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   

Background: Snoring is common among both children and adults and a sign of sleep disordered breathing (SDB). Adenotonsillectomy is often the solution offered, although the effect is uncertain. There are also some who say that young children who snore will outgrow it even without treatment. The present investigation compares snoring and co-founding symptoms in parental reports for a cohort of children at age 4 and at age 6 years. Method: A cohort of 4 year old chidren (615) was investigated with respect to SDB [B. Löfstrand-Tideström, B. Thilander, J. Ahlqvist-Rastad, O. Jakobsson, E. Hultcrantz, Breathing obstruction in relation to craniofacial and dental arch morphology in 4 year old children, Eur. J. Orthod. 21 (1999) 323-332]. Each child was given a questionnaire. Those reporting significant symptoms also received a clinical and an orthodontic examination. Forty-eight children were diagnosed with SDB, of these 28 were operated with adenoidectomy and/or tonsillectomy. After 2 years, the same questionnaire was administered and the same children as before were further examined as well as those newly reporting significant symptoms. The results from the two occasions were compared. Results: Eighty-three percent (509) of the original cohort participated. The frequency of snoring had changed from 53 to 46% for the group as a whole (p < 0.05). Significant gender differences in co-founding symptoms were seen. Severity of snoring had changed on an individual basis in half of the cases, some recovered, others got worse. Of the children with SDB at 4 years who were operated, 14/28, did not snore at all, compared to 3/18 of the non-operated (p < 0.05). Conclusion: Children who snore at the age 4 seldom "grow out of it" by age 6 and still show other signs of sleep related distress as well. Surgery does not always cure the snoring, thus postoperative follow-up is important. Since new cases develop during this age period, early intervention is not enough. © 2007 Elsevier Ireland Ltd. All rights reserved.

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.

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.

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.

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.

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

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.

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

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.

Objective: To compare the effect of Prednisolone and placebo on the recovery of unilateral idiopathic sudden sensorineural hearing loss. less thanbrgreater than less thanbrgreater thanStudy Design: Prospective, randomized, triple-blind, placebo-controlled multicenter trial. less thanbrgreater than less thanbrgreater thanSetting: Four tertiary and 10 secondary referral centers. less thanbrgreater than less thanbrgreater thanPatients: Of 103 patients randomly assigned, 93 were included in the modified intention-to-treat analysis. The patients, aged 18 to 80 years, were seeking care within 1 week after onset of acute unilateral sensorineural hearing loss with a mean decrease of 30 dB or greater in the 3 most affected contiguous frequencies. less thanbrgreater than less thanbrgreater thanIntervention: Patients were randomly assigned in permuted blocks of 10 to receive Prednisolone or placebo in tapering doses from 60 mg for 3 days and, thereafter, 10 mg less 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. less thanbrgreater than less thanbrgreater thanMain Outcome Measure: The primary endpoint was efficacy of treatment on recovery at Day 90. Secondary endpoints were prognostic factors for hearing recovery. Analyses were by modified intention-to-treat and per protocol. less thanbrgreater than less thanbrgreater thanResults: Hearing improvement for 47 Prednisolone-treated patients was 25.5 +/- 27.1 dB compared to 26.4 +/- 26.2 dB for 46 placebo-treated patients at Day 8 and 39 +/- 20.1 dB versus 35.1 +/- 38.3 dB after 3 months. Vertigo had significant negative effect on hearing improvement and inflammatory signs in the laboratory workup-a positive prognostic effect, irrespective of treatment. less thanbrgreater than less thanbrgreater thanConclusion: Prednisolone in customary dosage does not seem to influence recovery of idiopathic sudden sensorineural hearing loss.