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Hultcrantz, Elisabeth
Alternative names
Publications (10 of 71) Show all publications
Hultcrantz, E. & Nosrati Zare Noe, R. (2015). Corticosteroid treatment of idiopathic sudden sensorineural hearing loss: analysis of an RCT and material drawn from the Swedish national database. European Archives of Oto-Rhino-Laryngology, 272(11), 3169-3175
Open this publication in new window or tab >>Corticosteroid treatment of idiopathic sudden sensorineural hearing loss: analysis of an RCT and material drawn from the Swedish national database
2015 (English)In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 272, no 11, p. 3169-3175Article in journal (Refereed) Published
Abstract [en]

A randomized placebo-controlled study has demonstrated no effect of prednisolone in customary dosage on idiopathic sudden sensorineural hearing loss (ISSNHL). The aim of the present paper is to analyse a larger patient group by meta-analysis of data from the RCT together with a corresponding material drawn from the Swedish national database for ISSNHL. Data from 192 patients, 18-80 years with ISSNHL, were available. All had an acute hearing loss of at least 30 dB measured as PTA in the three most affected contiguous frequencies. All patients had been enrolled within one week after onset and evaluated by audiograms after 3 months. 45/99 (RCT) and 54/99 (the database) had been treated with prednisolone in tapering doses from 60 mg daily and 42/93 with placebo (RCT) or 51/93 with no treatment (the database). Primary outcome was the mean hearing improvement on day 90 for the different groups. A mean difference of greater than 10 dB improvement was required to demonstrate a treatment effect for prednisolone compared to placebo/no treatment. No significant difference was seen between the prednisolone group and placebo/no treatment (p = 0.06). Total recovery was 38 % in prednisolone group, 40 % in the placebo and 14 % in the no treatment group. Vertigo at the onset of hearing loss and age at onset had an equal negative prognostic value in all groups and signs of inflammation had a positive effect. Prednisolone in customary dosage does not influence recovery after ISSNHL.

Place, publisher, year, edition, pages
SPRINGER, 2015
Keywords
Idiopathic sudden sensorineural hearing loss; Sudden deafness; Prednisolone; Effect of treatment; Placebo; Vertigo
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:liu:diva-122095 (URN)10.1007/s00405-014-3360-4 (DOI)000361540600012 ()25351498 (PubMedID)
Available from: 2015-10-19 Created: 2015-10-19 Last updated: 2017-12-01
Ostvoll, E., Sunnergren, O., Ericsson, E., Hemlin, C., Hultcrantz, E., Odhagen, E. & Stalfors, J. (2015). Mortality after tonsil surgery, a population study, covering eight years and 82,527 operations in Sweden. European Archives of Oto-Rhino-Laryngology, 272(3), 737-743
Open this publication in new window or tab >>Mortality after tonsil surgery, a population study, covering eight years and 82,527 operations in Sweden
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2015 (English)In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 272, no 3, p. 737-743Article in journal (Refereed) Published
Abstract [en]

The objective of this retrospective cohort study was to evaluate mortality rate and cause of death after tonsil surgery in Sweden. Two national registries were used, both run by The Swedish National Board of Health and Welfare, an agency of the Ministry of Health and Social Affairs. In the National Patient register all tonsil surgeries performed in Sweden from 2004 through 2011 were identified. The result from this search was matched with the National Cause of Death Register to identify all deaths that occurred within 30 days of tonsil surgery. Personal identity numbers were used to do the matching of registers. Details on the cause of death were obtained from the Swedish National Board of Health and Welfare. Two deaths were identified in 82,527 operations. Both patients were male, otherwise healthy, children under the age of five, operated due to tonsil-related upper airway obstruction/snoring with coblation technique. Cause of death was bleeding-related airway obstruction in both cases and hemodynamic failure caused by blood loss. Both deaths occurred after discharge from the hospital within the first postoperative week. No abnormal levels of analgesics were found in the postmortal investigations. Two deaths related to tonsil surgery (performed on benign indications) were identified in 82,527 operations (2004-2011) in a well-defined national population. Both deaths were due to postoperative bleeding. Based on our findings, the frequency of post-tonsil-surgery mortality in Sweden was 1/41,263, 2004-2011. Level of evidence 2b retrospective cohort study.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2015
Keywords
Tonsillectomy; Adenotonsillectomy; Tonsillotomy; Tonsil surgery; Bleeding; Mortality
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:liu:diva-116510 (URN)10.1007/s00405-014-3312-z (DOI)000350031400030 ()25274044 (PubMedID)
Available from: 2015-03-27 Created: 2015-03-27 Last updated: 2017-12-04
Hessen Soderman, A.-C., Odhagen, E., Ericsson, E., Hemlin, C., Hultcrantz, E., Sunnergren, O. & Stalfors, J. (2015). Post-tonsillectomy haemorrhage rates are related to technique for dissection and for haemostasis. An analysis of 15734 patients in the National Tonsil Surgery Register in Sweden. Clinical Otolaryngology, 40(3), 248-254
Open this publication in new window or tab >>Post-tonsillectomy haemorrhage rates are related to technique for dissection and for haemostasis. An analysis of 15734 patients in the National Tonsil Surgery Register in Sweden
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2015 (English)In: Clinical Otolaryngology, ISSN 1749-4478, E-ISSN 1365-2273, Vol. 40, no 3, p. 248-254Article in journal (Refereed) Published
Abstract [en]

ObjectivesTo analyse post-tonsillectomy haemorrhage (PTH) rates related to technique for dissection and haemostasis. Study DesignRegister study from the National Tonsil Surgery Register in Sweden (NTSRS). MethodsAll patients, subjected to tonsillectomy (TE) without adenoidectomy from 1 March 2009 to 26 April 2013, were included in the study. The surgeon reports data about technique and early PTH, while late PTH is reported by the patient in a questionnaire 30days after surgery. Results15734 patients with complete data concerning technique for dissection and for haemostasis were identified in the NTSRS. Techniques used were cold steel dissection with uni- or bipolar diathermy haemostasis (65.3%), diathermy scissors (15.7%), coblation (9.1%), cold steel dissection with cold haemostasis (7.4%) and ultrascision (2.5%). Early and late PTH were reported in 3.2% and 9.4% of the cases, respectively, and return to theatre (RTT) in 2.7%. The rates for PTH and RTT related to technique were analysed. Compared with cold dissection+ cold haemostasis, late PTH rate was 2.8 times higher after cold dissection + hot haemostasis, 3.2 times higher after coblation, 4.3 times higher after diathermy scissors and 5.6 times higher after ultrascision. The risk for RTT was higher for all hot techniques except for coblation, while ultrascision resulted in a lower risk for early PTH. ConclusionsAll hot techniques resulted in a higher risk for late PTH compared with cold steel dissection +cold haemostasis. The risk for RTT was higher for all hot techniques except for coblation, while ultrascision resulted in a lower risk for early PTH. An early PTH was associated with an increased risk for late PTH.

Place, publisher, year, edition, pages
Wiley, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-119237 (URN)10.1111/coa.12361 (DOI)000354455700011 ()25515059 (PubMedID)
Note

Funding Agencies|Swedish Association of Local Authorities and Regions

Available from: 2015-06-15 Created: 2015-06-12 Last updated: 2017-12-04
Sunnergren, O., Hemlin, C., Ericsson, E., Hessén-Söderman, A.-C., Hultcrantz, E., Odhagen, E. & Stalfors, J. (2014). Radiofrequency tonsillotomy in Sweden 2009-2012. European Archives of Oto-Rhino-Laryngology, 271(6), 1823-1827
Open this publication in new window or tab >>Radiofrequency tonsillotomy in Sweden 2009-2012
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2014 (English)In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 271, no 6, p. 1823-1827Article in journal (Refereed) Published
Abstract [en]

The Swedish National Registry for TonsilSurgery has been operational since 1997. All ENT clinicsin Sweden are encouraged to submit data for all patientsscheduled for tonsil surgery. Preoperatively, age, genderand indication are recorded. Postoperatively, method(tonsillectomy or tonsillotomy), technique, and perioperativecomplications are recorded. Postoperative bleedings,pain, infections, and symptom relief are assessed throughquestionnaires. An earlier report from this registry showedthat tonsillotomy had become more common than tonsillectomyin children with tonsil-related upper airwayobstruction. The aim of this study was to categorize whichinstruments were used for tonsillotomy in Sweden and tocompare their outcome and complication rate. All children2–18 years, reported to the registry from March 2009 untilSeptember 2012, who underwent tonsillotomy on theindication upper airway obstruction, were included in thestudy. 1,676 patients were identified. In 1,602 cases(96 %), a radiofrequency instrument was used. The postoperativebleeding rate was low (1.2 %) and the degree ofsymptom relief was high (95.1 %). Three different radiofrequencyinstruments (ArthroCare Coblation, EllmanSurgitron, and Sutter CURIS) were used in 96 % of thepatients. There were no significant differences in thenumber of postoperative bleedings, postoperative infectionsor symptom relief between the instruments. The onlydifference found was in the number of days on analgesics,where more days were registered after use of Coblation.In Sweden, radiofrequency tonsillotomy is the dominantsurgical technique used for tonsil hypertrophy causingupper airway obstruction in children. There are no significantdifferences in outcome between the different radiofrequencyinstruments except for number of days onanalgesics after surgery.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2014
Keywords
Tonsillotomy, Radiofrequency, National registry, Tonsil surgery, Outcome, Complications
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-106917 (URN)10.1007/s00405-013-2867-4 (DOI)000335782000070 ()24366615 (PubMedID)
Available from: 2014-05-26 Created: 2014-05-26 Last updated: 2017-12-05Bibliographically approved
Ericsson, E., Graf, J., Lundeborg Hammarström, I. & Hultcrantz, E. (2014). Tonsillotomy versus tonsillectomy on young children: 2 year post surgery follow-up. Journal of Otolaryngology - Head & Neck Surgery, 43, Article ID 26.
Open this publication in new window or tab >>Tonsillotomy versus tonsillectomy on young children: 2 year post surgery follow-up
2014 (English)In: Journal of Otolaryngology - Head & Neck Surgery, ISSN 1916-0216, Vol. 43, article id 26Article in journal (Refereed) Published
Abstract [en]

Objectives: To study the long-term effect of tonsillotomy and tonsillectomy in young children after two years in comparison to the results after six months. Method: Children, age 4-5 with Sleep Disordered Breathing (SDB) and tonsil hyperplasia, were randomized to TE (32) or TT (35). TT was performed ad modum Hultcrantz with radiofrequency technique (Ellman). An adenoidectomy with cold steel was performed in the same session for 80% of cases. The patients were assessed prior to surgery, at six and 24 months postoperatively. Effects of surgery were evaluated clinically, through questionnaire (general health/snoring/ENT-infections), Quality of Life (QoL), survey of pediatric obstructive sleep apnea with OSA-18, and childrens behavior with the Child Behavior Checklist. Results: After two years there was still no difference between the groups with respect to snoring and frequency or severity of upper airway infections. Both TT and TE had resulted in large improvement in short and long term QoL and behavior. Three TT-children and one TE child had been re-operated due to recurrence of obstructive problems, the TE-child and one of the TT-children with adenoidectomy and two of the TT-children with tonsillectomy. Three of the TT-children had tonsil tissue protruding slightly out of the tonsil pouch and twelve TE-children had small tonsil remnants within the tonsil pouches, but with no need for surgery. Conclusion: Younger children have a small risk of symptom-recurrence requiring re-surgery within two years after TT. For the majority, the positive effect on snoring, infections, behavior and quality of life remain and is similar to TE.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keywords
Tonsillotomy; Tonsillectomy; Quality of life; Methodology
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-109881 (URN)10.1186/s40463-014-0026-6 (DOI)000340004200001 ()
Available from: 2014-08-28 Created: 2014-08-28 Last updated: 2017-02-20Bibliographically approved
Hultcrantz, E. & Ericsson, E. (2013). Factors Influencing the Indication for Tonsillectomy: A Historical Overview and Current Concepts. Journal for Oto-Rhino-Laryngology, 75(3), 184-191
Open this publication in new window or tab >>Factors Influencing the Indication for Tonsillectomy: A Historical Overview and Current Concepts
2013 (English)In: Journal for Oto-Rhino-Laryngology, ISSN 0301-1569, E-ISSN 1423-0275, Vol. 75, no 3, p. 184-191Article in journal (Refereed) Published
Abstract [en]

Tonsil surgery has been performed for more than 3,000 years. During the 19th century when anesthesia became available, techniques were refined and the number of procedures performed increased. Repeated throat infections often causing big tonsils was the reason why parents asked for the procedure. During the preantibiotic era, scarlet fever was feared since potential heart or kidney complications were life-threatening. The technique used before 1900 was tonsillotomy since neither a fingernail, snare nor the later guillotine were used extracapsularly. Bleeding was small and the surgery ambulatory. Extracapsular tonsillectomy developed around the turn of the 20th century with the purpose of avoiding remnants the focal infection theory was prevailing. The whole tonsil was now extirpated with good visibility of the tonsillar area in a deeply anesthetized patient. During the first half of the 20th century, the two methods competed, but by 1950, total tonsillectomy had become the only correct tonsil surgery. The indication was still recurrent infections. The risk for serious bleeding increased; therefore large clinics arose where patients remained for at least a week after tonsillectomy. When oral penicillin for children became available during the 1960s, the threat of throat infection decreased and the number of tonsillectomies declined. The awareness of obstructive problems in children rose at the same time when obstructive sleep apnea syndrome became a disease for adults (1970s). Tonsillotomy was revived during the 1990s and is today used increasingly in many countries. The indication is mainly obstructive sleep apnea syndromeor sleep-disordered breathing, especially in small children. Total tonsillectomy is still preferred for recurrent infections, which include periodic fever/adenitis/pharyngitis/aphthous ulcer syndrome and recurrent peritonsillitis.

Place, publisher, year, edition, pages
Karger, 2013
Keywords
Tonsil surgery history, Tonsillectomy, Tonsillotomy
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-97678 (URN)10.1159/000342322 (DOI)000323592200014 ()
Available from: 2013-09-19 Created: 2013-09-19 Last updated: 2017-12-06
Ericsson, E., Lundeberg, S., Brattwall, M., Stalfors, J., Hemlin, C., Hessén-Söderman, A. C., . . . Odhagen, E. (2013). Nationella riktlinjer för farmakologisk behandling av smärta och illamående i samband med med tonsillotomi och tonsillektomi på barn och ungdomar (<18 år). Ventilen, 4(48), 18-19
Open this publication in new window or tab >>Nationella riktlinjer för farmakologisk behandling av smärta och illamående i samband med med tonsillotomi och tonsillektomi på barn och ungdomar (<18 år)
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2013 (Swedish)In: Ventilen, ISSN 0348-6257, Vol. 4, no 48, p. 18-19Article in journal (Other academic) Published
Place, publisher, year, edition, pages
Luleå: SSF:s rikssektion för anestesi- och intensivvård, 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-103770 (URN)
Available from: 2014-01-27 Created: 2014-01-27 Last updated: 2014-02-10Bibliographically approved
Ericsson, E., Lundeberg, S., Brattwall, M., Stalfors, J., Hemlin, C., Hessén-Söderman, A.-C., . . . Odhagen, E. (2013). Nationella riktlinjer för farmakologisk behandling av smärta och illamående i samband med tonsillotomi och tonsillektomi på barn och ungdomar (<18 år). Svensk ÖNH-tidskrift, 30(3), 1-5
Open this publication in new window or tab >>Nationella riktlinjer för farmakologisk behandling av smärta och illamående i samband med tonsillotomi och tonsillektomi på barn och ungdomar (<18 år)
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2013 (Swedish)In: Svensk ÖNH-tidskrift, ISSN 1400-0121, Vol. 30, no 3, p. 4p. 1-5Article in journal (Refereed) Published
Abstract [sv]

Riktlinjerna är framtagna av referensgruppen för Tonsilloperation. Syftet med dessa riktlinjer är att optimera det perioperativa omhändertagandet (premedicinering - peroperativt - postoperativt smärtomhändertagande) i samband med tonsilloperationer på barn och ungdomar. Bakgrund och referenser till riktlinjerna finns i ett separat dokument.

Riktlinjerna gäller för friska barn. Finns det riskfaktorer som ex grav sömnapné, kraftig övervikt, komplicerande sjukdomstillstånd eller organpåverkan behöver den farmakologiska behandlingen anpassas efter situationen.

Tonsillkirurgi medför svår och långvarig smärta samt hög frekvens av illamående. Smärtan är ofta värst dag 3 till 5 efter tonsillektomi. Tonsillotomi ger generellt upphov till mindre smärta än tonsillektomi. För att uppnå effekt behöver den farmakologiska smärtbehandlingen påbörjas redan vid premedicineringen och fortlöpa under själva anestesin/ingreppet. En multimodal behandling ska eftersträvas och målsättningen är att uppnå en för individen acceptabel smärtnivå i det postoperativa skedet och i hemmet.

Den farmakologiska behandlingen ska kombineras med preoperativ information om ingreppet till patienten och vårdnadshavare. En lugn och trygg situation före anestesistart ökar chanserna för ett lugnt postoperativt förlopp.

Place, publisher, year, edition, pages
Stockholm: Scandinavian University Press, 2013. p. 4
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-98004 (URN)
Note

Referensgruppen för tonsilloperation.

Available from: 2013-09-24 Created: 2013-09-24 Last updated: 2017-12-06Bibliographically approved
Hultcrantz, E., Ericsson, E., Hemlin, C., Hessén-Söderman, A.-C., Roos, K., Sunnergren, O. & Stalfors, J. (2013). Paradigm shift in Sweden from tonsillectomy to tonsillotomy for children with upper airway obstructive symptoms due to tonsillar hypertrophy. European Archives of Oto-Rhino-Laryngology, 270(9), 2531-2536
Open this publication in new window or tab >>Paradigm shift in Sweden from tonsillectomy to tonsillotomy for children with upper airway obstructive symptoms due to tonsillar hypertrophy
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2013 (English)In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 270, no 9, p. 2531-2536Article in journal (Refereed) Published
Abstract [en]

Tonsillotomy (TT) is now used more often than tonsillectomy (TE) for tonsil obstructive symptoms in Sweden. Both TE and TT give high patient satisfaction although TT results in fewer postoperative bleedings and shorter time when analgesics are needed. The objective of this study is to analyze the current prevalence of different tonsil surgery procedures, the rates of early and late bleeding and other complications. Data from the National Tonsil Surgery Register in Sweden were analyzed. Patients 1–15 years operated for symptoms due to tonsil hypertrophy were included. Surgical procedure, technique and bleedings during hospital stay were registered. Thirty days after surgery, unplanned contacts due to bleeding, infection or pain were reported as were symptom relief after 6 months. 24,083 patients were registered. Of the 10,826 children 1–15 years operated for obstructive symptoms, 64 % were TT or TT+A, and 34 % TE, TE+A. 69 % answered the 30-day questionnaire and 50 % the 6 months. Bleeding in hospital occurred in 1.38 %, late bleedings in 2.06 %: 3.7 % after TE+A, 0.8 % after TT+A. Differences in readmissions due to bleeding, number of days using analgesics, health care contacts due to pain and nosocomial infections were significant between TT and TE, but not differences with regard to symptom relief after 6 months.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-95898 (URN)10.1007/s00405-013-2374-7 (DOI)000322654900021 ()
Available from: 2013-08-07 Created: 2013-08-07 Last updated: 2017-12-06Bibliographically approved
Hemlin, C., Sunnergren, O., Hultcrantz, E., Ericsson, E., Hessén Söderman, A.- . C., Roos, K., . . . Stalfors, J. (2012). A Patient questionnaire can give valid information on the prescence of morbidity after tonaillar surgery - results of a validation study. Paper presented at 11th International Congress of the European Society of Pediatric Otorhinolaryngology Amsterdam, Holland 20-23 maj.
Open this publication in new window or tab >>A Patient questionnaire can give valid information on the prescence of morbidity after tonaillar surgery - results of a validation study
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2012 (English)Conference paper, Oral presentation with published abstract (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-78834 (URN)
Conference
11th International Congress of the European Society of Pediatric Otorhinolaryngology Amsterdam, Holland 20-23 maj
Available from: 2012-06-21 Created: 2012-06-21 Last updated: 2012-07-16
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