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  • 1.
    Mjönes, Anna-Britta
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences.
    Svalgproblem och hiatushernia: reflektioner över symptom och fynd2009Licentiate thesis, comprehensive summary (Other academic)
    Abstract [sv]

    Denna licentiatavhandling består av tre delarbeten. Dessa tre arbeten handlar omsymtom som inte alltid kommer i fråga när det gäller gastroesofageal reflux.I det första arbetet var syftet att undersöka huruvida patienter medmagmunsbråck (hiatushernia) blev förbättrade med avseende på symtom somfelsväljning till larynx (MSL) och till näsan (MSN), samt heshet (H), som ettresultat av hiatusherniaoperation. Nittio patienter, som undersöktes före ochefter hiatusherniaoperation, fyllde i frågeformulär om H, MSL och MSN. Hos30% av patienterna förekom MSL och lika många hade MSN. Heshet fanns hos25% av patienterna före operation. Dessa symtom hade ett signifikant inbördessamband (p<0.008). Alla symtom minskade efter antirefluxkirurgi (p<0.001).Förbättringen var oberoende av patienternas vikt.

    I det andra arbetet studerades huruvida felsväljning var en extralaryngeal orsaktill heshet och om det var någon skillnad i prevalensen för felsväljning ochheshet mellan patienter med hiatushernia med gastroesofageal refluxsjukdom(GERD) och patienter med hiatushernia utan patologisk gastroesofageal reflux(GER). Patientmaterialet bestod av 198 patienter, som befunnits ha hiatusherniavid undersökning med esofagusmanometri och pH-refluxtest och somkontrollgrupp 262 personer ur normalbefolkningen, vilka inte visade sig hahiatushernia vid endoskopi. Dessa grupper svarade på ett frågeformulärangående symtom på heshet, felsväljning och halsbränna. Jämförelsen mellanpatientgrupp och kontrollgrupp visade H hos 35% respektive 13%, MSL hos35% respektive 5%, MSN hos 22% respektive 1% och halsbränna hos 85%respektive 6% (p<0.001). Båda symtomen MSL och MSN var vanliga(p<0.0001). H och MSL hade inget inbördes förhållande. H och MSL var likavanligt i gruppen med GERD som i gruppen med GER. Slutsatsen blev att detfinns en predisponering för H och MSL hos patienter med hiatushernia, menorsakssambandet är oklart. Heshet verkar inte vara orsakat av GERD.

    List of papers
    1. Hoarseness and misdirected swallowing before and after antirefluxsurgery
    Open this publication in new window or tab >>Hoarseness and misdirected swallowing before and after antirefluxsurgery
    2005 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 125, no 1, p. 82-85Article in journal (Refereed) Published
    Abstract [en]

    Conclusion Patients with hiatus hernia can be relieved from H, MSL and MSN by hiatus hernia repair.

    Objective It has been hypothesized that respiratory symptoms in patients with gastro-oesophageal reflux disease (GORD) may, in some cases, be due to misdirected swallowing as a consequence of defective opening of the upper oesophageal sphincter. The aim of this study was to investigate whether patients with hiatus hernia are relieved from symptoms of misdirected swallowing to the larynx (MSL) and nose (MSN), as well as hoarseness (H), as a result of hiatus hernia repair.

    Material and methods A questionnaire concerning symptoms of H, MSL and MSN was administered to 90 patients under investigation for hiatus hernia repair before and after surgery.

    Results Before surgery, MSL occurred in 30% of patients, MSN in 30% and H in 25%. These symptoms were significantly interrelated (p<0.008). After antireflux surgery, all symptoms were significantly reduced (p<0.001). Symptom reduction was not related to the weight of the patients.

    Keywords
    Gastro-oesophageal reflux disease, hiatus hernia, hiatus hernia repair, upper oesophageal sphincter dysfunction
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-20321 (URN)10.1080/00016480410017945 (DOI)
    Available from: 2009-09-03 Created: 2009-09-03 Last updated: 2017-12-13Bibliographically approved
    2. Hoarseness and misdirected swallowing in patients with hiatal hernia
    Open this publication in new window or tab >>Hoarseness and misdirected swallowing in patients with hiatal hernia
    Show others...
    2007 (English)In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 264, no 12, p. 1437-1439Article in journal (Refereed) Published
    Abstract [en]

    The purpose of this study was to elucidate whether misdirected swallowing is an extra-laryngeal cause of hoarseness and investigate whether the prevalence of misdirected swallowing and hoarseness in patients with hiatal hernias differ from those with and without pathological gastroesophageal reflux (GER). One hundred and ninety eight patients with hiatal hernias diagnosed via esophageal manometry and pH-reflux test and 262 subjects in the general population who did not have a hiatal hernia at endoscopy, filled in a questionnaire about symptoms on hoarseness, misdirected swallowing, and heartburn. Hoarseness (35%), misdirected swallowing to the larynx (MSL; 35%), misdirected swallowing to the nose (MSN; 22%) and heartburn (85%) were significantly more common in patients with hiatal hernia than in controls (13, 5, 1, and 6%, respectively, P<0.001). MSL and MSN in the patient group were significantly interrelated (P<0.0001). Hoarseness and MSL were not significantly associated (P<0.076). Hoarseness and MSL were as common in the hernia group with normal GER, as in the group with pathological GER. There is a predisposition for hoarseness and MSL in patients with hiatal hernias, but the cause-and-effect relationship is unclear. Hoarseness does not seem to be caused by pathological GER.

    Keywords
    Gastroesophageal reflux - Hiatal hernia - Hoarseness - Misdirected swallowing
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-20323 (URN)10.1007/s00405-007-0396-8 (DOI)17643255 (PubMedID)
    Available from: 2009-09-03 Created: 2009-09-03 Last updated: 2017-12-13Bibliographically approved
    3. Globus jugularis and dysphagia in patients with hiatus hernia
    Open this publication in new window or tab >>Globus jugularis and dysphagia in patients with hiatus hernia
    2010 (English)In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 267, no 2, p. 251-254Article in journal (Refereed) Published
    Abstract [en]

    The aim of the article was to study if there is any relationship between globus sensation in the jugular fossa (GJ), intermittent esophageal dysphagia (IED), and the presence of a hiatus hernia, and if GJ can be relieved after hiatus hernia repair. 167 patients with a hiatus hernia (Group A) and 61 other patients with hiatus hernia and gastroesophageal reflux disease who were surgically treated with Nissen fundoplication (Group B), filled in a symptom questionnaire on GJ and IED. GJ was found in 66% and IED in 68% of patients in group A. In group B, 49% had GJ and 64% IED before surgery. At surgical follow-up 16% (P < 0.005) and 43% (P < 0.05) had GJ and IED, respectively. The combination of GJ and IED was found in 28% of IED patients before operation and in 31% at surgical follow-up. The high frequency of GJ in patients with hiatus hernia and the significant relief of GJ after hiatus hernia repair imply that GJ most likely is a referred sensation from the esophagus. IED and GJ are two parallel phenomena in patients with hiatus hernia, but do not seem to have any causal relationship.

    Keywords
    Dysphagia - Fundoplication - Globus sensation - Globus jugularis - Hiatus hernia - Lump in the throat
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-20344 (URN)10.1007/s00405-009-1038-0 (DOI)19597835 (PubMedID)
    Note

    On the day of the defence date the status of this article was Submitted.

    Available from: 2009-09-04 Created: 2009-09-04 Last updated: 2017-12-13Bibliographically approved
  • 2.
    Mjönes, Anna-Britta
    et al.
    Linköping University, Department of Neuroscience and Locomotion, 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.
    Borch, Kurt
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Tibbling, Lita
    Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery Östergötland. Östergötlands Läns Landsting.
    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.
    Hoarseness and misdirected swallowing in patients with hiatal hernia2007In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 264, no 12, p. 1437-1439Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to elucidate whether misdirected swallowing is an extra-laryngeal cause of hoarseness and investigate whether the prevalence of misdirected swallowing and hoarseness in patients with hiatal hernias differ from those with and without pathological gastroesophageal reflux (GER). One hundred and ninety eight patients with hiatal hernias diagnosed via esophageal manometry and pH-reflux test and 262 subjects in the general population who did not have a hiatal hernia at endoscopy, filled in a questionnaire about symptoms on hoarseness, misdirected swallowing, and heartburn. Hoarseness (35%), misdirected swallowing to the larynx (MSL; 35%), misdirected swallowing to the nose (MSN; 22%) and heartburn (85%) were significantly more common in patients with hiatal hernia than in controls (13, 5, 1, and 6%, respectively, P<0.001). MSL and MSN in the patient group were significantly interrelated (P<0.0001). Hoarseness and MSL were not significantly associated (P<0.076). Hoarseness and MSL were as common in the hernia group with normal GER, as in the group with pathological GER. There is a predisposition for hoarseness and MSL in patients with hiatal hernias, but the cause-and-effect relationship is unclear. Hoarseness does not seem to be caused by pathological GER.

  • 3.
    Mjönes, Anna-Britta
    et al.
    Linköping University, Department of Neuroscience and Locomotion, 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 Neuroscience and Locomotion, 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.
    Tibbling Grahn, Lita
    Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, GE: gastromed.
    Hultcrantz, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences.
    Hoarseness and misdirected swallowing before and after antirefluxsurgery2005In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 125, no 1, p. 82-85Article in journal (Refereed)
    Abstract [en]

    Conclusion Patients with hiatus hernia can be relieved from H, MSL and MSN by hiatus hernia repair.

    Objective It has been hypothesized that respiratory symptoms in patients with gastro-oesophageal reflux disease (GORD) may, in some cases, be due to misdirected swallowing as a consequence of defective opening of the upper oesophageal sphincter. The aim of this study was to investigate whether patients with hiatus hernia are relieved from symptoms of misdirected swallowing to the larynx (MSL) and nose (MSN), as well as hoarseness (H), as a result of hiatus hernia repair.

    Material and methods A questionnaire concerning symptoms of H, MSL and MSN was administered to 90 patients under investigation for hiatus hernia repair before and after surgery.

    Results Before surgery, MSL occurred in 30% of patients, MSN in 30% and H in 25%. These symptoms were significantly interrelated (p<0.008). After antireflux surgery, all symptoms were significantly reduced (p<0.001). Symptom reduction was not related to the weight of the patients.

  • 4.
    Tibbling, Lita
    et al.
    Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery Östergötland.
    Johansson, Magnus
    Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery Östergötland. Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology. Linköping University, Faculty of Health Sciences.
    Mjönes, Anna-Britta
    Linköping University, Department of Neuroscience and Locomotion, 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.
    Franzén, Thomas
    Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery Östergötland.
    Globus jugularis and dysphagia in patients with hiatus hernia2010In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 267, no 2, p. 251-254Article in journal (Refereed)
    Abstract [en]

    The aim of the article was to study if there is any relationship between globus sensation in the jugular fossa (GJ), intermittent esophageal dysphagia (IED), and the presence of a hiatus hernia, and if GJ can be relieved after hiatus hernia repair. 167 patients with a hiatus hernia (Group A) and 61 other patients with hiatus hernia and gastroesophageal reflux disease who were surgically treated with Nissen fundoplication (Group B), filled in a symptom questionnaire on GJ and IED. GJ was found in 66% and IED in 68% of patients in group A. In group B, 49% had GJ and 64% IED before surgery. At surgical follow-up 16% (P < 0.005) and 43% (P < 0.05) had GJ and IED, respectively. The combination of GJ and IED was found in 28% of IED patients before operation and in 31% at surgical follow-up. The high frequency of GJ in patients with hiatus hernia and the significant relief of GJ after hiatus hernia repair imply that GJ most likely is a referred sensation from the esophagus. IED and GJ are two parallel phenomena in patients with hiatus hernia, but do not seem to have any causal relationship.

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