Karin Blomgren

A Prospective Study on Pros and Cons of Electrodissection Tonsillectomy

Objective Hemorrhages are main complications after tonsillectomy, whatever technique is used. This prospective study aimed at revealing pros and cons associated with monopolar electrodissection tonsillectomy.

Patient Contact with Healthcare Professionals after Elective Tonsillectomy

Objective —To assess the amount and causes of patient contact with healthcare professionals after elective tonsillectomy. Material and Methods —This was a prospective study. All consecutive patients undergoing elective tonsillectomy or adenotonsillectomy in 1997 received a questionnaire concerning the post-discharge period. Results —A total of 276 patients (93.6%) answered questions regarding post-discharge contact. After their discharge, 43.8% of patients contacted healthcare professionals. Pain was the leading indication for telephone contact, and hemorrhage for visits in person. Information given over the telephone was sufficient in 49.5% of cases. Telephone contact was followed by a visit in person in the case of hemorrhage in 88.9% of patients and in the case of pain in 34.1%. Contact was made most frequently in the older age groups. Conclusions —Although the patients repeatedly received both written and oral information, nearly half of them still contacted healthcare professionals during the recovery period. Frequent post-tonsillectomy contact should be taken into account when the financial and personnel resources of day surgery units are evaluated. In order to reduce the amount of post-tonsillectomy contact with healthcare professionals, careful attention must be paid to the quality of patient counseling prior to discharge.

Effect of accurate diagnostic criteria on incidence of acute otitis media in otitis-prone children.

Over 70% of children currently suffer from acute otitis media (AOM) before their second birthday, and incidence is increasing rapidly. Recent studies have raised concern about inadequate use of diagnostic equipment and insufficient training in diagnoses. We recruited 309 children with a history of recurrent otitis media who were followed for 6 months during 1 infectious season. A study physician examined and treated any child whose parents suspected AOM. Pneumatic otoscope and tympanometry were used. Number of AOM diagnoses during the study was compared with AOM diagnoses during the preceding 6-month period. AOM diagnoses decreased 56%, and nearly 80% of children had fewer episodes of AOM discovered than during the preceding 6 months. AOM is frequently over-diagnosed. Use of proper diagnostic criteria, the pneumatic otoscope, and tympanometry can help correct diagnosis, and thereby reduce incidence of AOM.

Diagnostic accuracy of acute maxillary sinusitis in adults in primary care

Objective - To evaluate the diagnostic value of symptoms and signs used in diagnosing acute community-acquired maxillary sinusitis (ACAMS), and to find useful clinical predictors for diagnosing it in adults in primary care. Design - Prospective study in the study group and retrospective study in the reference group. Setting - One primary care centre in the study group and another in the reference group. Subjects - 50 adults with prolonged upper respiratory tract infection ( S 7 days) or self-suspected maxillary sinusitis. As a reference group, an analysis of records and diagnoses made by GP of 45 adult patients with the same inclusion criteria from another primary care clinic. Main outcome measures - The signs and symptoms associated with the diagnosis of ACAMS by GP and otorhinolaryngologist. The value of CRP, ultrasound and peak nasal expiratory flow in the diagnosis. Results - Neither ultrasound nor any of the clinical signs increased the accuracy of diagnosis. Peak nasal expiratory flow below the normal range was associated with the diagnosis of ACAMS (p = 0.03). The presence of an otorhinolaryngologist had an influence on GP practice when compared with the reference group. Conclusion - The diagnosis of ACAMS is difficult with the available clinical methods. Peak nasal expiratory flow needs further study. New diagnostic means are needed.

Consequences of adenoidectomy in conjunction with tonsillectomy in children

OBJECTIVEnThe purpose of this prospective study was to investigate the role of adenoidectomy in children undergoing elective adenotonsillectomy.nnnPATIENTS AND METHODSnAll consecutive children less than 15 years of age operated on over a 12-month period were included. Adenoidectomy was done with curettes and forceps under mirror visualization and tonsillectomy with a unipolar electrodissection technique. Duration of the operation, intra-operative blood loss, and post-operative complications were recorded.nnnRESULTSnAdenotonsillectomy was done in 98 children with a mean age of 7.8 years. The mean duration of adenoidectomy was 10.3 min (S.E. 0.7), 51.8% of the time used for adenotonsillectomy and 25. 9% of the total operating room time. The blood loss was 43.6 ml (S.E. 5.4) and 7.8 ml (S.E. 2.5) for adenoidectomy and tonsillectomy, respectively. Both the duration (P=0.04) and blood loss (P=0.0005) of adenoidectomy increased significantly with the increasing age of children. Post-adenoidectomy complications did not occur.nnnCONCLUSIONnEven though adenoidectomy prolonged the operating time and increased the intra-operative blood loss, especially in older children the procedure in general remained relatively short and safe. However, adding adenoidectomy to tonsillectomy should always be carefully considered, particularly in children 10 years or older operated on principally because of palatine tonsil disease.

Effect of tonsillectomy on health-related quality of life and costs.

Abstract Conclusion: Tonsillectomy (TE) seems to be a cost-saving procedure with a positive effect on a patients health-related quality of life (HRQoL). Objectives: The aim of this study was to explore how TE affects health-related quality of life (HRQoL) and the costs due to health service use and absence from work. Methods: All 557 patients over the age of 15 years undergoing scheduled TE in the Helsinki University Central Hospitals Otorhinolaryngological Department between February 2008 and June 2009 were asked to participate and to complete the 15D HRQoL questionnaire as well as a questionnaire exploring the use of health-care services during the preceding 3 months. Follow-up questionnaires were sent 6 and 12 months after the operation. Results: Of the 557 patients, 124 (22%) answered all three questionnaires. Preoperatively the patients were significantly worse off than the age- and gender-standardized general population. TE improved their HRQoL on 6 of the 15 dimensions, and overall (15D score improved from baseline 0.939 to 0.959 at 12 months, p < 0.001). The most marked improvement (p < 0.001) occurred on the dimensions of breathing, sleeping, and discomfort and symptoms. Self-reported costs due to health service use and absence from work distinctly diminished.

Clinical significance of incidental magnetic resonance image abnormalities in mastoid cavity and middle ear in children

OBJECTIVEnMagnetic resonance imaging of the head may reveal incidental findings in paranasal sinuses. The purpose of this study was to discover whether similar changes could be identified in the mastoid cavity and middle ear as well.nnnMETHODSnA group of 50 children undergoing magnetic resonance imaging of the head for suspected intracranial pathology were prospectively gathered. Their parents completed a questionnaire concerning each childs medical history connected with acute otitis media. Otoradiologists evaluated the pictures for mastoid cavity and middle ear and paranasal sinus abnormalities.nnnRESULTSnIn six (12%) children, magnetic resonance imaging detected abnormalities resembling acute inflammatory changes, although none had had acute otitis media during the preceding last 3 months. Abnormalities detected in the paranasal sinuses were not correlated with abnormalities in the mastoid cavity and middle ear.nnnCONCLUSIONSnHigh signal intensity in magnetic resonance images from the mastoid cavity and middle ear may be incidental and without any clinical significance. These findings must be interpreted together with knowledge of the childs medical condition and clinical examination of the ears.

Microarray identification of bacterial species in peritonsillar abscesses

Peritonsillar abscess (PTA) is the most common otorhinolaryngological infection, requiring management at the special healthcare level. The microbiological findings vary due to geographical, etiological, and methodological factors. This study aimed to identify the bacterial species of PTAs by using a novel polymerase chain reaction (PCR)- and microarray-based assay, and to find causative cofactors among patients with different pathogens. We determined the bacterial findings of aspirates of pus prospectively collected from 180 PTA patients. Samples were pretreated prior to nucleic acid extraction and analyzed with a PCR- and microarray-based assay or DNA sequencing. Both methods were based on the gyrB/parE topoisomerase genes. Patients answered symptom questionnaires at admission, and their medical records were reviewed later. Altogether, 160 (89xa0%) aspirates of pus tested positive for bacteria, and a bacterial species was identified in 149 (83xa0%) of the samples. A polybacterial species was detected in 20 (13xa0%) and anaerobic bacteria in 77 (52xa0%) of the 149 samples. Fusobacterium necrophorum patients were younger (pu2009<u20090 .001) and had more severe symptoms (pu2009=u20090.04) than patients with other pathogens. Gender, smoking, or preadmission antibiotics showed no correlation with any of the pathogens. Although requiring some optimization, this microarray assay seems feasible and fast for bacterial identification directly from pus samples, and confirms the diversity of PTA pathogens. Young patients with more severe symptoms may require special attention. Species-specific antibiotic treatment of PTA remains challenging due to bacterial variations; the present assay may aid in specifying PTA antibiotic treatment in the future.

Immune Defense in Upper Airways: A Single-Cell Study of Pathogen-Specific Plasmablasts and Their Migratory Potentials in Acute Sinusitis and Tonsillitis

Background Despite the high frequency of upper respiratory tract (URT) infections and use of the nasal mucosa as route for vaccination, the local immune mechanism and dissemination of effector lymphocytes from the URT have been insufficiently characterized. To devise a single-cell approach for studying the mucosal immune response in the URT, we explored URT-originating B effector lymphocytes in the circulation of patients with one of two common respiratory infections, acute sinusitis or tonsillitis. Methods Patients with acute sinusitis (n = 13) or tonsillitis (n = 11) were investigated by ELISPOT for circulating pathogen-specific antibody-secreting cells (ASCs) of IgA, IgG and IgM isotypes approximately one week after the onset of symptoms. These cells’ potential to home into tissues was explored by assessing their expression of tissue-specific homing receptors α4β7, L-selectin, and cutaneous lymphocyte antigen (CLA). Results Pathogen-specific ASCs were detected in the circulation of all patients, with a geometric mean of 115 (95% CI 46–282) /106 PBMC in sinusitis, and 48 (27–88) in tonsillitis. These responses were mainly dominated by IgG. In sinusitis α4β7 integrin was expressed by 24% of the ASCs, L-selectin by 82%, and CLA by 21%. The proportions for tonsillitis were 15%, 80%, and 23%, respectively. Healthy individuals had no ASCs. Conclusions URT infections–acute sinusitis and tonsillitis–both elicited a response of circulating pathogen-specific plasmablasts. The magnitude of the response was greater in sinusitis than tonsillitis, but the homing receptor profiles were similar. Human nasopharynx-associated lymphoid structures were found to disseminate immune effector cells with a distinct homing profile.

Metronidazole in conjunction with penicillin neither prevents recurrence nor enhances recovery from peritonsillar abscess when compared with penicillin alone: a prospective, double-blind, randomized, placebo-controlled trial

OBJECTIVESnThe objectives of this study were to evaluate the efficacy of metronidazole in conjunction with penicillin in preventing the recurrence of peritonsillar abscess (PTA) and to learn whether metronidazole enhances the recovery from PTA when compared with penicillin alone.nnnMETHODSnIn this prospective, double-blind, randomized, placebo-controlled trial, 200 adult outpatients with PTA at our ear, nose and throat emergency department received either penicillin (1u200a000u200a000IU)u200a×u200a3 and metronidazole (400 mg)u200a×u200a3 for 10 and 7 days orally (combination group, Nu200a=u200a100) or penicillin and placebo (penicillin group, Nu200a=u200a100) after incision and drainage of the PTA. Afterwards they received a symptom questionnaire via e-mail daily for 2 weeks, then weekly for 6 weeks. The primary outcome was efficacy of metronidazole in conjunction with penicillin in preventing PTA recurrence in 56 days; the secondary outcome was ability of metronidazole plus penicillin to enhance recovery from PTA in 28 days. All healthcare contacts were registered during follow-up. Registered on www.clinicaltrials.gov with the identifier NCT01255670.nnnRESULTSnOf the 200 patients, 20 returned to hospital with recurrent symptoms, 10 in each group (Pu200a=u200a1.00). In the combination group, the mean (SD) duration of throat-related symptoms was 5.6 (5.0) days and in the penicillin group it was 5.3 (2.7) days, values for fever were 1.5 (0.9) and 1.6 (1.0) days, respectively, and those for poor overall physical condition were 4.0 (3.9) and 4.5 (4.9) days; there were no significant differences between groups. The adverse effects nausea and diarrhoea lasted longer in the combination group (Pu200a=u200a0.01).nnnCONCLUSIONSnFor healthy adult PTA patients treated with incision and drainage, metronidazole neither prevents recurrence nor enhances recovery when combined with penicillin compared with penicillin alone, but instead leads to increased adverse effects.