Change search
Refine search result
1 - 19 of 19
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Ericsson, Elisabeth
    Hälsouniversitetet, Linköping.
    Barns och ungdomars hälsa och välbefinnande i samband med tonsilloperation.2007In: Sammanfattning av avhandling april 2007: Medicinska Rikstämman, Stockholm 26-28 nov 2007, 2007Conference paper (Other academic)
    Abstract [sv]

    BakgrundI hela världen är tonsillektomi (TE) är det vanligaste kirurgiska ingreppet på barn och ungdomar. I Sverige opereras cirka 6 % av alla barn och ungdomar. Syftet med avhandlingen var att studera barn och ungdomar i samband med tonsilloperation för att komma fram till optimala förhållanden när det gäller information och omhändertagande och beskriva och utvärdera tonsillotomi (TT) med radiofrekvensteknik (RF) (Ellman International), i jämförelse med sedvanlig TE.ResultatAvhandlingen består av fem delstudier som är samtliga publicerade. I dessa delstudier deltog två åldersgrupper med 92 barn 5-15 år gamla och 76 ungdomar i åldern 16-25 år. Deltagarna randomiserades från ”tonsillväntelista” p.g.a. symtomgivande stora halsmandlar, med eller utan upprepande halsinfektioner till 49/TT och 43TE (5-15 år) respektive 32 TT och 44 TE (16-25 år). I studierna I och IV jämfördes de två kirurgiska metoderna vad beträffar smärta och postoperativ morbiditet. Smärtskalor var för barnet ansiktsskala/Face Pain Scale (FPS) och för ungdomar, föräldrar och personal en 7 gradig verbal smärtskala. Från första dagen skattade TT-gruppen signfikant lägre smärta än TE-gruppen. TT-gruppen hade mindre behov av rekommenderade läkemedel (Diclofenac och Paracetamol). Kombinationen av paracetamol och NSAID visade vara tillräcklig för de flesta TT/TE barnen och TT ungdomarna, medan de äldre i TE-grupperna behövde komplettering med opiod (Tramadol). Ingen sekundärblödning i yngre åldersgruppenTT/TE eller äldre TT-gruppen, medan fyra i den äldre TE gruppen hade sekundära blödningar. TT-gruppen var tillbaka till normal aktivitet tre dagar (5-15år) eller fyra dagar (16-25 år) dagar tidigare än TE-gruppen. Studie II fokuserade på barnets ”grundbeteende” (Child Behavior Checklist/CBCL), upplevelse av smärta, oro/ängslan (State-Trait-Anxity Inventory for Children/STAIC), tidigare erfarenheter av kirurgi och halsinfektioner, samt smärtbehandling. Barnen med obstruktionsbesvär hade mer beteende- och emotionella problem totalt sett jämfört med en svensk normalpopulation. Det fanns ingen relation mellan barnets grundbeteende och smärta efter TT/TE, inte heller samband mellan halsinfektioner eller tidigare kirurgi och hur man upplevde smärta efter operationen. TE-barnen skattade högre oro efter operation än TT-barnen. Det var ingen skillnad mellan barn och föräldrars smärtskattningar. Personalen skattade lägre smärta än barn och föräldrarna på sjukhuset och undermedicinerade det första dygnet, trots stående ordination av analgetika. Studierna III och V jämförde långtidseffekten av TT och TE kirurgi efter ett och tre år (5-15 år) och ett år (16-25 år). Effekten på snarkning var densamma för TT och TE och antalet halsinfektioner var lågt för båda operationsmetoderna. Det förelåg inga skillnader i dessa resultat mellan åldersgrupperna. Efter ett år hade barnens grundbeteende förbättrats i samma grad för båda operationsmetoderna och det var inte någon skillnad mellan gruppernas skattning på CBCL jämfört med genomsnittsvärden från svensk population. Både efter ett och efter tre år hade aptit, ork/energi, koncentrationsförmåga förbättrats, både vad gäller TT och TE. Ungdomarna skattade hälsorelaterad livskvalitet (SF-36) mycket lågt före operation, både fysiska och psykiska dimensioner, en betydligt lägre hälsa jämfört med data från svensk åldersanpassad befolkning. En betydande förbättring hade skett av livskvalitet hos ungdomarna inom samtliga dimensioner vid mätning ett år efter operationen. Det var ingen skillnad mellan TT/TE eller mellan grupperna och normaldata. Slutsats: Obstruktionsbesvär med kombination av varierande antal halsinfektioner har en negativ effekt på grundbeteende och livskvalitet. Både efter TT och TE ger stor förbättring av livskvalitet, infektion, obstruktivitet och beteende-problem ett och tre år efter kirurgi, vilket indikerar att båda kirurgiska metoderna är lika effektiva. Med färre postoperativa komplikationer, mindre smärta, kortare konvalescenttid och lägre samhälls- och sjukvårdsekonomisk kostnad, bör TT med RF övervägas som operationsmetod. Health and well-being of children and young adults in relation to surgery of the tonsils. Elisabeth Ericsson, Hälsouniversitetet, Linköpings

  • 2.
    Ericsson, Elisabeth
    Linköpings universitet, Hälsouniversitetet, Sverige.
    Health and well-being of children and young adults in relation to surgery of the tonsils2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Tonsillectomy is one of the most frequently performed surgical procedures in children and youths. The aim of this thesis was to study children and youths in relation to tonsil surgery with the goal of improving the care, and to describe partial tonsillectomy/tonsillotomy (TT) using radiofrequency technique (RF) (Ellman International) in comparison with the more commonly used total tonsillectomy (TE).

    The thesis covers studies of wo age-groups with obstructive problems, with or without recurrent tonsillitis. Randomization to surgery was done from the existing waiting list; 92 children, 5-15 years old to 49/TT and 43/TE, (I-III) and 76 youths, 16-25 years old to 32/TT and 44/TE (IV-V).

    The first purpose (I, IV) was to compare the two surgical techniques with respect to pain and postoperative morbidity. Pain measures were for the children the Face Pain Scale and for the youths and parents and staff a verbal-pain-rating-scale. From the first day, the TT-groups scored significantly less pain than the TE-groups. The doses of pain-killing drugs (paracetamol and diclofenac) taken were significantly less for the children and youths receiving the TT-surgery, they could stop taking pain-killers sooner, and were back to normal activity three (5-15yrs) or four (16-25yrs) days earlier compared with TE-groups.

    Paper II focused on the child’s behavior (Child Behavior Checklist/CBCL), experience of pain, anxiety (State-Trait-Anxiety Inventory for Children /STAIC), previous experiences of surgery/tonsillitis, and the management of pain. The children scored higher on CBCL than a normative group before surgery, but no connection was observed between CBCL rating and experience of pain reported post surgically. There was no relation between preoperative anxiety and reported pain, but the postoperative anxiety level correlated with pain. The Egroup scored higher anxiety after surgery. Previous experience of surgery or tonsillitis did not influence the postoperative pain. The nurses scored pain lower than the parents/children and under-medicated.

    The second purpose was to compare the long-term effects of TT and TE-surgery after one and three years (5-15yrs) and one year (16-25yrs) (III, IV). The effect on snoring was the same for both TT and TE-groups and the rate of recurrence of throat infections was low after both surgical techniques.

    After one year, all children (TT/TE) showed improvements on CBCL to the same degree and there was no longer a difference between total behavior and normative values. They also scored improvements in health-related quality of life (HRQL) with Glasgow-Children-Benefit-Inventory.

    For both TT and TE, the older group reported lower HRQL preoperatively on all dimensions of Study-Short-Form (SF-36) compared with a normal population. After one year, a large improvement was found in HRQL in both groups and there were no differences compared with a normal population.

    Conclusion: Preoperative obstructive problems, in combination with recurrent tonsillitis have a negative impact on HRQL. Both after TE and TT there are large improvements in HRQL, infections, obstructive, and behavior problems one to three years after surgery, indicating that both surgical methods are equally effective. With fewer postoperative complications, less pain, shorter recovery time, and lower cost, TT with RF should be considered as method of choice.

  • 3.
    Ericsson, Elisabeth
    Jönköping University, School of Health Science, HHJ. CHILD. Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Improvement of Quality of Life by Tonsillotomy & Tonsillectomy in Children and Youths2009In: 1st Meeting of the European Academy of ORL - HNS, Mannheim, Tyskland  27-30 juni, 2009, 2009Conference paper (Refereed)
    Abstract [en]

    Background: There has been increasing evidence over the last few years that paediatric sleep-disordered breathing is associated with behavioural and neurocognitive problems as well as with poor school performance, failure to thrive and poor health related quality of life (HRQL). Several studies indicate that both behaviour and quality of life improve after tonsillectomy (TE) in children with sleep-disordered breathing (SDB). However, TE causes considerable pain and morbidity which often lasts more than seven days. Postoperative pain is poorly managed and under-treatment of pain leads to increased morbidity and postoperative behavioural changes. Tonsillotomy (TT) for obstructive symptoms has re-appeared with focus on reduction of postoperative morbidity. Removing only the protruding parts of the tonsils seems to have the same beneficial long-term effect on obstructive symptoms due to hypertrophic tonsils.

    Material and Method: Children and youths have been studied in relation to tonsil surgery with the goal of improving care and comparisons have been made between TT and TE.

    The first part of this presentation will cover three randomized trials of children and youth  4 to 25 years old with respect to pain and morbidity and with six months to three years follow-up including assessment of HRQL.

    The second part presents preliminary results from a Swedish national study of a sample of 550 children (4-15 yrs) to determine the impact on HRQL before and six months after TT or TE.

    In the studies, the impact on HRQL was evaluated in the younger age group using the Obstructive Sleep Apnea-18 (OSA-18), Glasgow Children´s Benefit Inventory (GCBI); their behavioural and emotional problems were assessed using the Child Behaviour Checklist (CBCL). In the age group 16-25 yrs, the HRQL was measured using the SF-36.

    Results: In the TT groups, the children recorded less pain from the first day after surgery onwards, used fewer doses of painkillers, and were pain-free 3 days (5-15yrs)/4 days (16-25 yrs) earlier than the children/youths in the TE group. For most TT patients, the combination of Paracetamol and Diclophenac was sufficient for analgesia. However, most of the TE patients with that medication had considerable pain and 50% still experienced substantial pain after one week. Before surgery, HRQL was registered as much lower among patients with obstruction problems when compared to the reference sample. Surgery with either tonsillotomy or tonsillectomy was associated with a marked improvement of the quality of life both for children with severe obstructive sleep related distress or with milder sleep disordered breathing.

     

    Conclusion: TT is a safe method, which causes less pain and postoperative morbidity than regular TE. Children and young adults with tonsillar hypertrophy and different degrees of obstructive sleep related distress all show a negative impact on HRQL and behaviour. All improve dramatically after a tonsillar operation—equally after TT as compared to TE.

  • 4.
    Ericsson, Elisabeth
    Jönköping University, School of Health Science, HHJ. CHILD. Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Validering av OSA-18 på en svensk barnpopulation2009In: Svensk ÖNH-Tidskrift, ISSN 1400-0121, Vol. 16, no 4, p. 16-19Article in journal (Other academic)
  • 5.
    Ericsson, Elisabeth
    et al.
    University, Linköping, Sweden.
    Graf, Jonas
    University, Linköping, Sweden.
    Hultcrantz, Elisabeth
    University, Linköping, Sweden.
    Pediatric Tonsillotomy with Radiofrequency Technique: Long-Term Follow-Up2006In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 116, no 10, p. 1851-1857Article in journal (Refereed)
  • 6.
    Ericsson, Elisabeth
    et al.
    Jönköping University, School of Health Science, HHJ. CHILD.
    Hemlin, Claes
    Avdelningen för Otorhinolaryngologi, Aleris Sabbatsberg, Stockholm.
    Hessen-Söderman, Ann-Charlotte
    Avdelningen för Otorhinolaryngologi, Karolinska Universitetssjukhus, Stockholm.
    Hultcrantz, Elisabeth
    Avdelningen för Otorhinolaryngologi, Inst för Kliniks och Experimentell Medicin, Hälsouniversitetet, Linköping.
    Månsson, Ingemar
    Avdelningen för Otorhinolaryngologi, Sahlgrenska Universitetssjukhus, Göteborg.
    Roos, Kristian
    Avdelningen för Otorhinolaryngologi, Capio Lundby, Göteborg.
    Stahlfors, Joacim
    Avdelningen för Otorhinolaryngologi, Sahlgrenska Universitetssjukhus, Göteborg.
    The role of information and instruction to children and parents in homemanagement after tonsil surgery - what is it helpful for them to know?2010Conference paper (Refereed)
    Abstract [en]

    OBJECTIVES

    To create national recommendations for information after tonsil surgery to improve the management ofchildren.

    METHODS

    1. A search of Medline addressing evidence on expectations and advice about medication and nonpharamacological techniques to relieve pain after tonsil surgery and 2. A questionnaire focusing on the routines for information before and after tonsil surgery was administrated to all ENT-clinics in Sweden with 99% response rate.

    RESULTS

    There is evidence that information has an empowering effect upon parents to feel more control over their child’s care. Lack of information leads to anxiety and increased perception of pain in the child. Children and parents who were given specific information related to pain and morbidity, reported less pain and were less anxious than those with no or insufficient information. Constructive information should be given gradually, starting preoperatively, to parents and children. A leaflet should contain sufficient information about what happens before, during and is to be expected after surgery, the risks and possible complications, and advice and recommendation of medication and non-pharmacological techniques. Results from the national enquiry (N=48) showed the provision of a variety of different written information from the various clinics, often insufficient. Based on these findings, an information leaflet for patients and a checklist based on the literature for the staff to use at discharge were developed (both will be available).

    CONCLUSIONS

    A checklist for the staff insures that parents and children get consistent advice. A leaflet provided before surgery helps children and parents with methods to relieve pain. This could decrease the number of complications and later consultations and give shorter recovery.

  • 7.
    Ericsson, Elisabeth
    et al.
    Jönköping University, School of Health Science, HHJ. CHILD. Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Hultcrantz, Elisabeth
    University, Linköping.
    Månsson, Ingemar
    Hälso- och sjukvårdsstyrelsens kansli, Göteborg .
    Roos, Kristian
    Capio Lundby Sjukhus AB, Göteborg .
    Stalfors, Joachim
    Sahlgrenska Universitetssjukhus, Göteborg.
    Weitz, Per
    Centrallasarettet, Västerås .
    Erfarenheter från kvalitetsregistret för tonsilloperation 1997-20082008In: Medicinska Riksstämman, Göteborg 26-28 nov, 2008, 2008Conference paper (Other academic)
    Abstract [sv]

    Bakgrund

    Kvalitetsregister för svensk ÖNH-sjukvård infördes successivt med början 1997, ett av registren ägnades tonsillektomi. Detta register har nu varit i bruk i drygt 10 år. Det kommer att avslutas med operationer utförda t.o.m. 081231. Registret beräknas komma att omfatta ca 50 000 ingrepp, det fortsätter sedan i modifierad form och med ny teknik för insamling av data. Med anledning av att en period för tonsilloperationsregistret nu avslutas, ges här en översiktlig rapport om erfarenheterna.

    Metod

    Kvalitetsregistret är tänkt att användas såväl på kliniknivå som på nationell nivå. På kliniknivå ska effekter och bieffekter av ingreppet jämföras dels med riksgenomsnittet och dels med sig själv över tid. På riksnivå kan förändringar i indikationer, operationsmetoder och organisatoriska förändringar m.m. studeras. Rapporten analyserar utvecklingen av det nuvarande tonsilloperationsregistret med fokus på den nationella nivån samt presenterar några rapporter som tillkommit i anslutning till registret.

    Resultat

    En översiktlig presentation ges av: ⋅ Registrets data på nationell bas ⋅ Hälso- och sjukvårdsrapport 2001 ⋅ Oväntad ålders- och könsfördelning ⋅ Oplanerade återbesök ⋅ Patienters upplevelse av komplikationer till tonsillektomi ⋅ Nationella indikationer för tonsilloperation ⋅ M.m.

    Sammanfattning

    En sammanfattning av utvecklingen av ett nationellt kvalitetsregister med 50 000 tonsilloperationer presenteras.

  • 8.
    Ericsson, Elisabeth
    et al.
    University Linköping.
    Lundeborg, Inger
    University Linköping.
    Graf, Jonas
    University Linköping.
    McAllister, Anita
    University, Linköping.
    Hultcrantz, Elisabeth
    University, Linköping.
    Child Behavior and Quality of Life Before and After Tonsillotomy versus Tonsillectomy2008In: Swedish Sleep Medicine Congress: Skövde 2-4 april, 2008, 2008Conference paper (Refereed)
    Abstract [en]

    Objective: to compare two techniques for tonsil surgery with respect to postoperative pain and morbidity and changes in sleep, behavior, health related quality of life (HRQL) and benefit due to  surgery.

    Methods: 67 pre-school children  with  tonsillar hypertrophy were randomized to regular tonsillectomy (TE)  or tonsillotomy (TT) with Radiofrequency surgical technique.

    The parents completed a validated quality of life  survey, Obstructive Sleep Apnea-18 (OSA18) , assessed the children’s behavior  with the Child Behavior Checklist (CBCL) before and six month after surgery and evaluated the post-operative  health related benefits using the Glasgow Children’s Benefit Inventory (GCBI).

    Results: TT-children recorded less pain from the first day, and were pain-free 3 days earlier than TE-children. Six months post-surgery, there was no difference between TT and TE with regard to snoring and ENT-infections.

    The total scores in all the individual domains between the initial OSA-18 and post-surgery scores differed (p<0.0001). Improvement in CBCL score was also significant (p<0.01) . There were no differences between TT- and TE-children. GCBI indicated a significant health benefit of both methods.

    Conclusions: Tonsillar hypertrophy  shows  impact on HRQL and behavior. After  tonsillar operation, improvements occur as much after TT as after TE.  TT should be first choice for treatment.

  • 9.
    Ericsson, Elisabeth
    et al.
    Jönköping University, School of Health Science, HHJ. CHILD. Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Lundeborg, Inger
    University, Linköping.
    Hultcrantz, Elisabeth
    University, Linköping.
    Child Behavior and quality of life before and after tonsillotomy versus tonsillectomy2009In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 73, no 9, p. 1254-1262Article in journal (Refereed)
    Abstract [en]

    Objectives: Compare two techniques for pediatric tonsil surgery with respect to postoperative pain and morbidity and changes in sleep behavior, health related quality of life (HRQL) and benefits due to surgery.

    Methods: 67 children (4.5–5.5 years) with tonsillar hypertrophy and obstructive sleep-disordered breathing with or without recurrent tonsillitis were randomized to either regular tonsillectomy (TE) (n = 32) or intracapsular tonsillectomy/tonsillotomy (TT) (n = 35) with Radiofrequency surgical technique (ellman Int.). Before TT/TE, the parents completed a validated Quality of Life survey of pediatric obstructive sleep apnea, the OSA-18 (Obstructive Sleep Apnea-18) and a standardized assessment of their children’s behavior with the Child Behavior Checklist (CBCL). Six months after surgery, the parents repeated these measurements, and assessed the health related benefits of the surgery using the Glasgow Children’s Benefit Inventory (GCBI).

    Results: In the TT group, the children recorded less pain from the first day after surgery on wards, used fewer doses of painkillers and were pain-free 3 days earlier than the children in the TE group. Six months after surgery, there were no significant difference between TT and TE with regard to snoring and ENT-infections. The differences in the total scores and in all the individual domains between the initialOSA-18 and postsurgery scores were all significant (P < 0.0001). The improvement in the total problem score measured with CBCL was also significant (P < 0.01) and there was no difference between the TT and TE children. The improvements in all subscores of the GCBI indicated a significant health benefit of both TT and TE.

    Conclusions: TT with RF-surgery causes less pain and postoperative morbidity than regular TE and has an equal effect on snoring and recurrent infections. Pre-school children with tonsillar hypertrophy and obstructive sleep-disordered breathing all show an impact on HRQL and behavior before surgery and improve dramatically just as much after TT as after TE. Therefore TT would be considered for treatment of small children

  • 10.
    Ericsson, Elisabeth
    et al.
    University Linköping.
    Lundeborg, Inger
    University Linköping.
    Marcusson, Agneta
    University, Linköping.
    McAllister, Anita
    University, Linköping.
    Hultcrantz, Elisabeth
    University, Linköping.
    Oralmotorik, artikulation och livskvalitet: Sexmånadersuppföljning efter tonsillotomi respektive tonsillektomi2007In: Medicinska Riksstämman, Stockholm 28-30 nov 2007, 2007Conference paper (Refereed)
    Abstract [sv]

    Bakgrund: Barn med stora halsmandlar har oftare problem med näsandning, dregling, tal, röst och bettfysiologi. Kliniska rapporter har visat positiva resultat när det gäller dessa svårigheter efter tonsillektomi (TE). Barn med obstruktionsbesvär har mer beteende- och emotionella problem, studier har visat att barnets grundbeteende förbättras efter TE. Frågan är om partiellt borttagande, tonsillotomi (TT), av de förstorade delarna av halsmandlarna ger samma positiva långsiktiga resultat. Ingreppet ”tonsillotomi”( TT) påverkar barnet mycket mindre när det gäller smärta och blödningsrisk, och har ett snabbare läkningsförlopp än när hela tonsillen tas bort (TE). Syfte med studien att utröna om tonsillotomi förbättrar förutsättningarna för normal utveckling beträffande oralmotorik, tal och bett (artikulatorisk-, oralmotorisk- och bettutveckling) och därmed ger opererade barn en bättre livskvalitet.

    Metod: Prospektiv studie med 67 barn 4,5-5,5 år med tonsillhypertrofi samt med eller utan återkommande halsinfektioner  har randomiserats till  TT (n=35) med RF-teknik (Ellman international)  och sedvanlig TE (n=32). Före ingreppet bedömdes barnens oralmotorik och tal av logoped med Nordic Orofacial Test (NOT-S) och fonologisk test. Föräldrarna besvarade frågor om oralmotorik i allmänhet och tugg- och sväljfunktion i synnerhet. Tandläkare bedömer bett och gjorde cefalometri (rtg). Livskvalitetinstrument med OSA18 samt beteendeinstrument Child Behavior Checklist (CBCL) ifylldes av föräldrarna. Sex månader efter ingreppet upprepas samtliga bedömningar utom bettanalysen vilket görs först två år efter ingreppet.

    Resultat: Samtliga 66 barn har genomfört sexmånadersuppföljning av oralmotorik, tal och livskvalitet. Båda grupperna var signifikant förbättrade vad gäller obstruktionsbesvär, infektioner, aptit och ork/energi. Livskvaliteten skattades signifikant bättre beträffande sömnstörning, dagtidsfunktion, hälsa, fysiska och emotionella symtom. Logopedbedömningarna visar tydlig förbättring beträffande tugg - svälj- och andningsfunktion. Rapporterad dreglingsproblematik har helt försvunnit. Perceptuell analys av barnens röst och tal visar på att flera av barnen hade en tydlig förbättring postoperativt beträffande röst (talklang) och artikulation. Försenad fonologisk utveckling som upptäcktes preoperativt på barnen kvarstod vid sexmånaderskontrollen.

    Sammanfattning: Sexmånadersuppföljningens resultat visar att effekten är densamma efter TT som TE vid oralmotorisk dysfunktion inklusive artikulationsproblem och hälsa/livskvalitet, mycket är vunnit i både lidande, "sjukskrivningstid" och logopediska behandlingsinsatser. Tonsillotomi bör övervägas som rutinmetod vid samtliga ÖNH-kliniker vid denna indikation, även på barn med kombinerade funktionshandikapp vilka ofta lider av oraldysmotorik.

  • 11.
    Graf, Jonas
    et al.
    Hälsouniversitetet, Linköping.
    Ericsson, Elisabeth
    Jönköping University, School of Health Science, HHJ. CHILD. Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Lundeborg, Inger
    Hälsouniversitetet, Linköping.
    Hultcrantz, Elisabeth
    Hälsouniversitetet, Linköping.
    Tonsillotomi på förskolebarn — räcker det?2008Conference paper (Other academic)
    Abstract [sv]

    Bakgrund

    Under förskoleålder sker en fysiologisk ökning av den sk Waldeyerska ringen med tillväxt av tonsiller och adenoid som del i utvecklingen av barnets immunförsvar Många barn kan under denna tid debutera med obstruktionsbesvär(snarkning och sömnapné). Traditionellt har tonsillerna och adenoiden genom tonsillektomi och abrasio helt avlägsnats för att komma till rätta med dessa symptom, kirurgi förenad med hög postoperativ smärtnivå. På senare tid har tonsillotomi, dvs partiellt borttagande av tonsillerna, återinförts som en något mer skonsam operationsmetod. Immunsystemetpåverkas möjligtvis inte heller i lika stor omfattning. Frågan är om detta ingrepp är tillfyllest på barn som är i den ålder då tonsillerna fortfarande växer? Syftet med föreliggande studie var att jämföra tonsillotomi med radiofrekvenskirurgi med fullständig tonsillektomi på förskolebarn vad beträffar postoperativ morbiditet och långtidseffekt på snarkning och infektionsnbenägenhet upp till två år efter operation med tonsillektomi.

    Metod

    67 förskolebarn(4-5 år)med symtomgivade tonsillhypertrofi randomiserades till reguljär tonsillektomi(TE) eller tonsillotomi(TT) med radiofrekvensteknik. I de flesta fall utfördes samtidigt abrasio. 6 månader efter operationen svarade alla på frågeformulär och 2 år efter operationen bedömdes de åter av ÖNH-läkare. Snarkningen före, direkt efter operationen och vid tiden för läkarbesöket utvärderades då med VAS

    Resultat

    TT barnen registrerade lägre smärta från första dagen efter operation och var helt smärtfria 3 dagar tidigare än TE-barnen. Sex månader efter operationen förelåg ingen skillnad på grupperna vad gäller snarkning och infektionsbenägehet. Efter två år hade två av de 34 TT-barnen och ett av de 33 TE-barnen blivit re-opererade pga recidiv av obstruktionsbesvär, TE-barnet med reabrasio. Övriga barn i båda grupperna var i stort sett besvärsfria vad gäller snarkning och ingen ökad infektionsbenägehet noterades hos något barn. VAS före/ två år efter operationen var 8,4/1,3 för TE och 8,5/1,6 för TT. Tre av TT barnen hade tonsillvävnad något utanför tonsillogen och hälften av TE barnen hade små tonsillrester i logerna.

    Sammanfattning

    Cirka 6 % risk föreligger att ett yngre barn som opereras med tonsillotomi för obstruktionsbesvär behöver göra om operationen inom 2 år. Denna risk bör vägas mot den betydligt lägre postoperativa morbiditeten för tonsillotomi jämfört med tonsillektomi

  • 12.
    Graf, Jonas
    et al.
    Avdelningen för Otorhinolaryngologi, Inst för Kliniks och Experimentell Medicin, Hälsouniversitetet, Linköping.
    Ericsson, Elisabeth
    Jönköping University, School of Health Science, HHJ. CHILD.
    Lundeborg, Inger
    Avdelningen för Otorhinolaryngologi, Inst för Kliniks och Experimentell Medicin, Hälsouniversitetet, Linköping.
    Hultcrantz, Elisabeth
    Avdelningen för Otorhinolaryngologi, Inst för Kliniks och Experimentell Medicin, Hälsouniversitetet, Linköping.
    Tonsillotomy with RF on young children with obstructive sleep disorder in ashort and long term perspective. Does the risk for recurrence balance the gain ofless surgical trauma and morbidity?2010Conference paper (Refereed)
    Abstract [en]

    OBJECTIVES

    To compare two methods of tonsil surgery with respect to long term effect in a group of pre-school children

    METHODS

    67 pre-school children, age 4-5 with symptoms of tonsillar hyperplasia were randomized to conventional tonsillectomy,TE,(n: 32) or tonsillotomy using radio frequency technique,TT(n:35).

    28 TT patients and 25 TE patients underwent adenoidectomy at the same occasion. 5 TT and 1 TE had

    already undergone an adenoidectomy. Six months and two years after surgery all children were evaluated through questionnaires including the

    OSA-18 quality of life survey and two years after surgery they were again evaluated by an ENT-specialist, speech therapist and dentist.

    RESULTS

    The TT-children experienced less pain from the first day after surgery and were free from pain three days earlier than the TE-children. Six months after surgery there was no difference between the groups

    concerning snoring and frequency and severity of upper airway infections. After two years, three of the 35 TT-children and one of the TE children had been reoperated due to recurring obstructive problems, the TEchild and one of the TT-children with adenoidectomy, two TT-children with tonsillectomy. The otherchildren did not snore and no increased tendency towards infections was noted in any child. Evaluation with VAS before/two years after surgery was 8,4/1,3 for TE and 8,5/1,6 for TT.(Median). The total OSA-18 score and the scores for all domains within OSA 18 showed significant improvement after surgery for both groups of children(p<.0001) in short- and long term scores. Three of the TT-children had some tonsillar tissue protruding from the tonsillar cleft and half of the TEchildren had small tonsillar remains in the tonsillar clefts.

    CONCLUSIONS

    Young children in an age with rapid immunological development have a six percent risk of recurrence of tonsil hyperplasia-related obstructive symptoms within two years after tonsillectomy, and may need to be reoperated. This risk should be weighed against the much lower postoperative morbidity of tonsillotomy as compared to tonsillectomy.ral

  • 13.
    Hessen-Söderman, Anne-Charlotte
    et al.
    Karolinska Universitetssjukhuset, Stockholm.
    Stalfors, Joacim
    Institutionen för kliniksa vetenskaper vid Sahlgrenska akademin, Göteborg.
    Ericsson, Elisabeth
    Jönköping University, School of Health Science, HHJ. CHILD. Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Hemlin, Claes
    ÖNH-kliniken, Sabbatsbergssjukhus, Stockholm.
    Roos, Kristian
    ÖNH-kliniken, Lundbysjukhus, Göteborg.
    Hultcrantz, Elisabeth
    Hälsouniversitetet, Linköping.
    Blödning efter tonsilloperation: Resultat ur nya nationella kvalitetsregistret2009Conference paper (Other academic)
    Abstract [sv]

    Bakgrund: Det nya kvalitetsregistret för tonsilloperation startade 090301. Uppgifter angående operationsmetod och använd utrustning registreras nu samt om mer än en operationsindikation har använts. Nytt är en postop. 30-dagarsenkät som föräldrarna/vuxna patienter får besvara via nätet. Då får man besked angående det postoperativa förloppet inkl. sekundära blödningar.

    Resultat: Fem månader efter start har 2341 patienter registrerats varav 2020 är opererade. 1109 har besvarat 30-dagarsenkäten och ännu ingen 6- månaders-formuläret. Det vanligaste ingreppet är Tonsillektomi (TE) med 976 operationer följt av tonsillotomi (TT)+Abrasio, 495 ingrepp, därefter TE+Abrasio 413 och TT 104. Primär blödning är ungefär lika vanligt för de tre första ingreppen, 2,6%, 1,8% resp. 2,4% och enbart TT 0%.Sekundär blödning, som rapporterats av föräldrarna/patienten efter 30 dagar visar TE 9%, TE+Abrasio 2,6% , TT 2% och TT + Abrasio 0.7%. Av metoder har kallt stål använts flitigast: 1078 operationer med 2,7% primära blödningar och 6% sekundära, följt av Radiofrekvens, 684 operationer med 1,5% primära och 1,6% sekundära blödningar. Diatermisax har använts på 131 patienter med 1,5% primära och 22% sekundärblödningar, Ultracision vid 79 operationer med 0 primär och 7,7% sekundärblödning samt Laser vid 22 operationer med 1,5% primär och 9% sekundärblödning.

    Diskussion: De olika prevalenser av postoperative blödning som resultaten visar är inte entydiga: Enbart TE görs nästan enbart på vuxna, oftast på infektionsindikation, vilket kan förklara en högre blödningsförekomst jämfört med TE+Abrasio, som istället enbart görs på barn med obstruktionsindikation, med mindre blödning som följd. Skillnaden i blödning, mellan TE och TT är dock klar, eftersom relativt många individer är opererade i båda grupperna och man genomgående har signifikant lägre blödning för TT. När det gäller operationsmetod visar de ”heta” metoderna lägre primärblödning men fler sekundär-blödningar än kallt stål. Radiofrekvens, som arbetar vid lägre temperatur har de lägsta blödningstalen både vad gäller primär- och sekundärblödning. En bias är att enbart hälften av de opererade har skickat in 30-dagarsenkät. De minst nöjda, dvs. de som blött efteråt, är kanske mer villiga att påtala detta, vilket i så fall generellt ger för höga blödningstal. Konklusion: TT ger färre primära och sekundära blödningar än TE. ”Heta” tekniker ger ett stort antal sekundära blödningar. Högre svarsfrekvens eftersträvas.

  • 14.
    Hultcrantz, Elisabeth
    et al.
    Avdelningen för Otorhinolaryngologi, Inst för Kliniks och Experimentell Medicin, Hälsouniversitetet, Linköping.
    Ericsson, Elisabeth
    Jönköping University, School of Health Science, HHJ. CHILD.
    Hemlin, Claes
    Avdelningen för Otorhinolaryngologi, Aleris Sabbatsberg, Stockholm.
    Hessen Soderman, Anne-Charlotte
    Avdelningen för Otorhinolaryngologi, Karolinska Universitetssjukhus, Stockholm.
    Roos, Kristian
    Avdelningen för Otorhinolaryngologi, Capio Lundby, Göteborg.
    Stahlfors, Joacim
    Avdelningen för Otorhinolaryngologi, Sahlgrenska Universitetssjukhus, Göteborg.
    Tonsillectomy or Tonsillotomy - Is a change of paradigm on-going? Data out of a new National Tonsil Surgery Register in Sweden2010Conference paper (Refereed)
    Abstract [en]

    OBJECTIVES

    To study the current prevalence of different tonsil surgery techniques in children with obstructive symptoms in Sweden and the rates of primary and secondary bleeding as a function of the procedure and technique used.

    METHODS

    The new National Tonsil Surgery Register in Sweden was used; this registry was opened in March 2009.The data for patients aged 1–15 years operated for obstruction was analyzed. To the registry, age, sex,indication for surgery, surgical procedure and techniques is recorded prospectively, as is primary bleedings occurring during hospital stay. 30 days after surgery, complications such as secondary bleedings,uncontrolled pain and nosocomial infections are reported by parents in questionnaires collected using asecure internet-page.

    RESULTS

    A total of 3980 patients between 1–15 years were operated during the period covered, of whom 3172 for obstructive symptoms. Of the 1876 that have thus far answered the 30 day post-operative questionnaire 511 were operated with adenotonsillectomy (A+TE) and 943 with adenotonsillotomy (A+TT), 246 were operated with tonsillectomy (TE) and 174 with tonsillotomy (TT). Primary bleedings were reported in 55/3172 patients: 2.4% after A+TE, 1.8% after A+TT, 1.9% after TE and 0.35% after TT. Secondary bleedings were noted in 36/1876 patients: 3.3% after A+TE, 0.85% after A+TT, 4.1% after TE and 0.6% after TT. The used surgical techniques (TE/TT) were cold steel (455/17), radiofrequency (72/864), diathermy (39/2), ultracision (23/24) or laser (3/22).

    CONCLUSIONS

    TT for the indication, “obstruction” has become more common than TE. TT results in fewer both primary and secondary postoperative bleedings. Further analyzes

  • 15.
    Lundeborg, Inger
    et al.
    University, Linköping.
    Ericsson, Elisabeth
    University, Linköping.
    Graf, Jonas
    University, Linköping.
    Hultcrantz, Elisabeth
    University, Linköping.
    McAllister, Anita
    University, Linköping.
    Effects of tonsil surgery on speech and oral-motor function2007In: 27th World Congress International Association of Logopedics and Phonoiatrics, Köpenhamn, Danmark, 2007Conference paper (Refereed)
    Abstract [en]

    Large tonsils decrease the oropharyngeal airspace and cause upper respiratory obstruction and consequently mouth breathing in children. If mouth breathing is prolonged, it leads to muscular and postural alterations which, in turn cause dentoskeletal changes. In Sweden 6% of all children are surgically treated for hypertrophy of the tonsils. The indications for surgery are recurrent tonsillitis or severe obstructive-sleep-disorder. Oral motor dysfunction including swallowing problems, disordered speech and aberrant dentofacial growth are less recognized problems as indications for treatment. We report preliminary results from an ongoing project aiming at comparing outcome of oral motor function and speech in children treated with two different surgical methods, tonsillectomy (TE)and partial tonsil resection, tonsillotomy (TT). 67 children aged 4-5 years old on waiting list for tonsil surgery were randomized to either TE or TT. They were assessed before surgery 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 with the assessment of a control group.No significant differences were found between the TE and the TT group. Both groups performed significantly better on the oral motor test at the postoperative assessment, and voice quality had improved. However the delay in the phonological development that was found preoperatively in the children with enlarged tonsils still remained at the 6-month postoperative control

  • 16.
    Lundeborg, Inger
    et al.
    University Linköping.
    Ericsson, Elisabeth
    University, Linköping.
    McAllister, Anita
    University, Linköping.
    Hultcrantz, Elisabeth
    University, Linköping.
    Effects of tonsil surgery on speech and oral motor function2008In: 12th meeting of the International Clinical Phonetics and Linguistics Association: Istanbul, Turkiet 18-25 juni 2008, 2008Conference 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

  • 17.
    Lundeborg, Inger
    et al.
    University of Linköping.
    McAllister, Anita
    University of Linköping.
    Graf, Jonas
    University of Linköping.
    Ericsson, Elisabeth
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. CHILD.
    Hultcrantz, Elisabeth
    University of Linköping.
    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)
  • 18.
    Lundeborg, Inger
    et al.
    University of Linköping.
    McAllister, Anita
    University of Linköping.
    Samuelsson, Christina
    University of Linköping.
    Ericsson, Elisabeth
    Jönköping University, School of Health Science, HHJ. CHILD. Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Graf, Jonas
    University of Linköping.
    Hultcrantz, Elisabeth
    University of Linköping.
    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)
  • 19.
    Svanborg, E.
    et al.
    Linkoping Univ, Clin Neurosci, IKE, Linkoping, Sweden.
    Sunnergren, O.
    Ryhov Cty Hosp, ENT, Jonkoping, Sweden.
    Ulander, M.
    Linkoping Univ Hosp, Clin Neurophysiol, Linkoping, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Snoring causes OSA: sensory nervous lesions in the palate worsen over time in untreated snorers but not in CPAP-treated patients2018In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27, no 1, SI, p. 399-399, article id P682Article in journal (Refereed)
    Abstract [en]

    Objectives/Introduction: Previous studies have shown that there are signs of both motor and sensory nervous lesions in the upper airway of patients with obstructive apnea (OSA) and, to a lesser extent, of habitual snorers.

    Hypothesis: Snoring per se may damage upper airway neurons overtime, thereby causing the progression to manifest sleep apnea. To prove this, non‐snoring subjects, untreated snorers and CPAP‐treated OSA‐patients underwent repeated sensory testing in the upper airwayin a long‐time study.

    Methods: Cold detection threshold (CDT) testing, a routine neurophysiological method to study sensory function, was performed at the soft palate and the lip. 64 subjects were initially tested in 2008 for their ability to perceive the sensation of cold and retested 6 ‐7 years later. 20 were non‐snoring controls, 24 untreated snorers and 20 had received CPAP. CDT‐testing was performed using the method of limits by a Medoc TSA 2001 equipment with an intra‐oral thermod.

    Results: In untreated snorers AHI increased from average 9–12. Eight previously normal subjects had developed OSA (AHI/ODI >5). CDT:s worsened from 5.0°C to 14.5°C (p = 0.001). Three subjects had completely lost their cold sensitivity in the palate, whereas it was normal and unchanged on their lips. In non‐snorers there were no significant changes in AHI (mean values 2.0). Cold detection thresholds increased slightly from average 3.1°C to 6.0°C (p = 0.003). In the CPAP‐treated patients the CDT:s did not significantly change (from 5.1°C 2008 to 7.1°C in 2015).

    Conclusions: CDT:s worsened much more in the untreated snorers than in the other two groups (p = 0.03). This group therefore risks developing poor sensitivity in the upper airway in a couple of years of habitual snoring. This could contribute to sleep apnea, since also the snorers′ respiratory disturbance had increased. In contrast, it seems that efficient treatment of OSA protects the sensory innervation, since the CPAP‐treated group maintained their sensitivity to cold.

    Disclosure: Nothing to disclose.

1 - 19 of 19
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf