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Graf, Jonas
Publications (5 of 5) Show all publications
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
Lundeborg, I., McAllister, A., Graf, J., Ericsson, E. & Hultcrantz, E. (2009). Oral motor dysfunction in children with adenotonsillar hypertrophy-effects of surgery. Logopedics, Phoniatrics, Vocology, 34(3), 111-116
Open this publication in new window or tab >>Oral motor dysfunction in children with adenotonsillar hypertrophy-effects of surgery
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2009 (English)In: Logopedics, Phoniatrics, Vocology, ISSN 1401-5439, E-ISSN 1651-2022, Vol. 34, no 3, p. 111-116Article in journal (Refereed) Published
Abstract [en]

Adenotonsillar hypertrophy is associated with a wide range of problems. The enlargement causes obstructive symptoms and affects different functions such as chewing, swallowing, articulation, and voice. The objective of this study was to assess oral motor function in children with adenotonsillar hypertrophy using Nordic Orofacial Test-Screening (NOT-S) before and 6 months after surgery consisting of adenoidectomy combined with total or partial tonsil removal. A total of 67 children were assigned to either tonsillectomy (n=33) or partial tonsillectomy, 'tonsillotomy' (n=34); 76 controls were assessed with NOT-S and divided into a younger and older age group to match pre- and post-operated children. Most children in the study groups had oral motor problems prior to surgery including snoring, open mouth position, drooling, masticatory, and swallowing problems. Post-surgery oral motor function was equal to controls. Improvement was independent of surgery method.

Keywords
Adenotonsillar hypertrophy; children; NOT-S; oral motor function; tonsil surgery
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-51583 (URN)10.1080/14015430903066937 (DOI)19565403 (PubMedID)
Available from: 2009-11-09 Created: 2009-11-09 Last updated: 2017-12-12
Ericsson, E., LundeborgHammarström, I., Graf, J., McAllister, A. & Hultcrantz, E. (2008). Child behavior and quality of life before and after tonsillotomy versus tonsillectomy. In: International conference in pediatric otorhinolaryngology,2008 (pp. 40-40).
Open this publication in new window or tab >>Child behavior and quality of life before and after tonsillotomy versus tonsillectomy
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2008 (English)In: International conference in pediatric otorhinolaryngology,2008, 2008, p. 40-40Conference paper, Published paper (Other academic)
Abstract [en]

Introduction: The objective of the present investigation was to compare two techniques for pediatric tonsil surgery with respect to postoperative pain and morbidity and changes in sleep behavior, health related quality of life (HRQL) and benefit due to surgery. Methods: 67 children (4,5-5,5 years) with tonsillar hypertrophy and obstructive sleep related distress with or without recurrent tonsillitis were randomized to either regular tonsillectomy (TE)(n=32) or intracapsular tonsillectomy/tonsillotomy (TT) (n=35) with Radiofrequency surgical technique (Ellman Int) Before TT/TE, the parents completed a validated Quality of Life survey of pediatric obstructive sleep apnea, the OSA18 (Obstructive Sleep Apnea-18) and a standardized assessment of their children-s behavior with the Child Behavior Checklist (CBCL). Six months after surgery, the parents repeated these measurements, and assessed the health related benefits of the surgery using the Glasgow Children´s Benefit Inventory (GCBI). Results: In the TT group, the children recorded less pain from the first day after surgery onwards, used fewer doses of painkillers and were pain-free 3 days earlier than the children in the TE group. Six months after surgery, there was no significant difference between TT and TE with regard to snoring and ENT-infections. The differences were all significant in the total scores and in all the individual domains between the initial OSA-18 and post-surgery scores (p<0.0001). The improvement in the total problem score measured with CBCL was also significant (p<0.01) and there were no differences between the TT and TE children. The improvements in all sub scores of the GCBI indicated a significant health benefit of both TT and TE. Conclusions: TT with RF-surgery is a safe method, which causes less pain and postoperative morbidity than regular TE and has a similar effect on snoring and recurrent infections. Young children with tonsillar hypertrophy and different degrees of obstructive sleep related distress all show an impact on HRQL and behavior. All improve dramatically after a tonsillar operation-improving just as much after TT as after TE. Based on these results, TT should be the first choice for treatment of these small children. Support: Financial support from the Research Council of South East Sweden (FORSS).

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43874 (URN)75001 (Local ID)75001 (Archive number)75001 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2015-09-22Bibliographically approved
Graf, J., Ericsson, E., LundeborgHammarström, I. & Hultcrantz, E. (2008). Tonsillotomi på förskolebarn-räcker det?. In: The Annual General Meeting for the Swedish Society for Medicine,2008.
Open this publication in new window or tab >>Tonsillotomi på förskolebarn-räcker det?
2008 (Swedish)In: The Annual General Meeting for the Swedish Society for Medicine,2008, 2008Conference paper, Published paper (Refereed)
Abstract [sv]

 Under förskoleålder sker en fysiologisk ökning av den sk Waldeyerska ringen med tillväxt av tonsiller och adenoid som del i utvecklingen av barnets immunförsvar Många barn kan under denna tid debutera med obstruktionsbesvär(snarkning och sömnapné). Traditionellt har tonsillerna och adenoiden genom tonsillektomi och abrasio helt avlägsnats för att komma till rätta med dessa symptom, kirurgi förenad med hög postoperativ smärtnivå. På senare tid har tonsillotomi, dvs partiellt borttagande av tonsillerna, återinförts som en något mer skonsam operationsmetod. Immunsystemetpåverkas möjligtvis inte heller i lika stor omfattning. Frågan är om detta ingrepp är tillfyllest på barn som är i den ålder då tonsillerna fortfarande växer? Syftet med föreliggande studie var att jämföra tonsillotomi med radiofrekvenskirurgi med fullständig tonsillektomi på förskolebarn vad beträffar postoperativ morbiditet och långtidseffekt på snarkning och infektionsnbenägenhet upp till två år efter operation med tonsillektomi. 67 förskolebarn(4-5 år)med symtomgivade tonsillhypertrofi randomiserades till reguljär tonsillektomi(TE) eller tonsillotomi(TT) med radiofrekvensteknik. I de flesta fall utfördes samtidigt abrasio. 6 månader efter operationen svarade alla på frågeformulär och 2 år efter operationen bedömdes de åter av ÖNH-läkare. Snarkningen före, direkt efter operationen och vid tiden för läkarbesöket utvärderades då med VAS TT barnen registrerade lägre smärta från första dagen efter operation och var helt smärtfria 3 dagar tidigare än TE-barnen. Sex månader efter operationen förelåg ingen skillnad på grupperna vad gäller snarkning och infektionsbenägehet. Efter två år hade två av de 34 TT-barnen och ett av de 33 TE-barnen blivit re-opererade pga recidiv av obstruktionsbesvär, TE-barnet med reabrasio. Övriga barn i båda grupperna var i stort sett besvärsfria vad gäller snarkning och ingen ökad infektionsbenägehet noterades hos något barn. VAS före/ två år efter operationen var 8,4/1,3 för TE och 8,5/1,6 för TT. Tre av TT barnen hade tonsillvävnad något utanför tonsillogen och hälften av TE barnen hade små tonsillrester i logerna. Cirka 6 % risk föreligger att ett yngre barn som opereras med tonsillotomi för obstruktionsbesvär behöver göra om operationen inom 2 år. Denna risk bör vägas mot den betydligt lägre postoperativa morbiditeten för tonsillotomi jämfört med tonsillektomi.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43791 (URN)74822 (Local ID)74822 (Archive number)74822 (OAI)
Available from: 2009-10-10 Created: 2009-10-10
Ericsson, E., Graf, J. & Hultcrantz, E. (2006). Pediatric Tonsillotomy with the Radiofrequency Technique – Long-term Follow-up. The Laryngoscope, 116(10), 1851-1857
Open this publication in new window or tab >>Pediatric Tonsillotomy with the Radiofrequency Technique – Long-term Follow-up
2006 (English)In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 116, no 10, p. 1851-1857Article in journal (Refereed) Published
Abstract [en]

Objectives: Compare the effects of partial tonsil resection using a radiofrequency technique, tonsillotomy (TT), with total tonsillectomy (TE, blunt dissection) after 1 and 3 years. Compare frequency of relapse in snoring or infections and possible long-term changes in behavior among TT children with those in TE children.

Method: Ninety-two children (5-15 yr) randomized to TT (n = 49) or TE (n = 43) groups because of obstructive problems with or without recurrent tonsillitis. One year after surgery, general health, degree of obstruction, history of infections, and behavior were investigated using two questionnaires, the Qu1 and Child Behavior Checklist, as well as an ENT visit. After 3 years, two questionnaires, Qu2 and the Glasgow Children's Benefit Inventory, were answered by mail.

Results: After 1 year, both groups were in good health. The effect on snoring and total behavior was the same for both groups, and the rate of recurrence of infections was not higher in the TT group. After 3 years, two children in the TT group were tonsillectomized (4%, 2/49), one because of peritonsillitis and another because of increased snoring. Otherwise, no differences existed between the groups in general health, snoring, or number of infections.

Conclusion: Removing only the protruding parts of the tonsils has the same beneficial long-term effect on obstructive symptoms and recurrent throat infections as complete TE in the majority of cases. The need for re-operation is low; therefore, it appears inadvisable to follow the current common practice of routinely removing the whole tonsil given its higher morbidity and risk for serious complications.

Keywords
Tonsil surgery, tonsillotomy, snoring, behavior, reduced morbidity, immunology, long-term follow-up
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14512 (URN)10.1097/01.mlg.0000234941.95636.e6 (DOI)
Available from: 2007-05-21 Created: 2007-05-21 Last updated: 2017-12-13
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