Leif Bäck

Submucosal bipolar radiofrequency thermal ablation of inferior turbinates: A long-term follow-up with subjective and objective assessment

Objective To assess the efficacy and morbidity of bipolar radiofrequency thermal ablation of the inferior turbinates in patients with nasal obstruction caused by turbinate hypertrophy.

Otologic consequences of blast exposure: a Finnish case study of a shopping mall bomb explosion

Objective—On 11 October, 2002, in the Myyrmanni shopping mall, Vantaa city, Finland, an explosion by a suicide bomber killed 7 people and injured at least 160, 44 of whom had ear trauma. We investigated the acute and subacute otologic consequences of the explosion. Material and Methods—Otologic examination of the 29 patients treated for ear trauma at the ENT clinic of the University Hospital of Helsinki was performed during the first month after the explosion, and a questionnaire was completed regarding subjective aural symptoms. Symptoms occurring directly after the explosion and for up to 1 month afterwards were assessed. Results—Of the 29 patients, 66% had tinnitus as the initial symptom, 55% hearing loss, 41% pain in the ears and 28% sound distortion. Tinnitus and hearing loss in combination were experienced by 12 patients (41%). Eight patients who had been situated<10 m from the center of the explosion had a rupture of the tympanic membrane. This supported the initial evaluation by the authorities that the bomb had consisted of ≈3 kg ammonium nitrate, equivalent to ≈0.5 kg of trinitrotoluene. It was estimated that some kind of ear injury was likely for individuals situated<70 m from the center of the explosion. Conclusions—People often think that tinnitus and hearing impairment are naturally occurring phenomena after blast exposure, and if their symptoms resolve they do not seek medical advice. However, some of them may have substantial hearing impairment, particularly at high frequencies. Otologic consultation, or at least an audiometric screening test to exclude hearing impairment, should be performed regardless of symptoms, on the basis of exposure data only. Some symptoms, such as tinnitus and hearing loss, may be permanent consequences of a blast injury and their effect on quality of life may be substantial.

Pharyngocutaneous fistula following total laryngectomy: a single institution's 10-year experience.

The etiology of postoperative pharyngocutaneous fistula (PCF) formation following major head and neck surgery is multifactorial and the incidence varies greatly. We reviewed retrospectively the records of 108 consecutive patients who underwent a total laryngectomy during the period from December 1992 to December 2002 at the Helsinki University Central Hospital, Helsinki, Finland. PCF occurred postoperatively in 19 (18%) patients. Two additional patients (2%) developed a PCF later than 30xa0days after laryngectomy. Nineteen percent of these patients with fistula formation had received previous radiation therapy and laryngectomy was performed for local recurrence. Eighteen (86%) of the all fistulae closed spontaneously and surgical closure of the fistula was performed in three (14%) cases. We conclude that the PCFs in our patient population occurred both in radiated and nonirradiated patients. Although most fistulae close spontaneously without surgical intervention this complication leads to prolonged hospitalization and increased patient morbidity.

Radiofrequency thermal ablation for patients with nasal symptoms: a systematic review of effectiveness and complications

Radiofrequency ablation (RFA) is a relatively new method for the reduction of submucosal tissue. The method has gained increasing popularity in the treatment of snoring, tonsillar hypertrophy, tongue base hypertrophy, and nasal obstruction secondary to non-allergic or allergic rhinitis. We present a systematic literature review of current knowledge on the effectiveness, and complications of nasal radiofrequency thermal ablation (RFA) in the treatment of nasal obstruction. We performed a computerized literature search using several databases to select articles dealing with RFA treatment in the field of otorhinolaryngology. Selected articles were independently appraised by at least two of the authors. Thirty-five articles met the inclusion criteria. Twenty-six articles were reports on uncontrolled patient series. Of the nine included randomized controlled trials only one reported a double-blind comparison. Most of the studies reported an improvement in subjective symptoms after treatment and the number of serious side effects was small. However, the only placebo-controlled trial did not show effectiveness. Nasal-RFA appears to be a safe operative procedure and may reduce inferior turbinate submucosal tissue volume in patients having chronic nasal obstruction and who fail to respond to medical treatment. Based on current knowledge, RFA alters the nasal mucosa only slightly and causes only minor discomfort and risk of side effects for the patient. However, most of the published studies on nasal-RFA are observational and have a relatively short follow-up. Consequently, there is an urgent need for well-planned, double-blind, placebo-controlled randomized trials on nasal-RFA treatment.

Radiofrequency ablation treatment of soft palate for patients with snoring: A systematic review of effectiveness and adverse effects†

To assess the effectiveness and adverse effects of radiofrequency ablation (RFA) of soft palate (SP) in snoring.

Accuracy of the current TNM classification in predicting survival in patients with sinonasal mucosal melanoma

The first International Union Against Cancer (UICC) TNM classification for aerodigestive malignant mucosal melanoma was not published until 2009, and since then, only a few studies have evaluated the accuracy of this staging system. Our aim was to evaluate the accuracy of this UICC staging system for sinonasal malignant mucosal melanoma (SMMM) in a nationwide survey.

Sleep-Disordered Breathing: Radiofrequency Thermal Ablation Is a Promising New Treatment Possibility

Objectives The aim of this study was to assess the efficacy and morbidity of radiofrequency thermal ablation of the soft palate in subjects with sleep‐disordered breathing.

Management and outcome of salivary duct carcinoma in major salivary glands

Salivary duct carcinoma (SDC) is a rare and aggressive malignancy with poor prognosis. Its histomorphology is distinctly reminiscent of the ductal carcinoma of the breast. We reviewed the treatment and outcome of SDCs at a single tertiary care centre. Twenty-five cases of SDC of major salivary gland origin, diagnosed and treated at the Department of Otolaryngology, Head and Neck Surgery, Helsinki University Central Hospital, Helsinki, Finland, during a 14-year period from 1997 to 2011, were reviewed retrospectively. Survival outcome was analyzed for 18 patients with a minimum follow-up of 24xa0months. There were 16 male (64xa0%) and 9 female (36xa0%) patients with a median age of 61xa0years (range 36–82xa0years). The majority of the cases occurred in the parotid gland (nxa0=xa021, 84xa0%) followed by the submandibular gland (nxa0=xa04, 16xa0%). The primary treatment consisted of surgical resection in all cases and 17 (68xa0%) patients also underwent neck dissection. Most of the patients (nxa0=xa018, 72xa0%) were treated with postoperative radiotherapy. Seven patients (28xa0%) had a disease recurrence within a median follow-up time of 15xa0months (range 3–27xa0months). In the group (nxa0=xa018) with a minimum follow-up time of 24xa0months, the 2- and 5-year overall and disease-specific survival rates were 66, 41xa0% and 75, 55xa0%, respectively. These results confirm the aggressive nature of SDCs in major salivary glands. Diagnostics and management of these tumours need to be centralized in experienced surgical Head and Neck Oncology Centres, and new treatment strategies should be investigated.

Oropharyngeal carcinoma and its treatment in Finland between 1995-1999: a nationwide study.

The survival figures for advanced stage oropharyngeal carcinoma (OPC) have remained moderate in spite of radical combined modality treatments. The purpose of this study was to investigate the used treatment approach and the outcome of OPC in a nationwide study. Retrospective clinicopathological data of all patients diagnosed with OPC between 1995 and 1999 at the five university hospitals in Finland were reviewed. All patients had a minimum 4-year follow-up. A total of 168 patients (145 men and 23 women, mean age 59xa0years; range 28 – 89xa0years) were included. The T categories were as follows: T1, n =34; T2, n =55; T3, n =40; T4, n =39. One hundred and seventeen (69.6%) patients presented with neck node metastases and three (1.8%) patients with distant metastases. In the majority (61.3%) of the patients the tumor was located in the lateral wall of the oropharynx. In 144 (85.7%) patients the treatment was performed with curative intent. Of these, surgery of the primary tumor was performed in 123 (85.4%) patients, and the defect was reconstructed with a pedicled flap or free tissue transfer in 66 (53.7%) of these patients. A neck dissection (ND) was performed in 86 (69.9%) out of these 123 cases. Surgery was the only treatment modality in 10 (6.9%) patients. Radiation therapy (RT) only (with or without chemotherapy) was given to 21 (14.6%), combined treatment with surgery + radiation therapy (S + RT) to 110 (76.4%) and surgery + chemoradiotherapy (S + CRT) to 3 (2.1%) patients. Overall (OS) 3- and 5-year survival rates were 58 and 45%, respectively. Disease-specific (DSS) 5-year survival rates by T-class for the patients treated with curative intent were as follows: T1, 77%; T2, 70%; T3, 66%; T4, 53%. The variable treatment approach, the frequent locoregional recurrences and the moderate survival point out the need to consider new strategies in the management of OPC.

Laryngeal fractures: clinical findings and considerations on suboptimal outcome.

Conclusion. We recommend early surgical exploration and fixation for patients with dislocated or comminuted laryngeal fractures to avoid long-term voice complications. One-third of 33 fracture patients rated their voice after the fracture had healed as fair but altered. Objectives. To examine the indications for and the outcome of surgical management in patients with laryngeal fractures. Patients and methods. The study was carried out in a tertiary care referral university hospital and was a retrospective study of case series. Thirty-three consecutive patients, aged 14–84 years, presented with various types of laryngeal fractures. Patients were staged according to the type of the fracture and surgical correction was performed when indicated. Voice outcome was documented and patients with subjectively suboptimal result were further evaluated by phoniatric specialist. Results. In all, 32 of 33 laryngeal fracture patients had blunt trauma and the main causative factors were sport injuries (39%) and physical assault (33%). All of the 33 laryngeal fracture patients had a good airway outcome. The subjective voice outcome was good for 20 (61%) and fair for 13 (39%) patients. The mean follow-up time was 39.5 months (range 2–114 months). In phoniatric evaluation most (six of eight) patients with fair voice outcome could not produce high pitched voices because of inability to stretch the vocal folds.