Yrjö Qvarnberg

Long-Term Clinical, Audiologic, and Radiologic Outcomes in Palate Cleft Children Treated with Early Tympanostomy for Otitis Media with Effusion: A Controlled Prospective Study

Objectives: The role of tympanostomy in the treatment of otitis media with effusion (OME) in children with palate cleft with regard to the otologic and audiologic outcome is controversial. Little is known about the development of the mastoid air cell system (MACS) in these children.

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.

Development of mastoid air cell system in children treated with ventilation tubes for early-onset otitis media: A prospective radiographic 5-year follow-up study

Objectives/Hypothesis: Although most studies have agreed that small mastoid air cell systems correlate with long‐standing otitis media, the extent to which the environmental factors affect the development of MACS remains undetermined. We investigated the radiographic development of mastoid air cell systems in children with recurrent acute otitis media or otitis media with effusion who were treated with ventilation tubes early in life.

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.

Otological and Audiological Outcomes Five Years After Tympanostomy in Early Childhood

Objective Ventilation tubes in the treatment of otitis media in young children remain controversial. Despite abundant research, few prospective long‐term follow‐up studies have included even a minority of patients under 1 year old. We investigated long‐term otological and audiological outcomes in children with recurrent acute otitis media and otitis media with effusion, who were treated early with ventilation tubes.

Spontaneous fracture of an ossified stylohyoid ligament

The stylohyoid ligament extends from the styloid process to the hyoid bone. For an unknown reason it occasionally ossifies and forms a solid structure which can break because of trauma or even spontaneously. Symptoms of the fracture may mimic tumours, foreign bodies, infections or neuralgia. In our cases a spontaneous fracture of totally ossified stylohyoid ligaments presented as a painful neck swelling. The diagnosis was achieved by an ortopantomographic radiograph. In both cases the healing was spontaneous and complete.

Tympanostomy in young children with recurrent otitis media. A long-term follow-up study

A total of 305 children, five to 16 months of age, were treated from 1983-1984 with ventilation tubes-Shah vent Teflon tube-inserted under local anaesthesia for recurrent acute otitis media (RAOM) or otitis media with effusion (OME). The final study group comprised 281 children (92.1 per cent) monitored prospectively for five years, 185 in the OME-group and 96 in the RAOM-group. For the first insertion of tubes the average ventilation period was 15.4 months. Re-tympanostomy, with adenoidectomy simultaneously at the first time was performed in 99 ears (35.2 per cent); once in 27.0 per cent, twice in five per cent, and three times in 3.2 per cent. Mastoidectomy due to otorrhoea was performed in three ears (1.1 per cent). The children in the OME-group were at higher risk of repeated post-tympanostomy otorrhoea episodes than children in the RAOM-group. These episodes of otorrhoea during the first insertion of ventilation tubes significantly increased both the tube extrusion rate and the need for subsequent re-tympanostomies. No major complications were caused by the tympanostomy procedure as such. It is concluded that early tympanostomy is a safe procedure in young children with RAOM or OME. However, parents should be carefully informed of risks of post-tympanostomy otorrhoea and recurrent disease after insertion of ventilation tubes necessitating subsequent tube insertion, especially in children with OME.

Aspiration Cytology in Acute Otitis Media

One hundred and ninety-three middle ear effusion samples from patients with acute otitis media were studied for cellular content and bacteria. Findings were compared with clinical and radiological data. In samples positive for pathogenic bacteria (Haemophilus, pneumococci) neutrophils predominated, whereas monocytes or phagocytes were more numerous in samples with nonpathogens. Inflammatory cells were more frequent in large than in small mastoid air cell systems. Destruction of cell walls was associated with increase of neutrophils and sclerosis with preponderance of lymphocytes, monocytes and phagocytes.

Consequences of adenoidectomy in conjunction with tonsillectomy in children

OBJECTIVE The purpose of this prospective study was to investigate the role of adenoidectomy in children undergoing elective adenotonsillectomy. PATIENTS AND METHODS All 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. RESULTS Adenotonsillectomy 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. CONCLUSION Even 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.

Bacteria in Middle Ear Effusions in Children Treated with Tympanostomy; a 10-year series

During the 10-year period, 1983-92, altogether 7,411 ears of 5,291 children with recurrent or chronic otitis media problems were treated with tympanostomy at our hospital in central Finland, The series was divided into three groups: i) infants aged 6-12 months undergoing primary tube treatment. ii) children aged 1 year or more receiving their first ventilation tube(s) in connection with adenoidectomy, and iii) children who had already had ventilation tubes inserted at least once before the present tympanostomy. Middle ear effusion (MEE) samples were obtained from 4,769 (64.3%) of the affected ears, 69.5% of all MEE cultures were negative for bacteria, whereas 20.2% grew pathogenic bacteria. S. pneumoniae was the most frequent pathogen in group 1, whereas H. influenzae was more frequent than S. pneumoniae in groups 2 and 3. In only 3.7% of MEE cultures were beta-lactamase-producing strains of pathogenic bacteria found, either H. influenzae (0.9%) or M. catarrhalis (2.8%). Comparison of the first and second 5-year periods ( 1983-87 vs. 1988-92) showed no significant changes in the occurrence of the various pathogenic bacteria. An increase was observed in beta-lactamase production for M. catarrhalis but not for H. influenzae strains.