Publications by authors named "Jussi Jero"

45 Publications

Otitis Media-associated Bacterial Meningitis in Children in a Low-income Country.

Pediatr Infect Dis J 2019 08;38(8):791-797

Department of Otorhinolaryngology and Head and Neck Surgery, University of Turku, Turku, Finland.

Background: Otitis media (OM) is a common childhood infection that may result in bacterial meningitis (BM). However, OM-associated BM remains poorly characterized. We aimed to study the occurrence, clinical presentation and outcome of this type of childhood BM in Luanda, Angola.

Methods: Five hundred twelve children from our previous clinical BM trial, with the ear meticulously examined, were analyzed whether they had or not OM, and according to their age, ≤12 month old and >12 month old. Prospectively collected clinical data, laboratory test results and outcome for these groups were assessed.

Results: Sixty-two children (12%) had OM-associated BM, of whom 39 had otorrhea. Ear discharge was more common in older children (median age 45 months old vs. 12 months old; P < 0.001). Children with OM often showed an additional infectious focus (n = 20, 32% vs. n = 82, 18%; P = 0.016), were dehydrated (n = 16, 26% vs. n = 66, 15%; P = 0.04), and showed higher odds of complicated clinical course or death (odds ratios 2.27, 95% CI: 1.004-5.15, P = 0.049) compared with children without OM. The >12-month-old children with OM often arrived in poor clinical condition with coma and/or ptosis. Otorrhea was associated with HIV positivity. Infants with otorrhea frequently lived under poor socioeconomic conditions.

Conclusions: Children with OM-associated BM were prone to many problems, such as being especially ill at presentation, undergoing a difficult clinical course and showing a higher risk of complicated or fatal outcome. HIV infection and malnutrition were common in children with otorrhea, which was also associated with low socioeconomic status.
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http://dx.doi.org/10.1097/INF.0000000000002335DOI Listing
August 2019

Balloon Eustachian tuboplasty under monitored anaesthesia care with different balloon dilation devices: A pilot feasibility study with 18 patients.

Clin Otolaryngol 2019 01 4;44(1):87-90. Epub 2018 Nov 4.

Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

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http://dx.doi.org/10.1111/coa.13236DOI Listing
January 2019

Balloon Eustachian Tuboplasty: Systematic Review of Long-term Outcomes and Proposed Indications.

J Int Adv Otol 2018 Apr;14(1):112-126

Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Balloon Eustachian tuboplasty (BET) aims to improve the function of the Eustachian tube (ET). The objective of this study was to review the long-term outcome of BET and present the process and results of outlining indications for BET by the Finnish Otosurgical Society. The literature review is based on a database search performed in May 2017. The search resulted in 100 individual articles, which were screened for relevance. Five articles fulfilled the inclusion criteria (follow-up ≥12 months). Five additional articles (follow-up, 6-11 months) were analyzed to obtain supportive information. The proposed BET indications were constituted in the 2016 annual meeting of the Finnish Otosurgical Society. The workshop included a review of the Eustachian tube physiology, middle ear aeration mechanisms, and BET outcome studies. Thereafter, the members of the Society first voted and then discussed 14 cases in order to conclude whether BET was indicated in each case, and subsequently, a consensus statement on the indications for BET was outlined. The long-term follow-up studies were heterogeneous regarding the Eustachian tube dysfunction (ETD) definition, patient selection, follow-up duration, additional treatments, and outcome measures. The current, but limited, evidence suggests that BET is effective in the long-term. However, more long-term studies with uniform criteria and outcome measures as well as placebo-controlled studies are needed. The proposed indications for BET by the Finnish Otosurgical Society include chronic bothersome symptoms referring to ETD, ETD-related symptoms when pressure changes rapidly, or recurring serous otitis media. With the current evidence, we suggest treating only adults with BET.
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http://dx.doi.org/10.5152/iao.2018.4769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354503PMC
April 2018

Patient satisfaction in the long-term effects of Eustachian tube balloon dilation is encouraging.

Acta Otolaryngol 2018 Feb 10;138(2):122-127. Epub 2017 Oct 10.

a Department of Otorhinolaryngology, Head and Neck Center , Helsinki University Hospital, University of Helsinki , Helsinki , Finland.

Object: To investigate the long-term effects of balloon Eustachian tuboplasty (BET) from patient's perspective and to discover which symptoms of Eustachian tube dysfunction (ETD) benefit the most from BET.

Method: We designed a retrospective postal questionnaire based on the seven-item ETD questionnaire (ETDQ-7). Our questionnaire covered the severity of present ETD symptoms in comparison with the preoperative situation, the severity of current overall ear symptoms, and possible surgical interventions after BET. Forty-six patients treated in our institution between 2011 and 2013 fulfilled the inclusion criteria and 74% (34 patients; total 52 ears treated with BET) returned the questionnaire with a mean follow-up time of 3.1 years (range 1.8-4.6 years).

Results: Pain in the ears, feeling of pressure in the ears, and feeling that ears are clogged had reduced in 75% of the ears that suffered from these symptoms preoperatively. Seventy-seven percent of all the responders felt that their overall ear symptoms were reduced. Altogether, 82% of all the patients stated that they would undergo BET again if their ear symptoms returned to the preoperative level.

Conclusion: Patient satisfaction in the long-term effects of BET is encouraging. These results may help clinicians in preoperative patient selection and counselling.
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http://dx.doi.org/10.1080/00016489.2017.1384568DOI Listing
February 2018

Balloon Eustachian tuboplasty under local anesthesia: Is it feasible?

Laryngoscope 2017 May 3;127(5):1021-1025. Epub 2017 Feb 3.

Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Objective: To study whether balloon Eustachian tuboplasty (BET) is a feasible and safe procedure under local anesthesia.

Study Design: Prospective multicenter case-control study.

Methods: Patients undergoing either BET (n = 13) or endoscopic sinus surgery (ESS) (n = 12) under local anesthesia, with the possibility of sedation and analgesia, were monitored during the procedure and recovery period for possible adverse effects. After the procedure, the patients responded to a questionnaire assessing their experience.

Results: No adverse effects were detected in the BET group. Patients in the BET group reported similar Visual Analog Scale scores for pain during the operation as the ESS group (5.0 ± 0.7 vs. 3.2 ± 0.7, mean ± standard error of the mean). However, patients in the BET group experienced more discomfort (4.2 ± 0.6 vs. 2.5 ± 0.3, respectively, P = 0.049). Seventy-seven and 92% of the patients in the BET and ESS groups, respectively, considered the anesthesia and pain relief to be sufficient. Patients from both the BET and ESS groups were almost devoid of pain 1 to 2 hours postoperatively (0.8 ± 0.2 and 1.4 ± 0.3, respectively). In total, 12 of 13 patients in the BET group, and all 12 patients in the ESS group, would choose local anesthesia with sedation and analgesia if they needed to undergo the same procedure again.

Conclusion: BET is a safe and feasible procedure under monitored anesthesia care, including local anesthesia along with sedation and analgesia. There is need for further methodological improvement to reduce pain and discomfort during the operation.

Level Of Evidence: 4. Laryngoscope, 127:1021-1025, 2017.
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http://dx.doi.org/10.1002/lary.26488DOI Listing
May 2017

Otogenic Intracranial Abscesses, Our Experience Over the Last Four Decades.

J Int Adv Otol 2017 Apr 13;13(1):40-46. Epub 2017 Jan 13.

Department of Allergy, University of Helsinki and Helsinki University Hospital, Finland.

Objective: To evaluate the predisposing factors for otogenic intracranial abscesses, assess their changes over time, and analyze how they differ from those due to other causes.

Materials And Methods: The medical records of all patients treated for otogenic intracranial abscesses, between 1970 and 2012 at a tertiary referral center, were retrospectively analyzed. The analysis included patient demographics, clinical characteristics, causative pathogens, treatments, outcomes, and comparisons of otogenic and non-otogenic intracranial abscesses.

Results: Of all intracranial abscesses, 11% (n=18) were otogenic. In the 1970s, otogenic infections were a common predisposing factor for intracranial abscess; but within our study period, the incidence of otogenic intracranial abscesses decreased. Most (94%) otogenic cases were due to chronic suppurative otitis media and 78% were associated with cholesteatoma. Most patients (94%) had ear symptoms. The most common presenting symptoms were discharge from the infected ear (50%), headache (39%), neurological symptoms (28%), and fever (17%). The most common pathogens belonged to Streptococcus spp. (33%), Gram-negative enteric bacteria (22%), and Bacteroides spp. (11%). Neurosurgery was performed on all patients, 69% of which were prior to a later ear surgery. Surgery of the affected ear was performed on 14 patients (78%). A favorable recovery was typical (78%); however, one patient died.

Conclusion: Otogenic intracranial abscesses were most commonly due to a chronic ear infection with cholesteatoma. Ear symptoms and Gram-negative enteric bacteria were more common among patients with otogenic than non-otogenic intracranial abscesses.
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http://dx.doi.org/10.5152/iao.2016.2758DOI Listing
April 2017

Multidisciplinary Approach to Management of Temporal Bone Giant Cell Tumor.

J Neurol Surg Rep 2016 Jul;77(3):e144-e149

Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

 Giant cell tumors (GCTs) are rare osseous tumors that rarely appear in the skull.  We review the clinical course of a 28-year-old previously healthy woman with a complicated GCT.  The reviewed patient presented with a middle cranial fossa tumor acutely complicated by reactive mastoiditis. Left tympanomastoidectomy was performed for drainage of the mastoiditis and for biopsies of the tumor. Due to the challenging tumor location, the patient was treated with denosumab, a fully humanized monoclonal antibody against receptor activator of nuclear factor kappa-B ligand, for 7 months, which resulted in significant preoperative tumor shrinkage. Extensive temporal craniotomy and resection of the tumor followed utilizing a temporomandibular joint total endoprosthesis for reconstruction. A recurrence of the tumor was detected on computed tomography at 19 months after surgery and treated with transtemporal tumor resection, parotidectomy, and mandible re-reconstruction.  A multidisciplinary approach resulted in a good functional result and, finally, an eradication of the challengingly located middle cranial fossa tumor.
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http://dx.doi.org/10.1055/s-0036-1592082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045306PMC
July 2016

Severe Acute Otitis Media and Acute Mastoiditis in Adults.

J Int Adv Otol 2016 Dec 28;12(3):224-230. Epub 2016 Nov 28.

Department of Otorhinolaryngology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Objective: To evaluate and compare clinical and microbiological findings in adults hospitalized for acute otitis media (AOM) or mastoid infections (acute or latent).

Materials And Methods: We retrospectively reviewed the medical records of all adults (≥17 years old) hospitalized (between 2003 and 2012) at a tertiary referral center for acute mastoid infections or AOM not responding to outpatient medical treatment.

Results: Of the 160 patients in the study sample, 19% had an infection caused by S. pyogenes, 14% by S. pneumoniae, and 11% by P. aeruginosa. AOM was the most common infection (38%), whereas 33% had acute mastoiditis (AM), 18% had latent mastoiditis (LM), and 13% AM of a chronically infected ear (AMc). In contrast to the other infections, P. aeruginosa (30%) and S. aureus (25%) were most common in AMc. Otorrhea (83%), tympanic membrane perforation (57%), and hearing problems (83%) were common in S. pyogenes infections. Patients with S. pneumoniae had longer lengths of hospitalization than those with other bacterial infections (7 vs. 4 days). Otorrhea (94%) and retroauricular symptoms were more common in P. aeruginosa infections. Hearing symptoms were common (67%) but fever (32%) and retroauricular symptoms were uncommon in AOM. Fever (44%) and mastoid tenderness (65%) were common in AM. Patients with LM underwent the most mastoidectomies (54%). Prior medical conditions, retroauricular symptoms, otorrhea (90%), and post-infection problems were common in AMc.

Conclusion: The bacteriological etiology of hospitalized AOM more closely resembled those of LM and AM than that of AMc. Adults hospitalized for AOM or AM required fewer mastoidectomies than those hospitalized for LM or AMc.
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http://dx.doi.org/10.5152/iao.2016.2620DOI Listing
December 2016

Differentiating Acute Otitis Media and Acute Mastoiditis in Hospitalized Children.

Curr Allergy Asthma Rep 2016 10;16(10):72

Department of Otorhinolaryngology, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11-13, P.O. Box 263, Fin-00029 HUH, Helsinki, Finland.

Acute otitis media is a common infection in children. Most acute otitis media episodes can be treated at an outpatient setting with antimicrobials, or only expectant observation. Hospital treatment with parenteral medication, and myringotomy or tympanostomy, may be needed to treat those with severe, prolonged symptoms, or with complications. The most common intratemporal complication of acute otitis media is acute mastoiditis. If a child with acute mastoiditis does not respond to this treatment, or if complications develop, further examinations and other surgical procedures, including mastoidectomy, are considered. Since the treatment of complicated acute otitis media and complicated acute mastoiditis differs, it is important to differentiate these two conditions. This article focuses on the differential diagnostics of acute otitis media and acute mastoiditis in children.
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http://dx.doi.org/10.1007/s11882-016-0654-1DOI Listing
October 2016

Label-free visualization of cholesteatoma in the mastoid and tympanic membrane using CARS microscopy.

J Otol 2016 Sep 10;11(3):127-133. Epub 2016 Sep 10.

Hearing and Balance Research Unit, Field of Oto-laryngology, School of Medicine, University of Tampere, Tampere, Finland.

Objective: The present study aimed to evaluate the possibility of using coherent anti-Stokes Raman spectroscopy (CARS) microscopy to determine the specific molecular morphology of cholesteatoma by detecting the natural vibrational contrast of the chemical bonds without any staining.

Materials And Methods: Specimens from the mastoid and tympanic membrane with and without cholesteatoma were analyzed using CARS microscopy, two-photon excited fluorescence (TPEF) microscopy, and the second harmonic generation (SHG) microscopy.

Results: In cholesteatoma tissues from the mastoid, a strong resonant signal at 2845 cm was observed by CARS, which indicated the detection of the CH hydro-carbon lipid bonds that do not generate visible signals at 2940 cm suggestive of CH bonds in amino acids. A strong resonant signal at 2940 cm appeared in an area of the same specimen, which also generated abundant signals by TPEF and SHG microscopy at 817 nm, which was suggestive of collagen. In the tympanic membrane specimen with cholesteatoma, a strong resonant signal with corrugated morphology was detected, which indicated the presence of lipids. A strong signal was detected in the tympanic membrane with chronic otitis media using TPEF/SHG at 817 nm, which indicated collagen enrichment. The CARS and TPEF/SHG images were in accordance with the histology results.

Conclusion: These results suggest the need to develop a novel CARS microendoscope that can be used in combination with TPEF/SHG to distinguish cholesteatoma from inflammatory tissues.
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http://dx.doi.org/10.1016/j.joto.2016.09.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6002602PMC
September 2016

Jugulotympanic paragangliomas in southern Finland: a 40-year experience suggests individualized surgical management.

Eur Arch Otorhinolaryngol 2017 Jan 5;274(1):389-397. Epub 2016 Jul 5.

Head and Neck Centre, Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00029, Helsinki, HUS, Finland.

Treatment of jugulotympanic paragangliomas (JTPGLs) remains challenging with no clear guidelines for management or follow-up. The aim of this retrospective case-note study was to assess long-term results of operatively and conservatively managed JTPGLs between years 1974-2013. A total of 36 patients with JTPGLs were identified. Clinical characteristics and management outcomes of patients were reviewed. Data were extracted on demographics, symptoms, timing of diagnosis, tumor location and size, embolization, and management, including pre- and post-operative imaging, analysis of operative techniques, and follow-up. Pulsatile tinnitus and hearing loss were the most common presenting symptoms. Thirty-four (94 %) patients were treated with primary surgical therapy and two (6 %) with radiotherapy. The surgical approaches included endaural approach for Fisch Class A tumors and a variety of approaches for Fisch Class B-D tumors with an increasing predilection for function-preserving surgery. Eight (24 %) patients received subtotal resection. Five (15 %) patients had a local recurrence within 10 years after primary surgery. Two (6 %) patients suffered a permanent cranial nerve (CN) deficit after primary surgery. We advocate radical surgery when tumor resection is possible without compromising CNs. Function-preserving surgery with at least a 10-year follow-up for Fisch Class B-D tumors should be considered if CNs are in danger.
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http://dx.doi.org/10.1007/s00405-016-4184-1DOI Listing
January 2017

Intracranial abscesses over the last four decades; changes in aetiology, diagnostics, treatment and outcome.

Infect Dis (Lond) 2016 Apr 23;48(4):310-316. Epub 2015 Nov 23.

a Department of Otorhinolaryngology , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland.

Background The development of modern medicine has resulted in changes in the predisposing conditions, clinical picture, treatment and results of treatment of intracranial abscesses. This study sought to evaluate these changes in a hospital district. Methods A retrospective analysis of the clinical data of all patients treated due to intracranial abscesses at a tertiary referral centre, between 1970-2012. Results The total number of intracranial abscesses was 166. The incidence of intracranial abscesses was 0.33/100 000/year (2000-2012). The most common predisposing conditions were infection of the ear-, nose- and throat region (22%), odontogenic infection (15%) and cardiac anomaly (13%). Lately (2000-2012), infections of the ear-, nose- and throat region (15%) and cardiac anomalies (5%) have become less common, whereas odontogenic infections (32%) have become more common. The most common pathogens belong to Streptococcus spp (42%), Fusobacteriae (14%), Actinomycetales (8%) and Staphylococcus spp (8%). Most patients (66%) experienced a favourable recovery; the proportion of patients with favourable outcome enabling return to prior occupation rose over time, from 12% in 1970-1989 to 24% in 1990-2012. Conclusions The predisposing conditions for intracranial abscesses have changed markedly within the study period. Odontogenic infections have become a common predisposing condition, whereas infections of the ear-, nose- and throat region and cardiac malformations are nowadays less common as predisposing conditions compared to at the beginning of the study period. The proportion of patients with favourable outcome enabling return to prior occupation seems to have increased with time.
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http://dx.doi.org/10.3109/23744235.2015.1113557DOI Listing
April 2016

Children hospitalized due to acute otitis media: how does this condition differ from acute mastoiditis?

Int J Pediatr Otorhinolaryngol 2015 Sep 25;79(9):1429-35. Epub 2015 Jun 25.

Department of Otorhinolaryngology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4E, PO Box 220, Helsinki FI-00029 HUS, Finland.

Objectives: To evaluate the clinical picture and microbiological findings of children hospitalized due to acute otitis media and to analyze how it differs from acute mastoiditis.

Methods: A retrospective review of the medical records of all children (0-16 years) hospitalized due to acute otitis media in the Department of Otorhinolaryngology at the Helsinki University Hospital, between 2003 and 2012. Comparison with previously published data of children with acute mastoiditis (n=56) from the same institute and period of time.

Results: The most common pathogens in the children hospitalized due to acute otitis media (n=44) were Streptococcus pneumoniae (18%), Pseudomonas aeruginosa (16%), Streptococcus pyogenes (14%), and Staphylococcus aureus (14%). One of the most common pathogens of out-patient acute otitis media, Haemophilus influenzae, was absent. Otorrhea was common in infections caused by S. pyogenes and otorrhea via tympanostomy tube in infections caused by P. aeruginosa. In children under 2 years-of-age, the most common pathogens were S. pneumoniae (43%), Moraxella catarrhalis (14%), and S. aureus (7%). S. pyogenes and P. aeruginosa were only found in children over 2 years-of-age. Previous health problems, bilateral infections, and facial nerve paresis were more common in children hospitalized due to acute otitis media, compared with acute mastoiditis, but they also demonstrated lower CRP values and shorter duration of hospital stay. The number of performed tympanostomies and mastoidectomies was also comparatively smaller in the children hospitalized due to acute otitis media. S. aureus was more common and S. pneumoniae, especially its resistant strains, was less common in the children hospitalized due to acute otitis media than acute mastoiditis.

Conclusions: Acute otitis media requiring hospitalization and acute mastoiditis compose a continuum of complicated acute otitis media that differs from common out-patient acute otitis media. The bacteriology of children hospitalized due to acute otitis media resembled more the bacteriology of acute mastoiditis than that of out-patient acute otitis media. The children hospitalized due to acute otitis media needed less surgical treatment and a shorter hospitalization than those hospitalized due to acute mastoiditis.
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http://dx.doi.org/10.1016/j.ijporl.2015.06.019DOI Listing
September 2015

Bacteriology in relation to clinical findings and treatment of acute mastoiditis in children.

Int J Pediatr Otorhinolaryngol 2014 Dec 17;78(12):2072-8. Epub 2014 Sep 17.

Department of Otorhinolaryngology, Helsinki University Central Hospital, Haartmaninkatu 4E, PO Box 220, FI-00029 HUS, Helsinki, Finland; University of Helsinki, Helsinki, Finland.

Objective: We assessed clinical, radiological, laboratory and microbiological findings in children with acute mastoiditis in order to improve the diagnostics and treatment of these patients. We also investigated whether different pathogens cause different clinical findings of mastoiditis.

Methods: A retrospective review of the medical records of all children aged 0-16 years treated as in-ward patients for acute mastoiditis at Helsinki University Central Hospital, Department of Otorhinolaryngology, between 2003 and 2012.

Results: Fifty-six patients met the inclusion criteria. The incidence of mastoiditis was 1.88/100000/year. The most common pathogens were Streptococcus pneumoniae (38%), Streptococcus pyogenes (11%) and Pseudomonas aeruginosa (11%). Of S. pneumoniae, 48% had reduced susceptibility (intermediate or resistant) for the common antimicrobials; this was clearly overrepresented relative to the background population (p<0.001). Otalgia and retroauricular symptoms were common in the patients with S. pneumoniae. Otorrhoea was less common (p=0.03) in these patients relative to the other pathogens. Patients with S. pneumoniae had more destruction of the mastoid septa (p=0.05) than patients with any of the other pathogens. Mastoidectomy was performed in 34% of all cases, it was most common (60%) in the patients with S. pneumoniae with reduced susceptibility. The patients with S. pyogenes had less otalgia and seemed to have less retroauricular symptoms relative to other pathogens. P. aeruginosa especially affected children with tympanostomy tubes, caused otorrhoea in all patients and caused a milder form of disease with less retroauricular swelling (p=0.04) than the other pathogens, and there was no need for mastoidectomies. The younger children (<2 years) had less otorrhoea and more retroauricular symptoms of infection than the older patients. No significant differences emerged in outcome of the patient groups.

Conclusions: The clinical findings of acute mastoiditis differ according to the causative pathogen. S. pneumoniae, especially strains with reduced susceptibility, causes severe symptoms and leads to mastoidectomy more often than the other pathogens. S. pyogenes causes less otalgia than the other pathogens. P. aeruginosa particularly affects children with tympanostomy tubes and causes a less aggressive form of disease.
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http://dx.doi.org/10.1016/j.ijporl.2014.09.007DOI Listing
December 2014

[Tympanic membrane perforation ].

Duodecim 2014 ;130(8):810-8

Tympanic membrane perforation may be caused by, e.g., trauma or acute or chronic middle ear infection. Perforation causes conductive hearing loss. Since it predisposes to infections, it is important to keep the ear dry. In most cases traumatic perforations heal spontaneously. Perforations caused by acute middle ear infections are treated with antibiotics. Chronic perforation due to chronic middle ear infection or cholesteatoma will usually not heal without surgery. Most perforation cases can be taken care of in primary care. ENT consultation is needed when alarming signs, such as continuous pain, vertigo or facial paralysis exist, or if the perforation persists.
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June 2014

[Acute mastoiditis in children].

Duodecim 2014 ;130(3):251-7

Acute mastoiditis in children develops when acute otitis media (AOM) spreads into the mastoid air cells inside the temporal bone. The diagnosis is based on clinical findings of AOM with simultaneous signs of infection in the mastoid area. The most common pathogen causing acute mastoiditis in children is Streptococcus pneumoniae. Intravenous antimicrobial medication, tympanostomy and microbial sample are the cornerstones of the treatment. If a complication of mastoiditis is suspected, imaging studies are needed, preferably with magnetic resonance imaging. The most common complication of acute mastoiditis is a subperiosteal abscess.
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April 2014

Evaluation of Temporal Difference Limen in Preoperative Non-Invasive Ear Canal Audiometry as a Predictive Factor for Speech Perception after Cochlear Implantation.

Audiol Res 2014 Mar 27;4(1):91. Epub 2014 Feb 27.

Department of Otorhinolaryngology, Head & Neck Surgery, Helsinki University Central Hospital , Finland.

The temporal difference limen (TDL) can be measured with noninvasive electrical ear canal stimulation. The objective of the study wa to determine the role of preoperative TDL measurements in predicting patients' speech perception after cochlear implantation. We carried out a retrospective chart analysis of fifty-four cochlear implant (CI) patients with preoperative TDL and postoperative bisyllabic word recognition measurements in Helsinki University Central Hospital between March 1994 and March 2011. Our results show that there is no correlation between TDL and postoperative speech perception. However, patient's advancing age correlates with longer TDL but not-directly with poorer speech perception. The results are in line with previous results concerning the lack of predictive value of preoperativ TDL measurements in CI patients.
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http://dx.doi.org/10.4081/audiores.2014.91DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4627137PMC
March 2014

Post-tonsillectomy haemorrhage more common than previously described--an institutional chart review.

Acta Otolaryngol 2013 Feb 29;133(2):181-6. Epub 2012 Oct 29.

Department of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland.

Conclusions: Risk of post-tonsillectomy haemorrhage (PTH) was higher compared with previous studies and may be associated with the criteria used. Male gender and the use of haemostatic agents in the primary operation were associated with increased risk of PTH, whereas the use of non-steroidal anti-inflammatory drugs (NSAIDs) or dexamethasone was not.

Objectives: The aim of the study was to investigate the risk of PTH in adult patients, and its association with the use of NSAIDs, dexamethasone, paracetamol, serotonin (5-HT(3)) receptor antagonists, haemostatic agents, age and gender during preceding tonsillectomy (TE).

Methods: All PTH complications that resulted in an adult TE patient re-contacting the hospital were retrospectively recorded during a 12-month period. PTH types were allocated into three categories: (I) a history of bleeding, (II) bleeding requiring direct pressure or electrocautery under local anaesthesia or (III) reoperation under general anaesthesia.

Results: A total of 842 adult TE patients (aged between 16 and 85.8 years) were included in the study. Of these, 122 patients experienced PTH (risk 14.5%). Risk of category III PTH was 1.5%. Risk factors for PTH were the use of haemostatic agents (p = 0.006) and male gender (p = 0.011). The use of NSAID, opioid, 5-HT(3) receptor antagonist and dexamethasone medication did not significantly alter the number of postoperative bleeding events.
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http://dx.doi.org/10.3109/00016489.2012.723825DOI Listing
February 2013

Mastoid biofilm in chronic otitis media.

Otol Neurotol 2012 Jul;33(5):785-8

Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital, Helsinki, Finland.

Hypothesis: We designed a study to determine the role of mastoid mucosal biofilm in chronic otitis media (COM).

Background: Biofilm formation has been found in several chronic airway infections. COM is associated with chronic, recalcitrant infection of the mastoid mucosa, and surgery often is required.

Methods: COM patients were divided into 2 groups: one with chronic suppurative otitis media (CSOM) and one with cholesteatoma presence. All COM patients had mastoid involvement in a preoperative computed tomographic scan. The control group consisted of patients undergoing cochlear implantation, with no previous history of chronic otitis media. Mastoid mucosa samples were harvested during mastoidectomy. The samples were studied with multiplex-polymerase chain reaction and with CSLM using BacLight Live/Dead stain. Routine bacterial culture was performed in selected cases.

Results: A total of 29 COM patients underwent mastoidectomy. Mastoid mucosal biofilm formation could be found in 19 (66%) of these patients. In the control group, there were 11 cases of cochlear implantation, and 1 patient (9%) presented mastoid mucosal biofilm. In the cholesteatoma group, there were 17 patients, of which, 14 (82%) presented biofilm, whereas in the CSOM group, 5 (42%) of 12 patients presented biofilm. The correlation between COM and biofilm was statistically significant (Fisher's exact test, p = 0.003), as was the correlation between cholesteatoma and biofilm, in comparison with the CSOM group (Fisher's exact test, p = 0.046).

Conclusion: Mastoid mucosal biofilm could be seen in patients with COM with or without cholesteatoma. The role of mastoid biofilm in the development of cholesteatoma should be studied further.
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http://dx.doi.org/10.1097/MAO.0b013e318259533fDOI Listing
July 2012

[Complications of acute otitis media].

Duodecim 2012 ;128(9):959-68

HYKS, Korvaklinikka.

Most cases of acute otitis media (AOM) resolve even without antibiotic treatment. In the pre-antibiotic era, AOM complications were common and could lead to deafness and neurological sequelae. With the use of antibiotics, the complications have become less frequent, but they may still evolve. The possible increase in the occurrence of complications has to be considered if we start treating AOM more conservatively and if bacterial antibiotic resistance situation becomes more problematic. These rare but possibly lethal complications should be diagnosed and treated promptly. The need for cochlear implantation has to be evaluated soon after an episode of meningitis if deafness is suspected.
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August 2012

Speech recognition and communication outcomes with cochlear implantation in Usher syndrome type 3.

Otol Neurotol 2012 Jan;33(1):38-41

Department of Otorhinolaryngology, University of Helsinki, Helsinki, Finland.

Background: Usher syndrome Type 3 (USH3) is an autosomal recessive disorder characterized by variable type and degree of progressive sensorineural hearing loss and retinitis pigmentosa. Cochlear implants are widely used among these patients.

Objectives: To evaluate the results and benefits of cochlear implantation in patients with USH3.

Study Design: A nationwide multicenter retrospective review.

Materials And Methods: During the years 1995-2005, in 5 Finnish university hospitals, 19 patients with USH3 received a cochlear implant. Saliva samples were collected to verify the USH3 genotype. Patients answered to 3 questionnaires: Glasgow Benefit Inventory, Glasgow Health Status Inventory, and a self-made questionnaire. Audiological data were collected from patient records.

Results: All the patients with USH3 in the study were homozygous for the Finnish major mutation (p.Y176X). Either they had severe sensorineural hearing loss or they were profoundly deaf. The mean preoperative hearing level (pure-tone average, 0.5-4 kHz) was 110 ± 8 dB hearing loss (HL) and the mean aided hearing level was 58 ± 11 dB HL. The postoperative hearing level (34 ± 9 dB HL) and word recognition scores were significantly better than before surgery. According to the Glasgow Benefit Inventory scores and Glasgow Health Status Inventory data related to hearing, the cochlear implantation was beneficial to patients with USH3.

Conclusion: Cochlear implantation is beneficial to patients with USH3, and patients learn to use the implant without assistance.
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http://dx.doi.org/10.1097/MAO.0b013e31823dbc56DOI Listing
January 2012

[Future therapeutic options for inner ear diseases].

Duodecim 2011 ;127(8):848-53

HYKS:n korva-, nenä- ja kurkkutautien klinikka.

Knowledge of the structure, molecular biology and function of the inner ear will enable the research on new modes of treatment such as gene transfers, growth factor treatments and stem cell transfers. With respect to the treatment of inner ear diseases in humans, at present the majority of these means remain at an experimental level. Improvement of hearing has, however, been achieved in various experimental disease models by gene transfer. Regeneration of sensory cells and hair cells from stem cells has opened up new lines of research and treatment options for the restoration of a damaged inner ear.
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June 2011

Can head position after anesthesia cause occlusion of the tympanostomy tube?

J Otolaryngol Head Neck Surg 2010 Feb;39(1):1-4

of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland.

Objective: Owing to anecdotal evidence, in bilateral tympanostomy, there is a risk of tube occlusion in the ear that stays superior during the recovery after anesthesia. This observational analysis was designed to evaluate the side difference of tympanostomy tube occlusions owing to head position during the operation and postoperative recovery. It was part of a prospective clinical trial with bilateral tympanostomy tube insertion that was conducted to evaluate the effect of albumin coating tympanostomy tube sequelae.

Methods: In the bilateral tympanostomy, the right ear was always operated on first. After left ear tube insertion and during the recovery phase after anesthesia, the patient was turned to lie on the right side. The number of tube sequelae were studied during a 9-month follow-up period.

Results: At the first 1-month follow-up visit, 7 right ear tubes and 18 left ear tubes had occluded (p = .043). The same tendency was seen throughout the follow-up. Also, according to a survival analysis, in which survival functions according to laterality were compared using the log-rank test, stratified by tube coating, the left tube occluded at a significantly higher rate.

Conclusions: The position of the patient's head when awake after anesthesia may have an influence on tube occlusion. In this study, the tube located superiorly was occluded more often. This tendency remained during the follow-up. We concluded that there is a possible association between the position of the head during early recovery and occlusion of the tympanostomy tube.
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February 2010

[Microtia--not just an ear problem].

Duodecim 2009 ;125(9):975-82

HYKS:n korvaklinikka, HUS.

Microtia can be defined as a malformation of the auricle with varying severity. In the majority of patients it is combined with atresia or stenosis of the external auditory canal. The prevalence of microtia in Finland is approx. 4 out of 10000. Associated anomalies should be actively seeked and excluded. Approximately 70% of the patients seem to be non-syndromatic. Patients with microtia are known to more than usual have other structural abnormalities. With the exception of the mildest cases, the development of facial structure and dental occlusion should be monitored in all microtia patients, attempting to actively exclude any associated diseases.
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July 2009

Obliteration of radical cavities with autogenous cortical bone; long-term results.

BMC Ear Nose Throat Disord 2008 Jul 29;8. Epub 2008 Jul 29.

Audiology Unit, Dept. of Otorhinolaryngology, Mansoura Univ., Mansoura, Egypt.

Background: To evaluate the long-term surgical outcome(s) in patients who have undergone canal-wall-down operation with mastoid and epitympanic obliteration using autologous cortical bone chips, bone pate and meatally-based musculoperiosteal flap technique.

Method: Retrospective evaluation of seventy patients operated during 1986-1991 due to a cholesteatoma. An otomicroscopy was performed to evaluate the postoperative outer ear canal configuration with a modified Likert scale (1 - 4). The outer ear canal physical volume was assessed by tympanometry. The hearing outcome and a patient-filled questionnaire were also analyzed.

Results: The posterior wall results were 1.8 (+/- 0.9 SD) and the attic region 1.8 (+/- 0.9 SD) (ns., p > 0.05). These values show either no cavity formation or minor formation of a cavity, with a good functional result. The mean volume of the operated ear canal was 1.7 (+/- 0.5 SD) ml. The volume of the contralateral ear canal was 1.2 (+/- 0.3 SD) ml (*** p < 0.0001). A comparison of the current mean ABG to the preoperative mean ABG and to the ABG at one-year postoperatively, 5-years postoperatively or 10-years postoperatively showed no statistical significance (p > 0.05).

Conclusion: ABG does not significantly change in the long-term. The configuration of the cavity tends to change, however, the obliteration material is stable in the long-term and clinically significant cavitation rarely occurs.
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http://dx.doi.org/10.1186/1472-6815-8-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2527602PMC
July 2008

HOX-GFP and WOX-GFP lentivirus vectors for inner ear gene transfer.

Acta Otolaryngol 2008 Jun;128(6):613-20

Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki.

Conclusion: GFP transgene was expressed in the lining cells of the perilymphatic space. Lentivirus vectors are safe and cause only minimal inflammatory reaction. Transgene products can be delivered into the perilymph by utilizing lentivirus vectors.

Objectives: To analyze the efficiency and safety of lentiviral vectors HOX-GFP and WOX-GFP in intracochlear gene transfer.

Materials And Methods: Lentivirus vectors were tested for their transduction efficiency in vivo in CD-1 mice. Half of the animals were pretreated with kanamycin. Lentivirus vector or saline (1 microl) was injected into the inner ear. All the animals were sacrificed 14 days after the surgery and the cochleae and selected organs were analyzed immunohistochemically.

Results: HOX-GFP and WOX-GFP expression was restricted to the lining cells of the scala tympani and scala vestibuli. No GFP expression was seen in the organ of Corti or the spiral ganglion. Aminoglycoside treatment had no effect on the expression of these vectors. The distant spread of lentivirus vectors was minimal; only the liver of one animal showed some GFP expression. Inflammatory reaction caused by these vectors was mild. Few inflammatory cells were found in the perilymphatic space of the cochlea and in the vestibular organ.
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http://dx.doi.org/10.1080/00016480701663409DOI Listing
June 2008

Surgical treatment of chronic otitis media with temporomandibular joint involvement.

Auris Nasus Larynx 2008 Dec 1;35(4):552-5. Epub 2008 Feb 1.

Department of Otorhinolaryngology, University of Helsinki, HUCH, Helsinki, Finland.

We report a case of chronic otitis media with spread of the infection into the temporomandibular joint (TMJ), causing displacement of the joint and malocclusion. Chemotherapy of the malignant disease caused activation of the chronic ear infection with a temporomandibular joint involvement. The patient was operated twice to eradicate the infection from the mastoid, middle ear and temporomandibular joint. A radical cavity with musculoperiosteal flap obliteration was created. The joint was isolated from the radical cavity with a thin vascularized temporomyofascial flap. No restriction in the movements of the temporomandibular joint could be noted in the follow-up. After the surgeries chemotherapy could continue without signs of inflammation in the temporomandibular joint or mastoid region. Prompt surgical intervention is indicated when temporomandibular joint symptoms arise in cases of chronic otitis media.
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http://dx.doi.org/10.1016/j.anl.2007.10.013DOI Listing
December 2008

[Not Available].

Duodecim 2007 ;123(16):2014-8

HYKS:n korva-, nenä- ja kurkkutautien klinikka, HUS.

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April 2008

Role of albumin coating of tympanostomy tubes: long-term clinical evaluation.

Laryngoscope 2007 Dec;117(12):2213-7

Department of Otolaryngology, Helsinki University Central Hospital and Haartman Institute, Helsinki, Finland.

Objective: Our previous work has shown that albumin coating of tympanostomy tubes prevented adhesion of proteins or bacteria on the tube surface in vitro and in a 9-month prospective follow-up study. This study was continued until all tubes were extruded.

Study Design: A prospective, clinical trial.

Methods: The randomized, double-blind clinical trial had 149 patients. The randomization was revealed after the follow-up period of 9 months. The number of tube sequelae in ears with human serum albumin (HSA)-coated titanium tympanostomy tubes was compared with the contralateral ears with uncoated, otherwise identical titanium tubes. The follow-up continued until all tubes were extruded, followed by evaluation of each tympanostomized patient.

Results: No significant difference between the two tube types emerged after the 9-month follow-up. Among the patients younger than 2 years, one of the three typical bacteria causing acute otitis media (AOM), Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis, was found in 45% of all bacterial cultures taken during AOM. However, among patients older than 2, one of these bacteria appeared in 17% of all the bacterial cultures and in 8% of cultures taken during the summer.

Conclusions: After the first 9 follow-up months, no difference was found in the sequelae related to uncoated and HSA-coated tubes. The typical bacteria causing AOM were found less frequently among patients older than 2 years. A profile of tympanostomy patients in Finland will be given.
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http://dx.doi.org/10.1097/MLG.0b013e3181468631DOI Listing
December 2007

[Not Available].

Duodecim 2007 ;123(10):1191-3

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April 2008