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  • 101.
    Lundeborg Hammarström, Inger
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. 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. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    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.
    McAllister, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Acoustic and perceptual aspects of vocal function in children with adenotonsillar hypertrophy —effects of surgery2012In: Journal of Voice, ISSN 0892-1997, E-ISSN 1873-4588, Vol. 26, no 4, p. 480-487Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate outcome of two types of tonsil surgery (tonsillectomy+adenoidectomy or tonsillotomy +adenoidectomy) on vocal function perceptually and acoustically.

    Study Design: Sixty-seven children, aged 50-65 months, on waiting list for tonsil surgery were randomized to tonsillectomy (n=33) or tonsillotomy (n=34). Fifty-seven age and gender matched healthy pre-school children were controls. Twenty-eight of them, aged 48-59 months, served as control group before surgery, and 29, aged 60-71 months, after surgery

    Methods: Before surgery and six months postoperatively, the children were recorded producing three sustained vowels (/A, u, i/) and 14 words. The control groups were recorded only once.

    Three trained speech and language pathologists performed the perceptual analysis using Visual Analogue Scales (VAS) for eight voice quality parameters. Acoustic analysis from sustained vowels included average fundamental frequency, jitter percent, shimmer percent, noise-to-harmonic ratio and the centre frequencies of formants 1-3

    Results: Before surgery the children were rated to have more hyponasality and compressed/throaty voice (p<0,05) and  lower mean pitch (p<0,01) in comparison to the control group. They also had higher perturbation measures and lower frequencies of the second and third formant. After surgery there were no differences perceptually. Perturbation measures decreased but were still higher compared to the control group’s, p<0, 05. Differences in formant frequencies for /i/ and /u/ remained. No differences were found between the two surgical methods.

    Conclusion: Voice quality is affected perceptually and acoustically by adenotonsillar hypertrophy. After surgery the voice is perceptually normalized but acoustic differences remain. Outcome was equal for both surgical methods.

  • 102.
    Lundeborg, Inger
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Linköping University, Faculty of Health Sciences.
    McAllister, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Graf, Jonas
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences.
    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, 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.
    Oral motor dysfunction in children with adenotonsillar hypertrophy-effects of surgery2009In: Logopedics, Phoniatrics, Vocology, ISSN 1401-5439, E-ISSN 1651-2022, Vol. 34, no 3, p. 111-116Article in journal (Refereed)
    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.

  • 103.
    Lundeborg, Inger
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Linköping University, Faculty of Health Sciences.
    McAllister, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Samuelsson, Christina
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Linköping University, Faculty of Health Sciences.
    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, 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.
    Phonological development in children with obstructive sleep-disordered breathing2009In: Clinical Linguistics & Phonetics, ISSN 0269-9206, E-ISSN 1464-5076, Vol. 23, no 10, p. 751-61Article in journal (Refereed)
    Abstract [en]

    Adeno-tonsillar hypertrophy with obstructive sleep disordered breathing (OSDB) is known to affect oral-motor function, behaviour, and academic performance. Adeno-tonsillectomy is the most frequently performed operation in children, with total tonsillectomy (TE) being more common than partial resection, 'tonsillotomy' (TT). In the present study 67 children, aged 50-65 months, with OSBD were randomized to TE or TT. The children's phonology was assessed pre-operatively and 6 months post-operatively. Two groups of children served as controls. Phonology was affected in 62.7% of OSBD children before surgery, compared to 34% in the control group (p < .001). Also, OSBD children had more severe phonological deficits than the controls (p < .001). Phonology improved 6 months equally after both surgeries. Despite improvement post-operatively, the gap to the controls increased. Other functional aspects, such as oral motor function, were normalized regardless of surgical method--TE or TT. The impact of OSBD should be considered as one contributing factor in phonological impairment.

  • 104.
    LundeborgHammarström, Inger
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology .
    Ericsson, Elisabeth
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    McAllister, Anita
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Hultcrantz, Elisabeth
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Effects of tonsil surgery on speech and oral motor function2008In: The 12th Congress of the International Clinical Phonetics and Linguistics association,2008, 2008, p. 119-119Conference paper (Refereed)
    Abstract [en]

     Large tonsils decrease the upper airways and cause oral breathing in children. If oral breathing persists, it leads to muscular and postural alterations, which, in turn cause dentoskeletal changes. In Sweden 6% of all children, have tonsil surgery performed. The indications are usually recurrent tonsillitis or severe snoring and/or sleep apneoa. Oral motor dysfunction including swallowing problems , disordered speech and aberrant dentofacial growth are less recognized problems as indications for treatment. We report results from a project aiming at comparing oral motor function and speech in children trated with two different surgical methods, tonsillectomy (TE) and partial tonsil resection, tonsillotomy (TT). 67 children aged 4-5 years old on ordinary waiting list for tonsil surgery were randomized to either TE or TT. They were assessed with the Swedish version of Nordic Orofacial Test (NOT-S) and a Swedish phonological test. A voice recording was also made. The assessment was repeated 6 months after surgery. The results were compared to a control group without tonsil problems. No significant differences were found between the children operated with TE or TT. Both groups performed significantly better on the oral motor test at the postoperative assessment, and voice quality had improved. However, compared to the control group, the children with enlarged tonsils had a delay in phonological development, preoperatively that remained at the 6-month postoperative control   

  • 105.
    Lundin, Fredrik
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Neurology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    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, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Wikkelsø, C.
    Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Leijon, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Neurology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Postural Function in Idiopathic Normal Pressure Hydrocephalus Before and After Shunt Surgery: A Controlled Study Using Computerised Dynamic Posturography (EquiTest)Manuscript (preprint) (Other academic)
    Abstract [en]

    Postural dysfunction is one of the major features of idiopathic Normal Hydrocephalus (iNPH). With computerised dynamic posturography (CDP) balance can be assessed objectively. The primary aim of this study was to describe the postural function in iNPH patients pre- and post-operatively in comparison with healthy individuals (HI) using CDP.

    Subjects and methods: Thirty-five patients (16 M, 19 F) with a mean age of 73 (range 49-81) with iNPH, and sixteen HI (7 M, 9 F) aged 73 (62-89) were included. iNPH patients were operated on with a ventriculo-peritoneal shunt. Patients and HI were tested regarding motor function, balance and cognition. CDP, EquiTest (NeuroCom International, Clackamas, OR), was performed before and three months after shunt surgery and twice in HI, with a three-month interval.

    Results: Pre-operatively, the 35 patients had poorer balance measured with the Sensory Organising Test (SOT) score in every condition (p= 0.01 in SOT 1 and p<0.001 in SOT 2-6) compared to the HI. The greatest difference was in test conditions measuring mainly vestibular function, where loss of balance (LOB) was frequent. Twenty patients did undergo shunt surgery and 18/20 (90%) were considered shunt responders, with a mean improvement of motor score of 26% (range 5-67 %). There was an improvement post-operatively in the weighted composite SOT score (p<0.05) but no significant change in any of the SOT conditions. LOB was not significantly reduced in any of the test conditions.

    Conclusion: CDP showed that the patients had a poorer balance than the HI. The greatest difference was in SOT 5-6, indicating that the postural disturbance is of primarily central vestibular origin. There was a slight improvement of balance post-operatively.

  • 106.
    Lyxell, Björn
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Andersson, Jan
    Andersson, Ulf
    Linköping University, Department of Behavioural Sciences. Linköping University, Faculty of Arts and Sciences.
    Arlinger, Stig
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences.
    Bredberg, G.
    Harder, Henrik
    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.
    Phonological representation and speech understanding with cochlear implants in deafened adults1998In: Scandinavian Journal of Psychology, ISSN 0036-5564, Vol. 39, no 3, p. 175-179Article in journal (Refereed)
    Abstract [en]

    In the present study cognitive performance in 15 deafened adult cochlear implant candidates was examined and related to level of speech understanding after 12 months of experience with the implant. The implant group performed on par with normal hearing controls in all cognitive tasks used in the study with one exception: Performance was significantly lower in cognitive tasks where use of a phonological representation of sound is a key task-demand. Observations of the implanted individuals' level of speech understanding indicate that only those individuals who, pre-operatively, were in possession of phonological representations comparable to that of normal hearing could follow and understand a speaker that was out of sight. The results are discussed with respect to (a) deterioration in the phonological representation of sounds as a function of absence of external auditory stimulation, and (b) the role of cognitive factors in predicting success in speech understanding with the implant.

  • 107.
    Magnuson, Bengt
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences.
    Functions of the mastoid cell system: auto-regulation oftemperature and gas pressure2003In: Journal of Laryngology and Otology, ISSN 0022-2151, E-ISSN 1748-5460, Vol. 117, p. 99-103Article in journal (Refereed)
    Abstract [en]

    This article presents a new approach to understanding the physiological functions of the mastoid cellsystem. It is suggested that the cell system, in combination with the continuous blood fow through theadjacent large vessels, makes up a compound functional unit that serves to protect the sensitive vestibularpart of the inner ear from inadequate stimulation by external temperature changes. By virtue of the largesurface area of the cell system mucosa with respect to the enclosed gas volume, the mastoid cell systemmay also work as a pressure regulator. Variations of the bi-directional exchange of fuid over the capillarynetwork in the mucosa will change the size of the lumen that is available for the gas in the cell system.Volumes of gas and fuid can thus be exchanged to keep the intratympanic pressure within physiologicallimits. The process is most effective in a cell system with a high area-to-volume ratio.

  • 108. Magnusson, AK
    et al.
    Tham, Richard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery .
    The GABA-b antagonist CGP 36742 has decompensatory effects on vestibulo-oculomotor behaviour in pigmented rats with a unilateral vestibular lesion.2000In: European Journal of Neuroscience, ISSN 0953-816X, E-ISSN 1460-9568, Vol. 12, p. 143-143Conference paper (Other academic)
  • 109.
    Mahmoudi, S
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences.
    Roberg, Karin
    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.
    Farnebo, M
    Karolinska Institute.
    WRAP53 promotes cancer cell survival and is a potential target for cancer therapy2011In: CELL DEATH and DISEASE, ISSN 2041-4889, Vol. 2, no e114Article in journal (Refereed)
    Abstract [en]

    We previously identified WRAP53 as an antisense transcript that regulates the p53 tumor suppressor. The WRAP53 gene also encodes a protein essential for Cajal body formation and involved in cellular trafficking of the survival of motor neuron complex, the telomerase enzyme and small Cajal body-specific RNAs to Cajal bodies. Here, we show that the WRAP53 protein is overexpressed in a variety of cancer cell lines of different origin and that WRAP53 overexpression promotes cellular transformation. Knockdown of the WRAP53 protein triggers massive apoptosis through the mitochondrial pathway, as demonstrated by Bax/Bak activation, loss of mitochondrial membrane potential and cytochrome c release. The apoptosis induced by WRAP53 knockdown could moreover be blocked by Bcl-2 overexpression. Interestingly, human tumor cells are more sensitive to WRAP53 depletion as compared with normal human cells indicating that cancer cells in particular depends on WRAP53 expression for their survival. In agreement with this, we found that high levels of WRAP53 correlate with poor prognosis of head and neck cancer. Together these observations propose a role of WRAP53 in carcinogenesis and identify WRAP53 as a novel molecular target for a large fraction of malignancies.

  • 110.
    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
  • 111.
    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.

  • 112.
    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.

  • 113.
    Mäki-Torkko, Elina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology. Linköping University, Faculty of Health Sciences.
    Harder, Henrik
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Bergman, P
    Lyxell, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Improved speech recognition and good self-reported benefit from cochlear implantation in adults2012Conference paper (Other academic)
  • 114.
    Mäki-Torkko, Elina
    et al.
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping. Departmet of Otolaryngology, Linköping University Hospital, Sweden.
    Harder, Henrik
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Bergström, Pia
    Department of Otolaryngology, Ryhov Hospital Jönköping, Sweden.
    Lyxell, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Outcome of cochlear implants in elderly adults2011In: First International Conference on Cognitive Hearing Science for Communication, 2011, p. 89-89Conference paper (Other academic)
    Abstract [en]

    The proportion of elderly population increases and an increasing number of old adults have severe to profound hearing impairment, thus being possible cochlear implant (CI) candidates. The aim of the project was to assess the outcome of CI in terms of speech audiometric results and self-reported benefit in adults with a special emphasis on elderly adults.Subjects and methods: All 124 adult patients (≥ 18 years at implantation) who have been implanted in the Linköping CI program in 1992-2009 were eligible for the study. In addition to audiological tests, the pre-operative assessment of adult patients includes tests of working memory capacity, phonological and lexical processing skills. Glasgow Benefit Inventory (GBI), a self-assessment instrument covering general health, degree of social support and physical state, was mailed to the CI recipients.Results: Response rate was high (90%) and 43 of the participants were ≥ 65 years. The mean time the participants had used their CI was 5.1 years (SD 4, range 1.2-16.9). All patients, with one exception, reached some degree of open set speech recognition. GBI results were comparable to earlier reports in CI populations. Analyses of the cognitive test results and more detailed analyses of speech reception and GBI among the oldest olds (≥75 years) will be reported.Discussion: According to our preliminary results, CI gives good benefit in the whole group. Provided that a careful assessment of cognitive abilities has been made and general health is reasonably good, a good outcome can be expected also in the oldest part of the population.

  • 115.
    Mäki-Torkko, Elina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Harder, Henrik
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Lyxell, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Förväntningar och nytta av CI hos vuxna2009Conference paper (Other academic)
  • 116.
    Mäki-Torkko, Elina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Lyxell, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Harder, Henrik
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Expectations and benefit of cochlear implants in elderly adults2010In: 11th International Conference on Cochlear Implants and other Implantable Auditory Technologies, 2010, p. 111-Conference paper (Other academic)
  • 117.
    Nilsson, C
    et al.
    Östergötlands Läns Landsting.
    La Fleur, L
    Östergötlands Läns Landsting.
    Roberg, Karin
    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. Östergötlands Läns Landsting.
    Differences in radiation, cisplatin, and cetuximab sensitivity between subpopulations of head and neck cancer cells in EJC SUPPLEMENTS, vol 8, issue 5, pp 107-1072010In: EJC SUPPLEMENTS, Elsevier Science B.V., Amsterdam. , 2010, Vol. 8, no 5, p. 107-107Conference paper (Refereed)
    Abstract [en]

    n/a

  • 118.
    Nilsson, Cathrine
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Experimental Pathology. Linköping University, Faculty of Health Sciences.
    Roberg, Karin
    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.
    Grafström, Roland C.
    Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Öllinger, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Experimental Pathology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pathology and Clinical Genetics.
    Intrinsic differences in cisplatin sensitivity of head and neck cancer celllines correlates to lysosomal pH2010In: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 32, no 9, p. 1185-1194Article in journal (Refereed)
    Abstract [en]

    Cisplatin is part of the treatment regime of head and neck squamous cell carcinomas (HNSCC). In order to predict the clinical outcome of the treatment, markers for evaluation of the intrinsic cisplatin sensitivity are inquired. In this study we characterize the lysosomal compartment and compare cisplatin sensitivity in five HNSCC lines and normal oral keratinocytes (NOKs). Cisplatin sensitivity differed 3-fold between the least and most sensitive cell lines, and the cisplatin LD50 correlated significantly to lysosomal pH, which varied from 4.3 in NOKs to 4.9 in the most resistant HNSCC line. Lysosomes are acidified by the V0V1-ATPase complex located in the lysosomal membrane. Interestingly, in cell lines exhibiting high lysosomal pH, we found decreased expression of the V0V1-ATPase B2 subunit, possibly explaining the defective acidification. In all cell lines, exposure to cisplatin caused activation of caspase-3. Cisplatin exposure was accompanied by lysosomal membrane permeabilization and inhibition of the llysosomal cathepsins B, D and L partly prevented cell death. No correlation between cisplatin sensitivity and expression of cathepsins B, D and L or secretion of their respective proforms into the culture medium was found in the cell lines studied. We conclude that lysosomal pH and expression of V0V1-ATPase subunits are possible future markers of intrinsic cisplatin sensitivity.

  • 119.
    Nosrati-Zarenoe, Ramesh
    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.
    Idiopathic Sudden Sensorineural Hearing Loss: Corticosteroid Treatment, the Diagnostic Protocol and Outcome2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL) is a rapid loss of hearing caused by damage to the cochlea or auditory nerve. Spontaneous recovery has been seen in 32%–81%. The incidence of the ISSNHL has been estimated to be between 5 and 20 per 100,000 per year. Different theories (vascular catastrophes, immunologic damage, infections or intracochlear membrane break) about the etiology have resulted in different treatment policies. The effect of therapy is difficult to evaluate for a single physician who sees just a few patients annually.

    The aim of the present thesis was: 1) to investigate the current management and treatment of ISSNHL patients in Sweden with regard to outcome, 2) to evaluate whether, in comparison to placebo, the most common drug given in the treatment of ISSNHL in any way influences the outcome, and 3) to analyze which variables such as background data, concomitant disease, audiogram shape and laboratory tests, best can predict the outcome of ISSNHL.

    A national database was developed with half of all ENT clinics in Sweden participating by submitting a questionnaire for each patient with SSNHL (I-II). The questionnaire covered the patient’s background, current disorder, past and family history of different diseases, examinations, and treatment. Audiograms at the onset of SSNHL and after three months were requested.

    A randomized placebo controlled multicenter trial (RCT) was performed (III) using a modified version of the questionnaire used in the national database. Prednisolone in high tapering dosage, or placebo was given with a total treatment period of eight days. If recovery was complete, treatment stopped, otherwise medication was continued at 10 mg daily to a total of 30 days from beginning. After an initial pure tone audiogram, new audiograms were taken at three follow-up visits: day eight of treatment, after one month, and after three months.

    Meta-analysis (IV) was used in order to strengthen the analysis from the RCT by increasing the material with corresponding data drawn from the Swedish national database for ISSNHL.

    Results from the national database showed that out of 400 patients included in the study with ISSNHL, almost 60% were medically treated, of which nearly 90% were given corticosteroids. Hearing improvement was not statistically associated with receipt of medication. 40% of all patients had an MRI or CT, where 3–4% had acoustic neuroma. 24% of the patients with ISSNHL who had hematological tests taken, had one or more pathological findings.

    In the RCT, 47 patients were randomized to Prednisolone and 46 to placebo. No significant difference of hearing recovery was observed between the Prednisolone group and placebo group at either first or final follow-up regarding the effect of treatment. Presence of vertigo had significant negative effect on hearing improvement in both groups. Inflammatory signs in laboratory work-up had a positive prognostic effect, irrespective of treatment.

    The meta-analysis showed no significant difference between the Prednisolone group and placebo/no treatment group (p>0.05). Vertigo at the onset of hearing loss and age had a negative prognostic value equally in all groups and signs of inflammation had a positive.

    Conclusion: Regardless of diagnostic protocol, treatment of ISSNHL in Sweden is mainly limited to corticosteroids (50%) or to no medical treatment. In a randomized placebo-controlled clinical trial no positive effect of Prednisolone on ISSNHL could be demonstrated. A Meta-analysis of patient data from the Swedish national database for SSNHL and the RCT for ISSNHL demonstrated no effect of Prednisolone on ISSNHL. Is it time to change the focus of research to find new ways to treat ISSNHL?

    List of papers
    1. Idiopathic sudden sensorineural hearing loss: results drawn from the Swedish national database
    Open this publication in new window or tab >>Idiopathic sudden sensorineural hearing loss: results drawn from the Swedish national database
    2007 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 127, no 11, p. 1168-1175Article in journal (Refereed) Published
    Abstract [en]

    A national database was developed in Linköping by the authors to gather data from patients with Sudden Sensorineural Hearing Loss (SSNHL). A form was used for data collection covering background, current disease, examinations and treatment. Audiograms at the onset of SSNHL and after three months are analyzed. The aim of the study was to investigate the treatment policy of SSNHL in Sweden, the effect of treatments on outcome, and which variables are of value in predicting the outcome.

    Out of the first 300 patients reported to the database 208 patients were considered to have idiopathic SSNHL. 50% were treated with corticosteroids, 44% did not receive any treatment. The treated patients had the same outcome as the non-treated patients. The time interval from onset of SSNHL to start of treatment was of importance for the outcome irrespective of type of audiogram or results from laboratory tests. Higher age and heredity for hearing loss gave significant lower chance for improvement.

    The first results from 300 patients in the national database demonstrate that corticosteroids or “no treatment at all” are the treatment options in use today. No significant difference in outcome was seen between treated and non-treated patients. Since spontaneous recovery might be the cause, a placebo-controlled randomized study is required before a positive effect of corticosteroids can be asserted.

    Keywords
    Sudden Hearing Loss, Hearing Loss, Idiopathic, Corticosteroid treatment
    National Category
    Otorhinolaryngology
    Identifiers
    urn:nbn:se:liu:diva-19020 (URN)10.1080/00016480701242477 (DOI)
    Available from: 2009-06-08 Created: 2009-06-08 Last updated: 2017-12-13Bibliographically approved
    2. Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome
    Open this publication in new window or tab >>Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome
    2010 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 130, no 3, p. 384-391Article in journal (Refereed) Published
    Abstract [en]

    Conclusion: Results from a database for sudden sensorineural hearing loss (SSNHL) demonstrate no correlation between laboratory findings, treatment, and outcome in 400 patients. The patients with pathological test results were not treated differently from those with normal test results. The value of laboratory findings and MRI might increase if the results are categorized to more specific diagnoses. Objectives: To investigate diagnostic test batteries for SSNHL and evaluate their value in the management of idiopathic SSNHL. Methods: A total of 400 patients submitted to the Swedish national database for SSNHL were analyzed. Information was collected about the patients past medical history, potential precipitating events, trauma, medical history, hearing loss, current disease, diagnostic protocol, and treatment, using questionnaires as well as two audiograms, one at the first ENT clinic visit and another 3 months later. Results: In all, 65% of these 400 patients underwent hematological tests and 40% had an MRI/CT scan. Twenty-two of 160 MRI investigated had pathological findings including 5 acoustic neuromas. Also, 300 of these 400 patients were evaluated as having idiopathic sudden sensorineural hearing loss (ISSNHL); 24% of them had one or more pathological test results. No significant correlation was found between either the MRI findings or the laboratory findings with regard to treatment or hearing recovery in patients with ISSNHL.

    Keywords
    Sudden deafness, acoustic neuroma, Borrelia infection
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-54412 (URN)10.3109/00016480903161541 (DOI)000274884500013 ()
    Note

    This is an electronic version of an article published in: Ramesh Zarenoe, Magnus Hansson and Elisabeth Hultcrantz, Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome, 2010, ACTA OTO-LARYNGOLOGICA, (130), 3, 384-391. ACTA OTO-LARYNGOLOGICA is available online at informaworldTM: http://dx.doi.org/10.3109/00016480903161541 Copyright: Taylor & Francis http://www.tandf.co.uk/journals/default.asp

    Available from: 2010-03-12 Created: 2010-03-12 Last updated: 2017-12-12
    3. Corticosteroid treatment of Idiopathic Sudden Sensorineural Hearing Loss. Part 1: a randomized triple-blind placebo controlled trial
    Open this publication in new window or tab >>Corticosteroid treatment of Idiopathic Sudden Sensorineural Hearing Loss. Part 1: a randomized triple-blind placebo controlled trial
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Objective: To compare the effect of Prednisolone and placebo on recovery of unilateral Idiopathic Sudden Sensorineural Hearing Loss.

    Study design: Prospective, randomized, triple-blind placebo-controlled multicentre trial.

    Setting: Four tertiary and ten secondary referral centers.

    Patients: Of 103 patients randomly assigned, 93 included in the modified intention-to treat analysis. The patients were aged 18–80 years seeking care between Jan 2006–Sept 2010 within one week after onset of acute unilateral sensorineural hearing loss with a PTA of ≥30dB in the three contiguous frequencies most affected.

    Intervention: Patients were randomly assigned in permuted blocks of ten to receive Prednisolone or placebo in tapering doses from 60 mg for 3 days, and thereafter 50, 40, 30, 20, 10 mg each day until day 8. If complete recovery, no more medication given, otherwise medication continued at 10 mg per day until day 30. Final follow-up was after 3 months with audiogram. 47 patients received Prednisolone and 46 placebo.

    Main outcome measure: Primary endpoint was efficacy of treatment on recovery at day 8 and day 90. Analysis was by modified Intention-To Treat and Per Protocol. The secondary endpoints were prognostic factors for hearing recovery.

    Results: The hearing improvement for 47 patients treated with Prednisolone was 25.5 ± 27.1 dB compared to 46 patients treated with placebo 26.4 ± 26.2 dB at day eight and 39 ± 20.1 dB vs. 35.1 ± 38.3 dB after three months. (ns). Presence of vertigo had significant negative effect on hearing improvement in both groups. Inflammatory signs in laboratory work-up had a positive prognostic effect, irrespective of treatment.

    Conclusion: Prednisolone in customary dosage does not seem to influence recovery of idiopathic sudden sensorineural hearing loss.

    Keywords
    ¨Idiopathic Sudden Sensorineural Hearing Loss, Sudden Deafness, Prednisolone, Randomized, Triple-blind trial
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-67607 (URN)
    Available from: 2011-04-19 Created: 2011-04-19 Last updated: 2011-04-19Bibliographically approved
    4. Corticosteroid treatment of Idiopathic Sudden Sensorineural Hearing Loss. Part 2: a meta-analysis of a RCT and the Swedish national database
    Open this publication in new window or tab >>Corticosteroid treatment of Idiopathic Sudden Sensorineural Hearing Loss. Part 2: a meta-analysis of a RCT and the Swedish national database
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Objective: A randomized placebo-controlled study (paper ON-11-66) has demonstrated no effect of Prednisolone in customary dosage on Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL). The aim of the present paper is to analyze a larger patient group by meta-analysis of data from the RCT together with corresponding material drawn from the Swedish national database for ISSNHL.

    Study design: Meta-analysis of data from a RCT and a Swedish national database for ISSNHL.

    Patients: Data from 192 patients, 18–80 years, with ISSNHL was available. All had a hearing loss of at least 30 dB measured as PTA in the three most affected contiguous frequencies. Patients had been enrolled within one week after onset and evaluated by audiograms after three months.

    Intervention: 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 >10 dB improvement was needed to demonstrate treatment effect of Prednisolone compared to placebo/no treatment.

    Results: 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 had a negative prognostic value equally in all groups and signs of inflammation had a positive.

    Conclusion: Prednisolone in customary dosage does not influence recovery after ISSNHL.

    Keywords
    Idiopathic Sudden Sensorineural Hearing Loss, Sudden Deafness, Prednisolone, Effect of treatment, Placebo, Vertigo
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-67608 (URN)
    Available from: 2011-04-19 Created: 2011-04-19 Last updated: 2011-04-19Bibliographically approved
  • 120.
    Nosrati-Zarenoe, Ramesh
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences.
    Idiopathic Sudden Sensorineural Hearing Loss in Sweden: Diagnostic Protocol and Treatment in Relation to Outcome2009Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL) is a rapid loss of hearing caused by damage to the cochlea (inner ear) or auditory nerve. Spontaneous recovery has been seen in 32% - 81%. The incidence of the ISSNHL has been estimated to be between 5 and 20 per 100,000 per year. Different theories (infections, vascular catastrophes, immunologic damage or intracochlear membrane break) about the etiology have resulted in different treatment policies. The effect of therapy is difficult to evaluate for a single physician who sees just a few patients annually.

    The aim of the present thesis was to analyze the management and treatment of ISSNHL patients in Sweden with regard to outcome.

    A national database was developed for Sweden with half of all ENT clinics in Sweden participating by submitting a questionnaire for each patient with SSNHL. The questionnaire covered the patient’s background, current disorder, past and family history of different diseases, examinations and treatment. Audiograms at the onset of SSNHL and after three months were requested.

    All results were analyzed using ordinal logistic regression looking for interactions with hearing recovery and remaining hearing loss as dependent variables. Independent of treatment or no therapy heredity for hearing loss (I, II), older age (I, II) and presence of vertigo (II) was significantly associated with negative outcome. 40% of all patients had an MRI or CT, where 3 – 4% had acoustic neuroma. 24% of patients with ISSNHL who had hematological tests taken had one or more pathological findings. Blood screening varied from simple routine tests to a complete analysis with such tests as HSP70, Anti-Neutrophilic Cytoplasmic Antibodies (ANCA) and Borrelia tests. There was no association between any of these laboratory tests and either hearing improvement or remaining hearing loss evaluating the tests separately (I, II) or after categorization in comparison with those who had normal laboratory findings (II). Patients with hearing loss in the mid-frequency region had significantly better odds for hearing improvement compared to the other three frequency regions (low, high and “flat loss”). Almost 60% of patients with ISSNHL were medically treated, of which nearly 90% got corticosteroids. The medication had no association with either hearing improvement or remaining hearing loss. However, patients who were prescribed rest or sick leave had higher odds for hearing improvement regardless of other treatment. Those patients who did not receive any treatment at all also came significantly later to the ENT clinics than those treated medically and consequently had worse prognosis.

    Conclusion: There is no standard program for management or treatment of ISSNHL in Sweden. The diagnostic protocol varies. MRI is an underused resource to get specific diagnoses for the condition especially acoustic neuromas. Regardless of pathological findings, treatment is mainly limited to corticosteroids or no medication with no difference in outcome. A randomized placebo controlled study is necessary to evaluate whether there is an effect of corticosteroids on ISSNHL.

    List of papers
    1. Idiopathic sudden sensorineural hearing loss: results drawn from the Swedish national database
    Open this publication in new window or tab >>Idiopathic sudden sensorineural hearing loss: results drawn from the Swedish national database
    2007 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 127, no 11, p. 1168-1175Article in journal (Refereed) Published
    Abstract [en]

    A national database was developed in Linköping by the authors to gather data from patients with Sudden Sensorineural Hearing Loss (SSNHL). A form was used for data collection covering background, current disease, examinations and treatment. Audiograms at the onset of SSNHL and after three months are analyzed. The aim of the study was to investigate the treatment policy of SSNHL in Sweden, the effect of treatments on outcome, and which variables are of value in predicting the outcome.

    Out of the first 300 patients reported to the database 208 patients were considered to have idiopathic SSNHL. 50% were treated with corticosteroids, 44% did not receive any treatment. The treated patients had the same outcome as the non-treated patients. The time interval from onset of SSNHL to start of treatment was of importance for the outcome irrespective of type of audiogram or results from laboratory tests. Higher age and heredity for hearing loss gave significant lower chance for improvement.

    The first results from 300 patients in the national database demonstrate that corticosteroids or “no treatment at all” are the treatment options in use today. No significant difference in outcome was seen between treated and non-treated patients. Since spontaneous recovery might be the cause, a placebo-controlled randomized study is required before a positive effect of corticosteroids can be asserted.

    Keywords
    Sudden Hearing Loss, Hearing Loss, Idiopathic, Corticosteroid treatment
    National Category
    Otorhinolaryngology
    Identifiers
    urn:nbn:se:liu:diva-19020 (URN)10.1080/00016480701242477 (DOI)
    Available from: 2009-06-08 Created: 2009-06-08 Last updated: 2017-12-13Bibliographically approved
    2. Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome
    Open this publication in new window or tab >>Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome
    2010 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 130, no 3, p. 384-391Article in journal (Refereed) Published
    Abstract [en]

    Conclusion: Results from a database for sudden sensorineural hearing loss (SSNHL) demonstrate no correlation between laboratory findings, treatment, and outcome in 400 patients. The patients with pathological test results were not treated differently from those with normal test results. The value of laboratory findings and MRI might increase if the results are categorized to more specific diagnoses. Objectives: To investigate diagnostic test batteries for SSNHL and evaluate their value in the management of idiopathic SSNHL. Methods: A total of 400 patients submitted to the Swedish national database for SSNHL were analyzed. Information was collected about the patients past medical history, potential precipitating events, trauma, medical history, hearing loss, current disease, diagnostic protocol, and treatment, using questionnaires as well as two audiograms, one at the first ENT clinic visit and another 3 months later. Results: In all, 65% of these 400 patients underwent hematological tests and 40% had an MRI/CT scan. Twenty-two of 160 MRI investigated had pathological findings including 5 acoustic neuromas. Also, 300 of these 400 patients were evaluated as having idiopathic sudden sensorineural hearing loss (ISSNHL); 24% of them had one or more pathological test results. No significant correlation was found between either the MRI findings or the laboratory findings with regard to treatment or hearing recovery in patients with ISSNHL.

    Keywords
    Sudden deafness, acoustic neuroma, Borrelia infection
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-54412 (URN)10.3109/00016480903161541 (DOI)000274884500013 ()
    Note

    This is an electronic version of an article published in: Ramesh Zarenoe, Magnus Hansson and Elisabeth Hultcrantz, Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome, 2010, ACTA OTO-LARYNGOLOGICA, (130), 3, 384-391. ACTA OTO-LARYNGOLOGICA is available online at informaworldTM: http://dx.doi.org/10.3109/00016480903161541 Copyright: Taylor & Francis http://www.tandf.co.uk/journals/default.asp

    Available from: 2010-03-12 Created: 2010-03-12 Last updated: 2017-12-12
  • 121.
    Nosrati-Zarenoe, Ramesh
    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.
    Arlinger, Stig
    Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology. 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. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Idiopathic sudden sensorineural hearing loss: results drawn from the Swedish national database2007In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 127, no 11, p. 1168-1175Article in journal (Refereed)
    Abstract [en]

    A national database was developed in Linköping by the authors to gather data from patients with Sudden Sensorineural Hearing Loss (SSNHL). A form was used for data collection covering background, current disease, examinations and treatment. Audiograms at the onset of SSNHL and after three months are analyzed. The aim of the study was to investigate the treatment policy of SSNHL in Sweden, the effect of treatments on outcome, and which variables are of value in predicting the outcome.

    Out of the first 300 patients reported to the database 208 patients were considered to have idiopathic SSNHL. 50% were treated with corticosteroids, 44% did not receive any treatment. The treated patients had the same outcome as the non-treated patients. The time interval from onset of SSNHL to start of treatment was of importance for the outcome irrespective of type of audiogram or results from laboratory tests. Higher age and heredity for hearing loss gave significant lower chance for improvement.

    The first results from 300 patients in the national database demonstrate that corticosteroids or “no treatment at all” are the treatment options in use today. No significant difference in outcome was seen between treated and non-treated patients. Since spontaneous recovery might be the cause, a placebo-controlled randomized study is required before a positive effect of corticosteroids can be asserted.

  • 122.
    Nosrati-Zarenoe, Ramesh
    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, Sinnescentrum, 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, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Corticosteroid treatment of Idiopathic Sudden Sensorineural Hearing Loss. Part 1: a randomized triple-blind placebo controlled trialManuscript (preprint) (Other academic)
    Abstract [en]

    Objective: To compare the effect of Prednisolone and placebo on recovery of unilateral Idiopathic Sudden Sensorineural Hearing Loss.

    Study design: Prospective, randomized, triple-blind placebo-controlled multicentre trial.

    Setting: Four tertiary and ten secondary referral centers.

    Patients: Of 103 patients randomly assigned, 93 included in the modified intention-to treat analysis. The patients were aged 18–80 years seeking care between Jan 2006–Sept 2010 within one week after onset of acute unilateral sensorineural hearing loss with a PTA of ≥30dB in the three contiguous frequencies most affected.

    Intervention: Patients were randomly assigned in permuted blocks of ten to receive Prednisolone or placebo in tapering doses from 60 mg for 3 days, and thereafter 50, 40, 30, 20, 10 mg each day until day 8. If complete recovery, no more medication given, otherwise medication continued at 10 mg per day until day 30. Final follow-up was after 3 months with audiogram. 47 patients received Prednisolone and 46 placebo.

    Main outcome measure: Primary endpoint was efficacy of treatment on recovery at day 8 and day 90. Analysis was by modified Intention-To Treat and Per Protocol. The secondary endpoints were prognostic factors for hearing recovery.

    Results: The hearing improvement for 47 patients treated with Prednisolone was 25.5 ± 27.1 dB compared to 46 patients treated with placebo 26.4 ± 26.2 dB at day eight and 39 ± 20.1 dB vs. 35.1 ± 38.3 dB after three months. (ns). Presence of vertigo had significant negative effect on hearing improvement in both groups. Inflammatory signs in laboratory work-up had a positive prognostic effect, irrespective of treatment.

    Conclusion: Prednisolone in customary dosage does not seem to influence recovery of idiopathic sudden sensorineural hearing loss.

  • 123.
    Novozhilova, Ekaterina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Olivius, Petri
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Siratirakun, Piyaporn
    Karolinska University Hospital, Sweden.
    Lundberg, Cecilia
    Lund University, Sweden.
    Englund-Johansson, Ulrica
    Lund University, Sweden.
    Neuronal Differentiation and Extensive Migration of Human Neural Precursor Cells following Co-Culture with Rat Auditory Brainstem Slices2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 3Article in journal (Refereed)
    Abstract [en]

    Congenital or acquired hearing loss is often associated with a progressive degeneration of the auditory nerve (AN) in the inner ear. The AN is composed of processes and axons of the bipolar spiral ganglion neurons (SGN), forming the connection between the hair cells in the inner ear cochlea and the cochlear nuclei (CN) in the brainstem (BS). Therefore, replacement of SGNs for restoring the AN to improve hearing function in patients who receive a cochlear implantation or have severe AN malfunctions is an attractive idea. A human neural precursor cell (HNPC) is an appropriate donor cell to investigate, as it can be isolated and expanded in vitro with maintained potential to form neurons and glia. We recently developed a post-natal rodent in vitro auditory BS slice culture model including the CN and the central part of the AN for initial studies of candidate cells. Here we characterized the survival, distribution, phenotypic differentiation, and integration capacity of HNPCs into the auditory circuitry in vitro. HNPC aggregates (spheres) were deposited adjacent to or on top of the BS slices or as a monoculture (control). The results demonstrate that co-cultured HNPCs compared to monocultures (1) survive better, (2) distribute over a larger area, (3) to a larger extent and in a shorter time-frame form mature neuronal and glial phenotypes. HNPC showed the ability to extend neurites into host tissue. Our findings suggest that the HNPC-BS slice co-culture is appropriate for further investigations on the integration capacity of HNPCs into the auditory circuitry.

  • 124.
    Palmgren, Bjorn
    et al.
    Karolinska University Hospital.
    Jiao, Yu
    Karolinska University Hospital.
    Novozhilova, Ekaterina
    Karolinska University Hospital.
    Stupp, Samuel I
    Northwestern University.
    Olivius, Petri
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping. Karolinska University Hospital, Sweden .
    Survival, migration and differentiation of mouse tau-GFP embryonic stem cells transplanted into the rat auditory nerve2012In: Experimental Neurology, ISSN 0014-4886, E-ISSN 1090-2430, Vol. 235, no 2, p. 599-609Article in journal (Refereed)
    Abstract [en]

    Stem cells have been investigated as treatment for a variety of diagnoses such as Parkinsons disease, Alzheimers disease and spinal cord injuries. Here, we investigated the possibility of using stem cells as a replacement therapy for lesions of the auditory nerve (AN). We transplanted tau-GFP mouse embryonic stem cells into the AN either by the internal auditory meatus or via the modiolus in rats that had been previously deafened by application of beta-bungarotoxin to the round window niche. We investigated the effect of brain derived neurotrophic factor (BDNF) on cell transplant survival and differentiation. Additionally chondroitinase ABC (ChABC), a digestive enzyme that cleaves the core chondroitin sulfate proteoglycans, was used in order to promote possible migration of cells and axons through the transitional zone. A bioactive isoleucine-lysine-valine-alanine-valine (IKVAV) peptide amphiphile (PA) nanofiber gel was applied around the cell injection site. This nanofiber gel has been shown to promote neural differentiation and other similar gels have been used to encapsulate and release proteins. Three weeks after injection, transplanted cells were found in the scala tympani, the modiolus, the AN trunk and the brain stem. As compared to cell transplantation and gel only, BDNF content in the PA gel increased cell survival and neuronal differentiation. In the animals treated with ChABC we observed extensive migration of cells through the transitional zone to or from the CNS.

  • 125.
    Palmisano, Sadie
    et al.
    Ohio State University, USA .
    Schwartzbaum, Judith
    Ohio State University, USA .
    Prochazka, Michaela
    Karolinska Institute, Sweden .
    Pettersson, David
    Karolinska Institute, Sweden .
    Bergenheim, Tommy
    University of Umeå Hospital, Sweden .
    Florentzson, Rut
    Sahlgrens University Hospital, Sweden .
    Harder, Henrik
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Mathiesen, Tiit
    Karolinska Institute, Sweden .
    Nyberg, Gunnar
    University of Uppsala Hospital, Sweden .
    Siesjo, Peter
    University of Lund Hospital, Sweden .
    Feychting, Maria
    Karolinska Institute, Sweden .
    Role of Tobacco Use in the Etiology of Acoustic Neuroma2012In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 175, no 12, p. 1243-1251Article in journal (Refereed)
    Abstract [en]

    Two previous studies suggest that cigarette smoking reduces acoustic neuroma risk; however, an association between use of snuff tobacco and acoustic neuroma has not been investigated previously. The authors conducted a case-control study in Sweden from 2002 to 2007, in which 451 cases and 710 population-based controls completed questionnaires. Cases and controls were matched on gender, region, and age within 5 years. The authors estimated odds ratios using conditional logistic regression analyses, adjusted for education and tobacco use (snuff use in the smoking analysis and smoking in the snuff analysis). The risk of acoustic neuroma was greatly reduced in male current smokers (odds ratio (OR) = 0.41, 95% confidence interval (CI): 0.23, 0.74) and moderately reduced in female current smokers (OR = 0.70, 95% CI: 0.40, 1.23). In contrast, current snuff use among males was not associated with risk of acoustic neuroma (OR = 0.94, 95% CI: 0.57, 1.55). The authors findings are consistent with previous reports of lower acoustic neuroma risk among current cigarette smokers than among never smokers. The absence of an association between snuff use and acoustic neuroma suggests that some constituent of tobacco smoke other than nicotine may confer protection against acoustic neuroma.

  • 126.
    Persson, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Arlinger, Stig
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Kostnader och effekter vid förskrivning av hörapparat2008Report (Other academic)
    Abstract [en]

    This study aimed at investigating effectiveness and cost-effectiveness of hearing aid fitting. Especially, two types, i.e. linear one-channel AGC (simple) and nonlinear multichannel AGC (advanced), were compared. Randomised cross-over design was used, blinded through similar shells of the devices without any identifications of type. Outcome measures were “speech in noise”, problem solving ability (IPPA, PIRS) and health related quality of life (EQ-5D, HUI3). In addition, the users’ preferences with regard to final choice of hearing aid with and without information on costs were studied.

    The study was a collaboration with hearing aid centres in the county councils of Östergötland, Kalmar and Jönköping in the southeast of Sweden. During 2002 and 2003, 161 users were recruited to the study, mean age was 70 years, 60 % were men and 40 % women. The intervention was fitting of hearing aids to first time applicants, bilaterally “behind the ear” model, if no contra-indication for bilateral fitting was present.

    Free choice of equipment without any information on costs resulted in prescription of about 60 % of simple and and 40 % of advanced hearing aids. With information on costs the corresponding figures were 50%/50 %. The costeffectiveness, measured as cost per quality adjusted life years gained (cost/QALY) was 80 000 SEK based on EQ-5D and 17 300 SEK based on HUI3 Assumptions were an improvement of quality of life which was sustainable over five years. The costs included visit to physician, audiogram, assessment and construction of two earmolds and investment costs for the devices. Without information about costs 88% choose bilateral fitting and 12% unilateral. With information of costs these figures changed marginally to 87% and 13%, respectively.

    The advanced device performed significantly better in the “speech in noise” test (p=0.004) and problem solving ability measured through IPPA (p=0.044). Quality of life showed significantly lower results (p=0.009) of the use of the advanced device.

    Only a small fraction, 12 persons, changed their decision on device after cost information, 11 of these changed from advanced to simple device and one from bilateral to unilateral fitting (still advanced). The additional costs between bilateral and unilateral fitting amounted to about 8000 SEK, which seems to be an amount which the main group of users were willing to pay. No adjustment to household incomes was made.

    It has been shown that hearing aid fitting for first time applicants has a high (favorable) cost-effectiveness. The advanced device yields an improved speech recognition in noise in comparison with the simple device. The measurements of quality of life indicate difficulties to discriminate between types of devices. It could be that subgroups’ value the two types differently. An hypothesis, which has not been tested, is whether people with better cognitive ability prefer the advanced device to a higher extent than do users with lower cognitive ablity.

  • 127.
    Persson, Pekka
    et al.
    Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery VHN.
    Harder, Henrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Magnuson, Bengt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion.
    Using the glasgow benefit plot as a prognostic instrument and for preoperative counseling in patients with otosclerosis2007In: Otology and Neurotology, ISSN 1531-7129, E-ISSN 1537-4505, Vol. 28, no 6, p. 739-744Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The Glasgow Benefit Plot (GBP) is a graph showing the pure-tone thresholds preoperatively and postoperatively, and is meant to visualize the possible outcome of binaural hearing for individual patients. We used our database comprising a large number of patient data to test the usefulness of the GBP. STUDY DESIGN: Evaluation based on retrospective clinical data. SETTING: Tertiary referral center, University clinic. MAIN OUTCOME MEASURES: Audiometric assessment included bilateral preoperative and postoperative evaluation using conventional audiometry. Three preoperative groups (unilateral, asymmetric, and symmetric hearing impairment) were split into 6 postoperative categories in the GBP diagram. RESULTS: Considering the 509 operations, including 34 bilateral operations, the total outcome was distributed as follows: 34% resulted in bilateral normal hearing, 24% unilateral normal hearing (in operated ear), 14% still unilateral hearing impairment (in operated ear), 13% symmetric hearing impairment, 10% asymmetric hearing impairment (operated ear best), 5% still asymmetric hearing impairment (nonoperated ear best). The distribution of outcomes depended in part on the bone conduction level in the operated ear and in part on the hearing status in the contralateral ear. CONCLUSION: The GBP is a useful instrument that provides a means for judging the binaural hearing status. However, the outcome of stapes surgery for individual persons and for a group depends critically on the preoperative audiometric criteria for patients who are chosen for surgery. In cases of depressed bone conductions, the method does not indicate the upper limit for possible hearing improvement. A number of patients with combined hearing impairments were included in the present study population. In preoperative counseling, the GBP must be complemented with information with regard to the limitation of possible hearing improvement owing to the individual bone conduction level.

  • 128.
    Roberg, Karin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences.
    Ceder, Rebecca
    Division of Biochemical Toxicology and Experimental Cancer Research, Institute of Environmental Medicine, Karolinska Institute.
    Farnebo, Lovisa
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences.
    Norberg-Spaak, Lena
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences.
    Grafström, Roland
    Division of Biochemical Toxicology and Experimental Cancer Research, Institute of Environmental Medicine, Karolinska Institute.
    Multiple genotypic aberrances associate to terminal differentiation-deficiency of an oral squamous cell carcinoma in serum-free culture2008In: Differentiation, ISSN 0301-4681, E-ISSN 1432-0436, Vol. 76, no 8, p. 868-880Article in journal (Refereed)
    Abstract [en]

    Oral squamous cell carcinoma (OSCC) lines proliferative in the serum-free conditions devised for normal oral keratinocytes (NOK) are virtually absent, complicating studies of carcinogenesis. A tongue squamous cell carcinoma generated under conditions for normal cell culture an apparently immortal line (termed LK0412) that has undergone ≥200 population doublings from over a year in culture. LK0412 exhibited epithelial morphology, intermediate filaments, desmosomes, and cytokeratin. Soft agar growth and tumorigenicity in athymic nude mice indicated the malignant phenotype. Compared with NOK, LK0412 exhibited increased indices for proliferation and apoptosis, and a decreased terminal differentiation index. Fetal bovine serum inhibited growth and increased apoptosis but failed to induce terminal differentiation of LK0412; the latter outcome differed clearly from that in NOK. Gene ontology assessment of transcript profiles implicated multiple alterations in biological processes, molecular functions, and cellular components in LK0412. Genetic changes, some that were confirmed to the protein level, included previously proposed OSCC markers, i.e., BAX, CDC2, and TP53, as well as multiple cancer-associated genes not considered for OSCC, e.g., BST2, CRIP1, ISG15, KLRC1, NEDD9, NNMT, and TWIST1. Elevation of p53 protein agreed with a missense mutation detectable in both the LK0412 line and the original tumor specimen. Moderate differentiation characterized the original tumor as well as tumors generated from inoculation of LK0412 in mice. Overall, the results suggest that the LK0412 cell line represent a subgroup of OSCC with unique genomic and phenotypic profiles. LK0412 should be useful to exploration of OSCC development, particularly the deregulated growth and differentiation responsiveness to serum factors.

  • 129.
    Rönnberg, Jerker
    et al.
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Arlinger, Stig
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences.
    From signal to dialogue2008In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 47, no S2, p. S1-S2Article in journal (Other academic)
    Abstract [en]

    .

  • 130.
    Rönnberg, Jerker
    et al.
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Danielsson, Henrik
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Rudner, Mary
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Arlinger, Stig
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences.
    Sternäng, Ola
    Psykologiska institutionen, Stockholms universitet.
    Wahlin, Åke
    Psykologiska institutionen, Stockholms universitet.
    Nilsson, Lars-Göran
    Psykologiska institutionen, Stockholms universitet.
    Hearing Loss Is Negatively Related to Episodic and Semantic Long-Term Memory but Not to Short-Term Memory2011In: Journal of Speech, Language and Hearing Research, ISSN 1092-4388, E-ISSN 1558-9102, Vol. 54, no April, p. 705-726Article in journal (Refereed)
    Abstract [en]

    Purpose: To test the relationship between degree of hearing loss anddifferent memory systems in hearing aid users.

    Method: Structural equation modeling (SEM) was used to study the relationshipbetween auditory and visual acuity and different cognitive andmemory functions in an age-hetereogenous subsample of 160 hearingaid users without dementia, drawn from the Swedish prospectivecohort aging study known as Betula (L.-G. Nilsson et al., 1997).

    Results: Hearing loss was selectively and negatively related to episodicand semantic long-term memory (LTM) but not short-term memory(STM) performance. This held true for both ears, even when agewas accounted for. Visual acuity alone, or in combination withauditory acuity, did not contribute to any acceptable SEM solution.

    Conclusions: The overall relationships between hearing loss and memory systemswere predicted by the ease of language understanding model (J. Rönnberg, 2003), but the exact mechanisms of episodicmemory decline in hearing aid users (i.e., mismatch/disuse,attentional resources, or information degradation) remain openfor further experiments. The hearing aid industry should striveto design signal processing algorithms that are cognition friendly.

  • 131.
    Sjörs, Anna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Dahlman, Joakim
    Human Factors, Shipping and Marine Technology, Chalmers University of Technology, Göteborg, Sweden.
    Lundgren, Pontus
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    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.
    Falkmer, Torbjörn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Habilitation in Central County.
    Effects of motion sickness on encoding and retrieval performance and on psychophysiological responses2010Article in journal (Refereed)
    Abstract [en]

    Motion sickness has previously been found to deteriorate performance, e.g., regarding psychomotor functions and short term memory. Sustained ability to perform, despite motion sickness, is crucial in complex working environments. This study focuses on effects of motion sickness on encoding and retrieval of words through the use of long term memory. In addition, the temporal development of different psychophysiological responses and their relationship with perceived motion sickness were investigated. Forty healthy participants performed an encoding and retrieval task during exposure to an optokinetic drum. The results were compared with data from 20 controls that performed the task without motion sickness exposure. Measurements of heart rate, heart rate variability, skin conductance, blood volume pulse, respiration rate, and skin temperature were made throughout optokinetic drum exposure. Data analyses revealed no significant effects of moderate levels of motion sickness on the ability to encode or retrieve words. We found positive relationships between subjective motion sickness ratings and heart rate, blood volume pulse and skin temperature whereas respiration rate was negatively related to perceived motion sickness. The psychophysiological measurements did not show consistent patterns of sympathetic activation and parasympathetic withdrawal, as could be expected. Hence, they are not recommended as predictors of motion sickness.

  • 132.
    Skogman, Barbro H
    et al.
    Falun General Hospital, Sweden Centre Clin Research Dalarna, Sweden .
    Glimaker, Kajsa
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Nordwall, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Vrethem, Magnus
    Linköping University, Department of Clinical and Experimental Medicine, Neurology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Ödkvist, Lars
    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.
    Forsberg, Pia
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Infectious Diseases in Östergötland.
    Long-term Clinical Outcome After Lyme Neuroborreliosis in Childhood2012In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 130, no 2, p. 262-269Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To determine long-term clinical outcome in children with confirmed Lyme neuroborreliosis (LNB) and to evaluate persistent subjective symptoms compared with a control group. less thanbrgreater than less thanbrgreater thanMETHODS: After a median of 5 years, 84 children with confirmed LNB underwent a neurologic re-examination, including a questionnaire. Medical records were analyzed, and a control group (n = 84) was included. less thanbrgreater than less thanbrgreater thanRESULTS: The total recovery rate was 73% (n = 61). Objective neurologic findings, defined as "definite sequelae," were found in 16 patients (19%). The majority of these children had persistent facial nerve palsy (n = 11), but other motor or sensory deficits occurred (n = 5). Neurologic signs and/or symptoms defined as "possible sequelae" were found in another 7 patients (8%), mainly of sensory character. Nonspecific subjective symptoms were reported by 35 patients (42%) and 32 controls (38%) (nonsignificant). Affected daily activities or school performance were reported to the same extent in both groups (23% vs 20%, nonsignificant). less thanbrgreater than less thanbrgreater thanCONCLUSIONS: The long-term clinical recovery rate was 73% in children with confirmed LNB. Persistent facial nerve palsy occurred in 13%, whereas other motor or sensory deficits were found in another 14%. Neurologic deficits did not affect daily activities or school performance more often among patients than controls and should be considered as mild. Furthermore, nonspecific subjective symptoms such as headache, fatigue, or memory or concentration problems were reported as often among patients as controls and should not be considered as sequelae after LNB.

  • 133.
    Staab, C A
    et al.
    Karolinska Institute.
    Ceder, R
    Karolinska Institute.
    Roberg, Karin
    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.
    Grafstrom, R C
    Karolinska Institute.
    Hoog, J-O
    Karolinska Institute.
    Serum-responsive expression of carbonyl-metabolizing enzymes in normal and transformed human buccal keratinocytes2008In: Cellular and Molecular Life Sciences (CMLS), ISSN 1420-682X, E-ISSN 1420-9071, Vol. 65, no 22, p. 3653-3663Article in journal (Refereed)
    Abstract [en]

    Gene expression of carbonyl-metabolizing enzymes (CMEs) was investigated in normal buccal keratinocytes (NBK) and the transformed buccal keratinocyte lines SVpgC2a and SqCC/Y1. Studies were performed at a serum concentration known to induce terminal squamous differentiation (TSD) in normal cells. Overall, 39 of 58 evaluated CMEs were found to be expressed at the transcript level. Together the transformed cell lines showed altered transcription of eight CME genes compared to NBK, substantiating earlier results. Serum increased transcript levels of ALDH1A3, DHRS3, HPGD and AKR1A1, and decreased those of ALDH4A1 in NBK; of these, the transformed, TSD-deficient cell lines partly retained regulation of ALDH1A3 and DHRS3. Activity measurements in crude cell lysates, including relevant enzymatic inhibitors, indicated significant capacity for CME-mediated xenobiotic metabolism among the cell lines, notably with an increase in serum-differentiated NBK. The results constitute the first evidence for differential CME gene expression and activity in non-differentiated and differentiated states of epithelial cells.

  • 134.
    Stalfors, J.
    et al.
    Sahlgrenska Universitetssjukhuset, Göteborg.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Hemlin, C.
    Aleris Sabbatsberg, Stockholm.
    Hessén-Söderman, A-C
    Karolinska Universitetssjukhuset, Solna.
    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.
    Roos, K.
    Lundby Sjukhus, Göteborg.
    Sunnergren, Ola
    Länssjukhuset Ryhov, Jönköping.
    Årsrapport av kvalitetsregisterdata för tonsilloperation2011Conference paper (Refereed)
  • 135.
    Stalfors, J
    et al.
    Sahlgrenska Universitetssjukhuset, Göteborg.
    Ericsson, Elisabeth
    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 Otorhinolaryngology in Linköping.
    Hemlin, Claes
    Aleris, Sabbatsberg, Stockholm.
    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, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Månsson, Ingemar
    Sahlgrenska Universitetssjukhuset, Göteborg.
    Roos, Kristian
    Capio Lundby, Göteborg.
    Hessén Söderman, Anne-Charlotte
    Karolinska Universitetssjukhuset, Stockholm.
    Tonsil surgery efficiently relieves symptoms, Analysis of 54 696 paqtients in The National Tonsil Surgery Register in Sweden2012In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 132, no 5, p. 533-539Article in journal (Refereed)
    Abstract [en]

    CONCLUSION:

    Patients operated with tonsillar surgery report a high degree of symptom relief 6 months after surgery.

    OBJECTIVE:

    The purpose of this study was to analyze symptom relief 6 months after tonsil surgery in relation to age, indication, surgical procedure, primary bleeding and unplanned postoperative visits. The National Tonsil Surgery Register in Sweden offers data from 54,696 patients registered during 1997-2008.

    METHODS:

    This was a prospective assessment by questionnaire. Data were collected using three questionnaires, two completed by professionals and one 6 months postoperatively by the parents/patients.

    RESULTS:

    Among 54,696 patients, the most common surgical indications were obstruction (49.7%), followed by recurrent tonsillitis (35.2%). Symptom relief 6 months after surgery was high in all indication groups (>92%), and highest for patients operated on the indication peritonsillitis (>98%). The indications obstruction, recurrent tonsillitis or chronic tonsillitis reported a high degree (>96%) of symptom relief. Of the patients who underwent tonsillectomy with adenoidectomy, 97.5% were symptom-free compared to 96% of patients who had tonsillectomy alone and 96.1% who underwent tonsillotomy (p < 0.0001). In all, 13.9% of patients required an unplanned visit to the clinic postoperatively. Only 148 of 54,696 patients reported worsening of symptoms after surgery.

  • 136.
    Stalfors, Joacim
    et al.
    Öron-, näs- och halskliniken, Sahlgrenska Universitetssjukhuset, Göteborg.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Hemlin, Claes
    Aleris specialistvård, Sabbatsbergs sjukhus, Stockholm.
    Hessén Söderman, Anne-Charlotte
    Öron-, näs- och halskliniken, Karolinska Universitettsjukhuset, Danderyd.
    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.
    Odhagen, Erik
    Öron-, näs- och halskliniken, Södra Älvsborgs Sjukhus, Borås.
    Padoan, Serge
    Öron-, näs- och halskliniken, Kristianstad.
    Sunnergren, Ola
    Öron-, näs- och halskliniken, Länssjukhuset Ryhov, Jönköping.
    Nationellt kvalitetsregister för tonsilloperation. Öron- näs- och halssjukvård. Årsrapport 20112012Report (Other academic)
  • 137.
    Stalfors, Joacim
    et al.
    Sahlgrenska University Hospital, Göteborg.
    Hemlin, Claes
    Aleris Sabbatsberg Hospital, Stockholm.
    Hessén Söderman, Anne- Charlotte
    Karolinska University Hospital.
    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.
    Roos, Kristian
    Capio Lundby Hospital, Göteborg.
    Sunnergren, Ola
    County Hospital Ryhov, Jönköping.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Presentation of large datavolumes with the valuecompass - a qualitive method2012Conference paper (Other academic)
  • 138.
    Stenfelt, Stefan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology. Linköping University, Faculty of Health Sciences.
    Asp, Filip
    Karolinska Institutet.
    Harder, Henrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Hergils, Leif
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Karltorp, Eva
    Karolinska Institutet.
    Mäki-Torkko, Elina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology.
    Klinisk utvärdering av 80 barn med bilaterala cochleaimplantat2009In: TeMA Hörsel, Jönköping, Sweden, 2009Conference paper (Refereed)
  • 139.
    Stroikin, Yuri
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Experimental Pathology. Linköping University, Faculty of Health Sciences.
    Mild, Hanna
    Linköping University, Department of Clinical and Experimental Medicine, Experimental Pathology. Linköping University, Faculty of Health Sciences.
    Johansson, Uno
    Linköping University, Department of Clinical and Experimental Medicine, Experimental Pathology. Linköping University, Faculty of Health Sciences.
    Roberg, Karin
    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.
    Öllinger, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Experimental Pathology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pathology and Clinical Genetics.
    Lysosome-targeted stress reveals increased stability of lipofuscin-containing lysosomes2008In: Age (Omaha), ISSN 0161-9152, E-ISSN 1574-4647, Vol. 30, no 1, p. 31-42Article in journal (Refereed)
    Abstract [en]

    Cellular ageing is associated with accumulation of undegradable intralysosomal material, called lipofuscin. In order to accelerate the lipofuscin-accumulation, confluent, growth arrested human fibroblasts were cultured under hyperoxic conditions. To provide a better insight into the effects of lipofuscin on cellular functions, we compared lysosomal stability in control and lipofuscin-loaded human fibroblasts under conditions of lysosome-targeted stress induced by exposure to either the lysosomotropic detergent MSDH or the redox-cycling quinone naphthazarin. We show that lysosomal damage, assessed by acridine-orange relocation, translocation of cathepsin D to the cytosol, and alkalinization of lysosomes is more pronounced in control than in lipofuscin-loaded fibroblasts. Finding that lysosomal integrity was less affected or even preserved in case of lipofuscin-loaded cells enables us to suggest that lipofuscin exerts lysosome-stabilizing properties.

  • 140.
    Sundberg, Mikael
    et al.
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Peebo, Markus
    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.
    Strömberg, Tomas
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
    In vitro tympanic membrane position identification with a co-axial fiber optic otoscope2011In: Journal of Biomedical Optics, ISSN 1083-3668, E-ISSN 1560-2281, Vol. 16, no 9, p. 097002-Article in journal (Refereed)
    Abstract [en]

    Otitis media diagnosis can be assisted by measuring the shape of the tympanic membrane. We have developed an ear speculum for an otoscope, including spatially distributed source and detector optical fibers, to generate source-detector intensity matrices (SDIMs), representing the curvature of surfaces. The surfaces measured were a model ear with a latex membrane and harvested temporal bones including intact tympanic membranes. The position of the tympanic membrane was shifted from retracted to bulging by air pressure and that of the latex membrane by water displacement. The SDIM was normalized utilizing both external (a sheared flat plastic cylinder) and internal references (neutral position of the membrane). Data was fitted to a two-dimensional Gaussian surface representing the shape by its amplitude and offset. Retracted and bulging surfaces were discriminated for the model ear by the sign of the Gaussian amplitude for both internal and external reference normalization. Tympanic membranes were separated after a two-step normalization: first to an external reference, adjusted for the distance between speculum and the surfaces, and second by comparison with an average normally positioned SDIM from tympanic membranes. In conclusion, we have shown that the modified otoscope can discriminate between bulging and retracted tympanic membranes in a single measurement, given a two-step normalization. (C) 2011 Society of Photo-Optical Instrumentation Engineers (SPIE). [DOI: 10.1117/1.3622486]

  • 141.
    Sundberg, Mikael
    et al.
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
    Peebo, Markus
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences.
    Öberg, Åke
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Lundquist, Per-Gotthard
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences.
    Strömberg, Tomas
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
    Diffuse reflectance spectroscopy of the human tympanic membrane in otitis media2004In: Physiological Measurement, ISSN 0967-3334, Vol. 25, no 6, p. 1473-1483Article in journal (Refereed)
    Abstract [en]

    We have investigated if features in the diffuse reflectance spectra from in vivo spectroscopic measurements of the tympanic membrane could aid the diagnosis of otitis media in children. Diffuse reflectance spectroscopy, in the visible wavelength range, was used in 15 ears from children with otitis media with effusion before and after myringotomy and in 15 healthy ears as a reference. Two previously published erythema detection algorithms yielded numerical quantities of haemoglobin content. With a combination of the algorithms, induced erythema (after myringotomy) was distinguished from healthy ears using Student's t-test (p < 0.01). Otitis media with mucous effusion was distinguished from (1) otitis media with serous effusion, (2) induced erythema and (3) healthy ears, (p < 0.05) using Student's t-test for independent groups and the paired t-test for dependent groups. Our results imply that reflectance spectroscopy is a promising technique to be used for the diagnosis of otitis media.

  • 142.
    Sundelin, Kaarina
    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.
    Head and Neck Cancer: Factors Affecting Tumour Growth2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Head and neck cancer is the fifth most common cancer worldwide with an estimated annual global incidence of over 500 000 cases. These malignant tumours develop in the mucosal linings of the upper respiratory tract or in the salivary glands. The most common sites are in the oral cavity and larynx. Treatment modalities comprising surgery and chemoradiotherapy have improved significantly during the last 20 years, but not the long-term survival of patients. The aim of this thesis was to study the different factors affecting tumour growth in head and neck cancer that may have clinical implications in the future. Factors involving apoptosis, cell cycle activity, inflammation, and enzyme activity were of special interest.

    The results of the thesis indicate that patients with malignant salivary gland tumours having the lowest level of actively replicating cells have the best prognosis. The largest amount of replicating cells in tongue cancer specimens was found in the peripheral areas of tumour nests. Metallothionein, a protein that can hinder apoptosis, was found in excess in the same areas, whereas apoptosis activity was considerably lower. Taken together, these results indicate that the most aggressive cancer cells are found in the peripheral areas of tumours where apoptosis may be hindered.

    The expression of the death receptor Fas was higher in tongue cancer specimens than in normal mucosa. The expression of this receptor was studied further in two cell lines established from oral cancers. When a low dose of cisplatin was added to cell cultures, the Fas expression was enhanced in both cell lines and, furthermore, the Fas-induced apoptosis was increased in one of the cell lines. The results show that a common chemotherapeutic drug given in a low, less toxic dose may enhance receptor-mediated apoptosis of cancer cells.

    Malignant solid tumours are often distinguished by an increased proteolytic activity resulting in invasive growth, neo-angiogenesis, and metastases. This activity is conducted by enzymes that are secreted from tumour cells, or from normal cells in the tumour microenvironment. The regulation of enzyme secretion may be mediated by cytokines, small signalling molecules also present in cancer tissue. The results of this thesis show that two cytokines can synergistically induce enzyme secretion (matrix metalloproteinase-1 and -9) from oral cancer cells. Cytokine tumour necrosis factor-alpha and hepatocyte growth factor added alone to cell cultures strongly stimulated secretion of these enzymes. Thus, the tested cytokines, which are commonly secreted by fibroblasts and immune cells, may promote tumour growth.

    This thesis has contributed to an increased understanding of factors affecting tumour growth in head and neck cancer. The upcoming cancer therapies will be based on the increasing knowledge of these and other aberrant cellular mechanisms that may vary between different cancer forms.

    List of papers
    1. Tumour growth fraction and apoptosis in salivary gland acinic cell carcinomas: Prognostic implications of Ki-67 and bcl-2 expression and of in situ end labelling (TUNEL)
    Open this publication in new window or tab >>Tumour growth fraction and apoptosis in salivary gland acinic cell carcinomas: Prognostic implications of Ki-67 and bcl-2 expression and of in situ end labelling (TUNEL)
    Show others...
    1997 (English)In: The Journal of Pathology, ISSN 0031-3025, Vol. 181, no 3, p. 323-329Article in journal (Refereed) Published
    Abstract [en]

    bcl-2 protein and Ki-67 (MIB-1) were studied in 32 acinic cell carcinomas (ACCs), all with a minimum of 5 years' clinical follow-up. Tumour apoptosis was evaluated by TdT dUTP nick end labelling (TUNEL) and by morphological criteria. Five patients died of their disease. Patients with stage I tumours had significantly better survival compared with other stages (P<0·05). Patients with MIB-1-negative tumours had significantly better survival than patients with MIB-1-positive tumours (P=0·05). This study confirms a previous report that MIB-1 is an independent prognostic factor for survival in patients with ACC. Stage I tumours had high expression of bcl-2 protein, but there was no difference when compared with other stages. TUNEL positivity was most prevalent in stage I tumours, compared with stages II, III, and IV (P<0·05), probably indicating more apoptosis. This could imply a capacity of stage I tumours ('early tumours') for early selection of tumour cells for elimination by apoptosis. There was no significant difference between expression of bcl-2 and TUNEL, between these parameters and clinical outcome, or between any parameter and morphological subclassification. We conclude that MIB-1 has prognostic value in ACC. Clinical staging, bcl-2, and TUNEL are also potentially useful as prognostic markers.

    Keywords
    apoptosis, bcl-2, TUNEL, end labelling, salivary neoplasm, Ki-67
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-12804 (URN)10.1002/(SICI)1096-9896(199703)181:3<323::AID-PATH780>3.0.CO;2-K (DOI)
    Available from: 2007-11-28 Created: 2007-11-28 Last updated: 2009-08-18
    2. Metallothionein and Fas (CD95) are expressed in squamous cell carcinoma of the tongue
    Open this publication in new window or tab >>Metallothionein and Fas (CD95) are expressed in squamous cell carcinoma of the tongue
    Show others...
    1997 (English)In: European Journal of Cancer, ISSN 0959-8049, Vol. 33, no 11, p. 1860-1864Article in journal (Refereed) Published
    Abstract [en]

    Metallothionein (MT) is a chelator present in myoepithelial cells, whilst the Fas-receptor (APO-1, CD95) has been described primarily in human T Jurkat cells. 20 cases of carcinoma of the tongue were investigated immunocytochemically with regard to MT, Fas and Bcl-2. In normal oral squamous epithelium, MT is located in the basal/parabasal dividing cells only. In well-differentiated nests of carcinomas, MT is observed almost entirely in peripherally located cells. In situ end-labelling indicates apoptosis in the centre of these nests, but not in the peripheral areas. Less-differentiated areas show more general MT-positivity, but little apoptosis. All 24 tumours are Fas-positive, but normal epithelia are mainly negative (P< 0.0001). Bcl-2 protein was sparse in the tumours compared with MT and Fas (P< 0.0001). We thus suggest that MT, possibly due to its chelating properties, may contribute to delaying cells entering apoptosis, both in normal epithelium near the base and in less-differentiated regions of carcinoma. Moreover, Fas may be present in cells of human malignancies, as well as those of established malignant cell lines.

    Keywords
    apoptosis, Bcl-2, carcinoma squamous cell, chelator, Fas, metallothionein, tongue
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-12805 (URN)10.1016/S0959-8049(97)00216-5 (DOI)
    Available from: 2007-11-28 Created: 2007-11-28 Last updated: 2009-08-21
    3. Effects of cisplatin, interferon-alpha and 13-cis retinoic acid on the expression of Fas (CD95), intercellular adhesion molecule-1 (ICAM-1) and epidermal growth factor receptor (EGFR) in oral cancer cell lines
    Open this publication in new window or tab >>Effects of cisplatin, interferon-alpha and 13-cis retinoic acid on the expression of Fas (CD95), intercellular adhesion molecule-1 (ICAM-1) and epidermal growth factor receptor (EGFR) in oral cancer cell lines
    2007 (English)In: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 36, no 3, p. 177-183Article in journal (Refereed) Published
    Abstract [en]

    Background: Previous studies showed that many chemotherapeutic agents can induce immuno-suppression at therapeutic drug concentrations whereas low drug doses induce immuno-augmentation.

    Methods: The effect of low-dose cisplatin, interferon-alpha, and 13-cis retinoic acid on receptors involved in immune-mediated apoptosis (Fas/CD95), cell growth (epidermal growth factor receptor) and lymphocyte adhesion (intercellular adhesion molecule-1) was investigated in two oral cancer cell lines (UT-SCC-20A and UT-SCC-24A). Different methods for cell preparation were studied: mechanical and enzymatic detachment, and culture on chamber slides. Receptor expression was investigated using immunohistochemical staining. The amount of soluble and cell-bound Fas was determined with the ELISA technique, and the functional relevance of Fas expression, apoptosis induction, was analyzed.

    Results: Cisplatin enhanced cytoplasm and membrane staining for Fas in both cell lines. After cisplatin treatment, the amount of soluble Fas was increased in UT-SCC-20A cultures, but no effect was observed in the UT-SCC-24A cell line. Apoptosis, measured as enhanced caspase-3 activity, was induced by an agonistic Fas antibody (CH11) after cisplatin treatment in UT-SCC-24A cells.

    Conclusions: Low-dose cisplatin treatment enhanced Fas expression in both cell lines and increased susceptibility to apoptosis in one of them.

    Place, publisher, year, edition, pages
    Blackwell Publishing, 2007
    Keywords
    apoptosis, 13-cis retinoic acid, cisplatin, EGFR, Fas (CD95), ICAM-1, α-interferon, oral cancer
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-12806 (URN)10.1111/j.1600-0714.2006.00503.x (DOI)000244244500009 ()17305640 (PubMedID)
    Available from: 2007-11-28 Created: 2007-11-28 Last updated: 2017-12-14Bibliographically approved
    4. Effects of cytokines on matrix metalloproteinase expression in squamous cell carcinoma in vitro
    Open this publication in new window or tab >>Effects of cytokines on matrix metalloproteinase expression in squamous cell carcinoma in vitro
    2007 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 125, no 7, p. 765-773Article in journal (Refereed) Published
    Abstract [en]

    Objective: MMPs play an important role in enhanced intra-tumoral proteolytic activity, promoting angiogenesis and invasion by acting on extracellular matrix substances. Cytokines secreted by tumour-infiltrating immune cells, fibroblasts and tumour cells can modulate MMP expression and secretion by cancer cells. The objective of this study was to investigate the effects of IL-6, soluble IL-6 receptor (sIL-6R), HGF, TNF- and IL-8 on MMP-1, -2 and -9 expression by two oral squamous cell carcinoma cell lines (UT-SCC-20A and -24A).

    Material and methods: ELISA was used to analyse secretion of total MMP protein and gelatin zymography was used for activity analysis.

    Results: IL-6 had a moderate stimulatory effect on MMP-1 secretion in both cell lines, whereas sIL-6R had no effect. When these cytokines were added together, a dose-dependent, synergistic stimulatory effect was observed. HGF also upregulated MMP-1 secretion, especially in one cell line (UT-SCC-24A), and a synergistic effect was observed when HGF was added to IL-6 in both cell lines. MMP-9 secretion by UT-SCC-24A was increased when stimulated with HGF and IL-6 combined with sIL-6R, whereas no effect was found in the other cell line. TNF- stimulated MMP-9 secretion in both cell lines, but only stimulated MMP-1 secretion in one (UT-SCC-24A). The zymographic results were consistent with the ELISA results, indicating an upregulation of active enzyme when a stimulatory effect on protein expression was detected.

    Conclusions: The intra-tumoral cytokines IL-6, hepatocyte growth factor (HGF) and tumour necrosis factor- (TNF-) stimulate oral cancer cells to enhanced secretion of matrix metalloproteinase (MMP)-1 and -9. These results contribute to an understanding of the extracellular events necessary for tumour progression.

    Keywords
    Cytokine, matrix metalloproteinase, oral cancer, squamous cell carcinoma
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-12807 (URN)10.1080/00016480510027484 (DOI)
    Available from: 2007-11-28 Created: 2007-11-28 Last updated: 2017-12-14
  • 143.
    Sundelin, Kaarina
    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.
    Jadner, M.
    Norberg-Spaak, Lena
    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.
    Davidsson, A.
    Department of Otorhinolaryngology, Örebro Medical Center Hospital, Örebro, Sweden.
    Hellquist, H.B.
    Eur, J.
    Metallothionein and Fas (CD95) are expressed in squamous cell carcinoma of the tongue1997In: European Journal of Cancer, ISSN 0959-8049, Vol. 33, no 11, p. 1860-1864Article in journal (Refereed)
    Abstract [en]

    Metallothionein (MT) is a chelator present in myoepithelial cells, whilst the Fas-receptor (APO-1, CD95) has been described primarily in human T Jurkat cells. 20 cases of carcinoma of the tongue were investigated immunocytochemically with regard to MT, Fas and Bcl-2. In normal oral squamous epithelium, MT is located in the basal/parabasal dividing cells only. In well-differentiated nests of carcinomas, MT is observed almost entirely in peripherally located cells. In situ end-labelling indicates apoptosis in the centre of these nests, but not in the peripheral areas. Less-differentiated areas show more general MT-positivity, but little apoptosis. All 24 tumours are Fas-positive, but normal epithelia are mainly negative (P< 0.0001). Bcl-2 protein was sparse in the tumours compared with MT and Fas (P< 0.0001). We thus suggest that MT, possibly due to its chelating properties, may contribute to delaying cells entering apoptosis, both in normal epithelium near the base and in less-differentiated regions of carcinoma. Moreover, Fas may be present in cells of human malignancies, as well as those of established malignant cell lines.

  • 144.
    Sundelin, Kaarina
    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.
    Roberg, Karin
    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.
    Grénman, Reidar
    Department of Otorhinolaryngology – Head and Neck Surgery and Department of Medical Biochemistry, University Hospital and University of Turku, Turku, Finland.
    Håkansson, Leif
    Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    Effects of cisplatin, interferon-alpha and 13-cis retinoic acid on the expression of Fas (CD95), intercellular adhesion molecule-1 (ICAM-1) and epidermal growth factor receptor (EGFR) in oral cancer cell lines2007In: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 36, no 3, p. 177-183Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies showed that many chemotherapeutic agents can induce immuno-suppression at therapeutic drug concentrations whereas low drug doses induce immuno-augmentation.

    Methods: The effect of low-dose cisplatin, interferon-alpha, and 13-cis retinoic acid on receptors involved in immune-mediated apoptosis (Fas/CD95), cell growth (epidermal growth factor receptor) and lymphocyte adhesion (intercellular adhesion molecule-1) was investigated in two oral cancer cell lines (UT-SCC-20A and UT-SCC-24A). Different methods for cell preparation were studied: mechanical and enzymatic detachment, and culture on chamber slides. Receptor expression was investigated using immunohistochemical staining. The amount of soluble and cell-bound Fas was determined with the ELISA technique, and the functional relevance of Fas expression, apoptosis induction, was analyzed.

    Results: Cisplatin enhanced cytoplasm and membrane staining for Fas in both cell lines. After cisplatin treatment, the amount of soluble Fas was increased in UT-SCC-20A cultures, but no effect was observed in the UT-SCC-24A cell line. Apoptosis, measured as enhanced caspase-3 activity, was induced by an agonistic Fas antibody (CH11) after cisplatin treatment in UT-SCC-24A cells.

    Conclusions: Low-dose cisplatin treatment enhanced Fas expression in both cell lines and increased susceptibility to apoptosis in one of them.

  • 145.
    Sundelin, Kaarina
    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.
    Roberg, Karin
    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.
    Grénman, Reidar
    Departments of Otorhinolaryngology—Head and Neck Surgery and Medical Biochemistry, University Hospital and University of Turku, Turku, Finland.
    Håkansson, Leif
    Department of Medical Oncology, University Hospital, Linköping, Sweden.
    Effects of cytokines on matrix metalloproteinase expression in squamous cell carcinoma in vitro2007In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 125, no 7, p. 765-773Article in journal (Refereed)
    Abstract [en]

    Objective: MMPs play an important role in enhanced intra-tumoral proteolytic activity, promoting angiogenesis and invasion by acting on extracellular matrix substances. Cytokines secreted by tumour-infiltrating immune cells, fibroblasts and tumour cells can modulate MMP expression and secretion by cancer cells. The objective of this study was to investigate the effects of IL-6, soluble IL-6 receptor (sIL-6R), HGF, TNF- and IL-8 on MMP-1, -2 and -9 expression by two oral squamous cell carcinoma cell lines (UT-SCC-20A and -24A).

    Material and methods: ELISA was used to analyse secretion of total MMP protein and gelatin zymography was used for activity analysis.

    Results: IL-6 had a moderate stimulatory effect on MMP-1 secretion in both cell lines, whereas sIL-6R had no effect. When these cytokines were added together, a dose-dependent, synergistic stimulatory effect was observed. HGF also upregulated MMP-1 secretion, especially in one cell line (UT-SCC-24A), and a synergistic effect was observed when HGF was added to IL-6 in both cell lines. MMP-9 secretion by UT-SCC-24A was increased when stimulated with HGF and IL-6 combined with sIL-6R, whereas no effect was found in the other cell line. TNF- stimulated MMP-9 secretion in both cell lines, but only stimulated MMP-1 secretion in one (UT-SCC-24A). The zymographic results were consistent with the ELISA results, indicating an upregulation of active enzyme when a stimulatory effect on protein expression was detected.

    Conclusions: The intra-tumoral cytokines IL-6, hepatocyte growth factor (HGF) and tumour necrosis factor- (TNF-) stimulate oral cancer cells to enhanced secretion of matrix metalloproteinase (MMP)-1 and -9. These results contribute to an understanding of the extracellular events necessary for tumour progression.

  • 146.
    Sunnergren, Ola
    et al.
    County Hospital Ryhov, Jönköping.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Hemlin, Claes
    Aleris Sabbatsberg Hospital, Stockholm.
    Hessén Söderman, Anne- Charlotte
    Karolinska University Hospital.
    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.
    Roos, Kristian
    Capio Lundby Hospital, Göteborg.
    Stalfors, Joacim
    Sahlgrenska University Hospital, Göteborg.
    Adenotonsillotomy; first line treatment for pediatric sleep disordered breathing?2012Conference paper (Other academic)
  • 147.
    Sunnergren, Ola
    et al.
    County Hospital Ryhov, Jönköping.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Hemlin, Claes
    Aleris Sabbatsberg Hospital, Stockholm.
    Hessén Söderman, Anne- Charlotte
    Karolinska University Hospital.
    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.
    Roos, Kristian
    Capio Lundby Hospital, Göteborg.
    Stalfors, Joacim
    Sahlgrenska University Hospital, Göteborg.
    Pediatric tonsillotomy; a comparison of high- and low radiofrequency techniques with regard to postoperative bleeding, pain, infection and symptom relief2012Conference paper (Refereed)
  • 148.
    Svanborg, Eva
    et al.
    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.
    Harder, Lena
    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.
    Sarberg, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Harder, Henrik
    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.
    Broström, Anders
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    SNORING DURING PREGNANCY AND ITS RELATION TO PRE-ECLAMPSIA2009In: In Sleep, vol 32, 2009, Vol. 32, p. A219-A219Conference paper (Refereed)
  • 149.
    Thomsen, J.
    et al.
    Dept. Otolaryngol./Head/Neck Surg., Gentofte University Hospital, 2900 Hellerup, Denmark.
    Sass, K.
    ENT Department, Halmstad, Sweden.
    Ödkvist, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Arlinger, Stig
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery .
    Local overpressure treatment reduces vestibular symptoms in patients with Ménière's disease: A clinical, randomized, multicenter, double-blind, placebo-controlled study2005In: Otology and Neurotology, ISSN 1531-7129, E-ISSN 1537-4505, Vol. 26, no 1, p. 68-73Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the efficacy of a new device, the Meniett, in the treatment of Ménière's disease. The device delivers pressure pulses to the middle ear through a ventilating tube in the tympanic membrane at a frequency of 6 Hz for 0.6 second. After rising to a pressure level of 1.2 kPa, the pressure oscillates between 0.4 and 1.2 kPa. It is believed that the pressure changes are conveyed to the inner ear, inducing a transport of fluids via the pressure outlets and thus reducing the endolymphatic hydrops. Study Design: A clinical, randomized, multicenter, double-blind, placebo-controlled study. A total of 40 patients were included that had active Méniè re's disease according to American Academy of Otolaryngology-Head and Neck Surgery criteria, aged between 20 and 65 years, with a history of at least eight attacks during the past year. After insertion of the ventilation tube, the patients should have had attacks of vertigo for 2 months before entering the study. Outcome Measures: Primary study endpoints were change in frequency of vertigo, change of functionality profile, and change in patient perception of vertigo (visual analogue scale), secondary endpoints were perception of tinnitus, aural pressure, and hearing, as well as an audiologic evaluation of hearing before and after the treatment period. Results: The functionality level improved statistically significantly in the active group compared with the placebo group (p = 0.0014), as did the visual analogue scale evaluation of vertigo (p = 0.005). There was a trend toward a reduction of the frequency of vertiginous attacks that was not significant (p = 0.090). With regard to the secondary endpoints, there was no statistical difference between active and placebo groups. Conclusion: Local overpressure treatment is a novel treatment that is noninvasive, nondestructive, and safe. It significantly reduces vestibular symptoms in patients with Ménière's disease. The Meniett was cleared by the Food and Drug Administration in 2000.

  • 150.
    Tibbling, Lita
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences.
    Ask, Per
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Sökjer, H.
    Oesophagus fysiology mot bakgrund av nya medicintekniska landvinningar1977In: Svensk Oe NH Tidskrift, ISSN 1400-0121, Vol. 1, no 2, p. 1-1Article in journal (Other academic)
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