.4 Hz. In eight of the samples (18.2%) no ciliary activity was detected. The amount of ciliated cells, the orientation of cilia, epithelial metaplasia, and secretion were found to be explanatory factors accounting for the decreased ciliary activity. Ciliary disorientation and a lack of ciliated cells in SEM correlated with low ciliary activity. In cases where sinusitis secretion was not seen, the CBF was slower than in cases with mucus or mucopurulent secretion. Sinusitis with disoriented cilia, a loss of ciliated cells, and a lack of mucosal secretion is associated with a decreased CBF. This may lead to impaired mucociliary clearance and increase the risk of recurrent and chronic sinusitis.

Acetaminophen is Highly Effective in Pain Treatment After Endoscopic Sinus Surgery

Objectives/Hypothesis: Endoscopic sinus surgery (ESS) is increasingly performed by otorhinolaryngologists. However, the early recovery and pain management after ESS is still largely unexplored. In the present study, we have evaluated the incidence and severity of pain and the efficacy and safety of acetaminophen (paracetamol) for pain management in patients undergoing ESS.

Paranasal Sinus Mucormycosis: a Report of Two Cases

Mucormycosis of the nose and paranasal sinuses is a rare invasive fungal infection, which often has a very fulminant course and characteristic clinical findings. The patients are usually immunocompromised, with diabetic ketoacidosis being the commonest underlying disorder. In some immunocompetent patients, the disease is associated with local predisposing factors, such as chronic sinusitis. Although the prognosis has improved in recent decades, the disease can still be fatal. The underlying disease is an important determinant of prognosis and correction of the metabolic disorder, if present, is essential. Herein we report two cases: one of our patients was immunocompetent but had earlier suffered from polypous rhinosinusitis whereas the other had mild adult-type diabetes. Both patients were successfully treated with surgical debridement and amphotericin B.