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  • 1. Bunne, Marie
    et al.
    Falk, Berndt
    Magnusson, Bengt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, RC - Rekonstruktionscentrum, ÖNH - Öron- Näsa- Halskliniken.
    Hellström, Sten
    Variability of Eustachian tube function: Comparison of ears with retraction disease and normal middle ears2000In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 110, no 8, p. 1389-1395Article in journal (Refereed)
    Abstract [en]

    Objective: To explore the short-term and long-term variability of tubal opening and closing in ears with advanced retractions and in healthy ears. Study Design/Methods: Twenty ears with retraction type middle ear disease (R-MED) and 20 normal ears underwent direct recording of the middle ear pressure during repeated forced openings, equalization of +100 daPa and -100 daPa by swallowing, Valsalva inflation, and forceful sniffing. Tests were performed twice (separated by 30 min) on each of 2 days separated by 3 to 4 months. Results: There was considerable intraindividual variability of the forced opening pressure and the closing pressure in both groups, within as well as between sessions and test days. Although the variability was 1.5 to 2 times higher in ears with retraction than in the normal group, mean Po and Pc did not differ between the groups. Compared with normal ears, ears with retraction changed more frequently from a positive to negative test response, or vice versa, when re-tested after 30 minutes. Rates of positive response in the equalization and Valsalva tests were significantly lower in diseased ears compared with normal ears. Conclusions: Eustachian tube opening and closing functions vary more in ears with retraction disease than in normal ears, which is consistent with the variable clinical course of R-MED and implies that single tubal function tests have little prognostic value on the individual level.

  • 2. Davidsson, A.
    et al.
    Andersson, T.
    Hellquist, HB
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Pathology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pathology and Clinical Genetics.
    Apoptosis and phagocytosis of tissue-dwelling eosinophils in sinonasal polyps2000In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 110, no 1, p. 111-116Article in journal (Refereed)
    Abstract [en]

    Objective: Sinonasal polyps contain numerous tissue-dwelling eosinophils, but the mechanisms causing their accumulation, functional activities, and resolution are largely unknown. Study Design: Nasal polyp tissue from 14 patients was evaluated for cellular expression of CD95, CD68, and Annexin-V, for the degree of apoptosis, and for phagocytosis of eosinophils. Material and Methods: Histological sections were immunostained as single stains for CD95, CD68, and Annexin-V, and as an immunostaining for CD68 combined with a modified Vital New Red staining. The latter staining is specific for eosinophils. Other sections were stained by terminal d-UTP nick end labeling (TUNEL) assay and routinely stained for H and E. Evaluation of the amount of stained cells was performed by counting the average number in 10 randomly chosen high-power fields. The TUNEL positivity was in all cases confirmed with apoptotic morphology. Results: The inflammatory infiltrate consisted of numerous eosinophils but also a considerable amount of lymphocytes, mast cells, and macrophage-like CD68+ cells. CD95 was frequently expressed on eosinophils, on numerous other inflammatory cells, and also on morphologically apoptotic cells. Annexin-V-positive eosinophils were not as frequent as CD95+ cells, but numerous Annexin-V-positive eosinophils were found. CD68+ cells approximately equalled the number of eosinophils. The number of cells phagocytosing eosinophils varied between polyps. Apoptosis of eosinophils (as evaluated by TUNEL combined with apoptotic morphology) was a common finding in six of the polyps. Conclusions: Previous in vitro and ex vivo findings of CD95 on eosinophils are now supported by demonstration of CD95 on eosinophils in this in vivo study. This investigation revealed a switch of the membrane-bound phosphatidylserine of apoptotic cells, which is a novel observation. The study has demonstrated apoptosis of tissue-dwelling eosinophils, and that CD68+ macrophage-like cells phagocytose eosinophils within the sinonasal polyps.

  • 3.
    Ericsson, Elisabeth
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences.
    Graf, Jonas
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences.
    Hultcrantz, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences.
    Pediatric Tonsillotomy with the Radiofrequency Technique – Long-term Follow-up2006In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 116, no 10, p. 1851-1857Article in journal (Refereed)
    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.

  • 4.
    Ericsson, Elisabeth
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Hultcrantz, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Tonsil Surgery in Youths – Good Results with Less Invasive Method2007In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 117, no 4, p. 654-661Article in journal (Refereed)
    Abstract [en]

    Objective: Comparison of two types of tonsil surgery for 16- to 25-year-old patients, with respect to primary morbidity, snoring, and recurrent infections after 1 year. Teenagers and young adults are a significant proportion (26%) of the population that receive tonsil surgery each year and appear to suffer more pain than younger children. Recurrent tonsillitis, in combination with obstructive problems, is the main indication for surgery.

    Method: One hundred fourteen patients 16 to 25 years of age were randomized to tonsillotomy (TT) with radiosurgery (RF) (Ellman International) or to cold tonsillectomy (TE). Pain and analgesics were logged until patients were pain free.

    Results: Thirty-two patients were operated on with TT and 44 with TE. The TT group had less blood loss during surgery and no postoperative bleedings, compared with the TE group (2 primary and 4 late hemorrhages). The TT group recorded significantly less pain from the first day, had less need of analgesics (diclofenac and paracetamol), and were pain free and in school/at work 4 days earlier than the TE group. After 7 days, the TE patients had lost a mean of 1.8 kg compared with TT, with no significant weight loss. After 1 year, both groups were satisfied. The positive effect on snoring was the same for both groups. There were few throat infections in both groups.

    Conclusion: TT with RF is an effective method for tonsil surgery for many teenagers and young adults, with much less postoperative morbidity than regular TE. Long-term follow-up is necessary.

  • 5.
    Ericsson, Elisabeth
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Ledin, Torbjörn
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Hultcrantz, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Long-Term Improvement of Quality of Life as a Result of Tonsillotomy (With Radiofrequency Technique) and Tonsillectomy in Youths2007In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 117, no 7, p. 1272-1279Article in journal (Refereed)
    Abstract [en]

    Objective: This is a 1 year follow-up to compare the effects of partial tonsil resection using the radiofrequency technique (RF) tonsillotomy (TT) with total tonsillectomy (TE) (blunt dissection). Obstructive symptoms, tendency for infections, and health-related quality of life (HRQL) were studied and compared with the HRQL data from a normal population.

    Method: The study group consisted of 74 patients (16-25 yr old) randomized to TT (n = 31) or TE (n = 43) with obstructive throat problems with or without recurrent tonsillitis. The Short Form 36 (SF-36) and EuroQul Visual Analogue Scale were used to evaluate HRQL. A questionnaire investigated the degree of obstruction and history of infections.

    Results: Preoperatively, both groups reported significantly lower HRQL in all dimensions of the SF-36 compared with the normal population (P < .05-P < .001). After 1 year, a large improvement (P < .01-P < .001) in both groups in HRQL was found. No differences were found when these groups were compared with the normal population or between the study groups. The effect on snoring was the same for both groups, and the rate of recurrence of infections was low and not any higher in the TT group.

    Conclusion: Preoperative obstructive problems in combination with recurrent tonsillitis have a negative impact on HRQL. Both the TT and TE groups demonstrated large improvements on HRQL, infections, and obstructive problems 1 year after surgery, indicating that the surgical methods are equally effective. With its reduced postoperative complications, less pain, shorter recovery time, and cost reduction, TT with RF should be considered the method of choice.

  • 6. Haraldsson, PO
    et al.
    Karling, J
    Lysdahl, M
    Svanborg, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Neurophysiology. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Voice quality after radiofrequency volumetric tisseu reduction of the soft palate in habitual snorers2002In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 112, p. 1260-1263Article in journal (Refereed)
  • 7.
    Hertegard, S.
    et al.
    Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Cedervall, J.
    Karolinska Institutet, Stockholm, Sweden.
    Svensson, B.
    Östersunds Hospital, Sweden.
    Forsberg, K.
    University of Umeå, Sweden.
    Maurer, F. H. J.
    Lund University, Sweden.
    Vidovska, D.
    Lund University, Sweden;.
    Olivius, Petri
    Karolinska University Hospital, Solna, Stockholm, Sweden.
    Ährlund-Richter, L.
    Karolinska Institutet, Stockholm, Sweden.
    Le Blanc, K.
    Karolinska University Hospital Huddinge and Karolinska Institutet, Stockholm, Sweden.
    Viscoelastic and histologic properties in scarred rabbit vocal folds after mesenchymal stem cell injection2006In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 116, no 7, p. 1248-1254Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE/HYPOTHESIS:

    The aim of this study was to analyze the short-term viscoelastic and histologic properties of scarred rabbit vocal folds after injection of human mesenchymal stem cells (MSC) as well as the degree of MSC survival. Because MSCs are antiinflammatory and regenerate mesenchymal tissues, can MSC injection reduce vocal fold scarring after injury?

    STUDY DESIGN:

    Twelve vocal folds from 10 New Zealand rabbits were scarred by a localized resection and injected with human MSC or saline. Eight vocal folds were left as controls.

    MATERIAL AND METHODS:

    After 4 weeks, 10 larynges were stained for histology and evaluation of the lamina propria thickness. Collagen type I content was analyzed from six rabbits. MSC survival was analyzed by fluorescent in situ hybridization staining from three rabbits. Viscoelasticity for 10 vocal folds was analyzed in a parallel-plate rheometer.

    RESULTS:

    The rheometry on fresh-frozen samples showed decreased dynamic viscosity and lower elastic modulus (P<.01) in the scarred samples injected with MSC as compared with the untreated scarred group. Normal controls had lower dynamic viscosity and elastic modulus as compared with the scarred untreated and treated vocal folds (P<.01). Histologic analysis showed a higher content of collagen type 1 in the scarred samples as compared with the normal vocal folds and with the scarred folds treated with MSC. MSCs remained in all samples analyzed.

    CONCLUSIONS:

    The treated scarred vocal folds showed persistent MSC. Injection of scarred rabbit vocal folds with MSC rendered improved viscoelastic parameters and less signs of scarring expressed as collagen content in comparison to the untreated scarred vocal folds.

     

  • 8.
    Hessen Soderman, Anne-Charlotte
    et al.
    Karolinska University Hospital.
    Ericsson, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Hemlin, Claes
    Karolinska Institute.
    Hultcrantz, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Mansson, Ingemar
    Sahlgrens University Hospital.
    Roos, Kristian
    Capio Lundby.
    Stalfors, Joacim
    Sahlgrens University Hospital.
    Reduced Risk of Primary Postoperative Hemorrhage After Tonsil Surgery in Sweden: Results from the National Tonsil Surgery Register in Sweden Covering More Than 10 Years and 54,696 Operations2011In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 121, no 11, p. 2322-2326Article in journal (Refereed)
    Abstract [en]

    Objectives/Hypothesis: To analyze the incidence of primary bleeding following tonsil surgery and to evaluate risk factors. less thanbrgreater than less thanbrgreater thanStudy Design: Register study of the results from the National Tonsil Surgery Register in Sweden covering the period 1997 to 2008 and 54,696 operations. less thanbrgreater than less thanbrgreater thanMethods: Data were collected by means of three questionnaires, two filled in by professionals and one 6 months post-operatively by the patient/parent. less thanbrgreater than less thanbrgreater thanResults: A total of 719 patients experienced primary postoperative bleeding during the hospital stay (1.3%). A number of independent factors were correlated with decreased risk of post-tonsillectomy hemorrhage: younger age (P andlt; .0001), female sex (P andlt; .0001), type of surgery (tonsillotomy) (P = .0006), and surgery performed on a day-surgery basis (P andlt; .0001). Indication for surgery and number of operations performed at the department did not correlate with postoperative bleeding risk. A significant decrease in primary postoperative hemorrhage rate from 2% to 0.96% was found during the study period. less thanbrgreater than less thanbrgreater thanConclusions: Primary hemorrhage following tonsil surgery is rare. During the study period, a significant decrease in primary bleeding rates occurred. The changes in practice with an increasing proportion of day-surgery cases and tonsillotomy have contributed to the reduced risk, but cannot completely explain the reduction.

  • 9.
    Odhagen, Erik
    et al.
    Sodra Alvsborgs Hosp, Sweden; Univ Gothenburg, Sweden.
    Stalfors, Joacim
    Univ Gothenburg, Sweden; Sheikh Khalifa Med City, U Arab Emirates.
    Sunnergren, Ola
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences. Ryhov Cty Hosp, Sweden.
    Morbidity after pediatric tonsillotomy versus tonsillectomy: A population-based cohort study2019In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 129, no 11, p. 2619-2626Article in journal (Refereed)
    Abstract [en]

    Objectives/Hypothesis To compare and evaluate morbidity following pediatric tonsillectomy (TE) and tonsillotomy (TT) performed due to tonsil-related upper airway obstruction. Study Design Retrospective population-based cohort study based on data from the Swedish National Patient Register (NPR). Methods All patients aged 1 to 12 years who were registered in the NPR between January 1, 2007 and December 31, 2015, and who underwent an isolated tonsil surgery (+/- adenoidectomy) for the sole indication of upper airway obstruction were included. Postoperative morbidity within 30 days of surgery, including readmission due to hemorrhage and return to theater (RTT), was evaluated and compared between the two groups. A forward stepwise multivariable logistic regression analysis was used to identify independent predictors of postoperative morbidity. Results In total, 35,060 patients were included in the study, 23,447 of whom underwent TT and 11,613 of whom underwent TE. Readmission due to postoperative hemorrhage, RTT, readmission due to any reason, and contact with healthcare were all less common after TT than after TE. Readmission due to postoperative hemorrhage was significantly more common after TE (2.5%) than after TT (0.6%) (odds ratio: 3.91, 95% confidence interval: 3.20-4.77). Conclusions This study showed that TT is associated with a statistically significantly lower risk of postoperative complications than TE when performed in children to correct tonsil-related upper airway obstruction. Statistically significant differences were found for all outcome variables, namely, readmission to hospital due to bleeding, RTT, readmission due to any reason, and postoperative contact with healthcare for any reason. Level of Evidence 2b Laryngoscope, 129:2619-2626, 2019

  • 10.
    Priwin, C
    et al.
    Göteborg University.
    Stenfelt, Stefan
    Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology.
    Granström, G
    Göteborg University.
    Tjellström, A
    Göteborg University.
    Håkansson, B
    Chalmers.
    Bilateral bone-anchored hearing aids (BAHAs): An audiometric evaluation2004In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 114, no 1, p. 77-84Article in journal (Refereed)
    Abstract [en]

    Objectives: Since the technique to implant bone-anchored hearing aids (BAHAs) with the use of osseointegrated implants was developed in 1977, more than 15,000 patients have been fitted with BAHAs worldwide. Although the majority have bilateral hearing loss, they are primarily fitted unilaterally. The main objective of this study was to reveal benefits and drawbacks of bilateral fitting of BAHAs in patients with symmetric or slight asymmetric bone-conduction thresholds. The possible effects were divided into three categories: hearing thresholds, directional hearing, and binaural hearing. Study Design: Prospective study of 12 patients with bilateral BAHAs. Methods: Baseline audiometry, directional hearing, speech reception thresholds in quiet and in noise, and binaural masking level difference were tested when BAHAs were fitted unilaterally and bilaterally. Results: Eleven of the 12 patients used bilateral BAHAs on a daily basis. Tests performed in the study show a significant improvement in sound localization with bilateral BAHAs; the results with unilateral fitting were close to the chance level. Furthermore, with bilateral application, the improvement of the speech reception threshold in quiet was 5.4 dB. An improvement with bilateral fitting was also found for speech reception in noise. Conclusions: Overall, the results with bilateral fitted BAHAs were better than with unilaterally fitted BA-HA; the benefit is not only caused simply by bilateral stimulation but also, to some extent, by binaural hearing. Bilateral BAHAs should be considered for patients with bilateral hearing loss otherwise suitable for BAHAs.

  • 11.
    Sunnergren, Ola
    et al.
    The ENT Clinic, Ryhov County Hospital, Jönköping, Sweden.
    Broström, Anders
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Soft palate sensory neuropathy in the pathogenesis of obstructive sleep apnea2011In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 121, no 2, p. 451-456Article in journal (Refereed)
    Abstract [en]

    Objectives/ Hypothesis:In general, obstructive sleep apnea (OSA) seems to be a progressive disorder whose pathogenesis is not fully understood. One hypothesis is that long-standing snoring vibrations cause a local neuropathy in the upper airway, which predisposes to obstructive events during sleep. The aim of this study was to investigate sensory function in the upper airway in a cohort of subjects comprising nonsnorers, snorers, and untreated subjects with OSA, and to correlate data to apnea–hypopnea index (AHI) and duration of snoring.

    Study Design:Cross-sectional cohort study.

    Methods:Subjects were recruited from primary care hypertension clinics. Whole-night respiratory recordings were performed to determine presence and degree of OSA. Three groups were formed based on AHI and snoring history: 1) nonsnorers (n = 25); 2) snorers, AHI < 10 (n = 32); 3) OSA subjects, AHI ≥ 10 (n = 33). Quantitative cold sensory testing of the soft palate and lip was used to assess neuropathy.

    Results:There were no significant differences concerning lip sensory function between groups. Nonsnorers showed significantly lower thresholds for cold (i.e., better sensitivity) in the soft palate compared to both other groups (P < .01). Snorers had lower thresholds than OSA subjects (P < .05). There were significant correlations (P < .01) between decreased sensory function and AHI (rs = .41) and to duration of snoring (rs = .47).

    Conclusions:The degree of sensory neuropathy in the upper airway correlates with degree of obstructive sleep disorder. Our results strengthen the hypothesis that snoring vibrations may cause a neuropathy in the upper airway, which contributes to the progression and development of OSA. Laryngoscope, 2011

  • 12.
    Sunnergren, Ola
    et al.
    Ryhov County Hospital.
    Broström, Anders
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Soft Palate Sensory Neuropathy in the Pathogenesis of Obstructive Sleep Apnea2011In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 121, no 2, p. 451-456Article in journal (Refereed)
    Abstract [en]

    Objectives/Hypothesis: In general, obstructive sleep apnea (USA) seems to be a progressive disorder whose pathogenesis is not fully understood. One hypothesis is that long-standing snoring vibrations cause a local neuropathy in the upper airway, which predisposes to obstructive events during sleep. The aim of this study was to investigate sensory function in the upper airway in a cohort of subjects comprising nonsnorers, snorers, and untreated subjects with USA, and to correlate data to apnea-hypopnea index (AHI) and duration of snoring. Study Design: Cross-sectional cohort study. Methods: Subjects were recruited from primary care hypertension clinics. Whole-night respiratory recordings were performed to determine presence and degree of USA. Three groups were formed based on AHI and snoring history: 1) nonsnorers (n = 25); 2) snorers, AHI andlt; 10 (n = 32); 3) USA subjects, AHI andgt;= 10 (n = 33). Quantitative cold sensory testing of the soft palate and lip was used to assess neuropathy. Results: There were no significant differences concerning lip sensory function between groups. Nonsnorers showed significantly lower thresholds for cold (i.e., better sensitivity) in the soft palate compared to both other groups (P andlt; .01). Snorers had lower thresholds than USA subjects (P andlt; .05). There were significant correlations (P andlt; .01) between decreased sensory function and AHI (r(s) = .41) and to duration of snoring (r(s) = .47). Conclusions: The degree of sensory neuropathy in the upper airway correlates with degree of obstructive sleep disorder. Our results strengthen the hypothesis that snoring vibrations may cause a neuropathy in the upper airway, which contributes to the progression and development of USA.

  • 13.
    Westergren, Viveka
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine.
    Bassiri, M.
    Division of Clinical Bacteriology, Department of Medical Sciences, University Hospital, Uppsala, Sweden.
    Engstrand, L.
    Division of Clinical Bacteriology, Department of Medical Sciences, University Hospital, Uppsala, Sweden, Swed. Inst. for Infect. Dis. Control, Solna, Sweden.
    Bacteria detected by culture and 16S rRNA sequencing in maxillary sinus samples from intensive care unit patients2003In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 113, no 2, p. 270-275Article in journal (Refereed)
    Abstract [en]

    Objectives/Hypothesis: In critically ill patients, the occurrence of artificial ventilation-acquired sinus disease is common. A possible sinus bacterial infection is occult and is combined with diagnostic difficulties. Culture as a method has limited capacity to verify the presence of bacteria and leaves unanswered the question of a possible infective agent because bacteria are difficult to grow when killed or suppressed by current antibiotic therapy. Hitherto unidentified micro-organisms are also possible in the microenvironments of maxillary sinuses. Study Design: Prospective case series. Methods: Twenty maxillary sinus samples (17 aspirates and 3 lavages) from nine critically ill patients with possible infectious disease were investigated by broad-range 16S rRNA polymerase chain reaction followed by sequencing. These results were compared with the previous culture results from gingiva (passage route), maxillary sinus absorption, and mucosa samples. Results: The contaminations were rare (2 of 20) and corresponded well to culture results. One previously undiagnosed bacterium was found. Two aspirates were negative on both culture and polymerase chain reaction, whereas the corresponding maxillary sinus mucosal cultures had been positive. Conclusions: Applying a lowcontamination maxillary sinuses sampling technique makes 16S rRNA sequencing clinically useful. The polymerase chain reaction and culture results were generally comparable. However, by polymerase chain reaction, bacteria were found that were missed by culturing. Some aspirates were free of bacterial remnants on 16S rRNA polymerase chain reaction, but corresponding mucosal cultures were positive. This could indicate that infection is induced within the tissue. It also indicates that infectious agents introduced into the sinuses may have routes other than the ostium. Further clinical use of 16S rRNA sequencing is required to enlarge our knowledge in applied microbiology and paranasal sinus disease.

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