Publications by authors named "Karin Blomgren"

43 Publications

Long-Term Follow-Up After Maxillary Sinus Balloon Sinuplasty and ESS.

Ear Nose Throat J 2021 Feb 19:145561320986030. Epub 2021 Feb 19.

Skin and Allergy Hospital, 159841Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Objectives: The aim of this controlled follow-up study was to compare the need for revision surgery, long-term efficacy, and satisfaction in chronic rhinosinusitis patients who had undergone maxillary sinus operation with either balloon sinuplasty or traditional endoscopic sinus surgery (ESS) technique.

Methods: Thirty-nine ESS patients and 36 balloon patients of our previously described cohort, who had been primarily operated in 2008 to 2010, were contacted by phone. Symptoms, satisfaction, and need for revision surgery were asked. In addition, we collected data of patients who had undergone primary maxillary sinus balloon sinuplasty in the Helsinki University Hospital during the years 2005 to 2019. As a control group, we collected data of patients who had undergone primary maxillary sinus ESS at 3 Finnish University Hospitals, and 1 Central Hospital in years 2005, 2008, and 2011.

Results: Altogether, 77 balloon patients and 82 ESS patients were included. The mean follow-up time was 5.3 years in balloon group and 9.8 years in ESS group. Revision surgery was performed on 17 balloon patients and 6 ESS patients. In the survival analysis, the balloon sinuplasty associated significantly with a higher risk of revision surgery compared to ESS. According to the phone interviews, 82% of ESS patients and 75% of balloon patients were very satisfied with the primary operation.

Conclusion: Although the patient groups expressed equal satisfaction and change in symptoms after the operations, the need for revision surgery was higher after balloon sinuplasty than after ESS. This should be emphasized when counselling patients regarding surgical options.
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http://dx.doi.org/10.1177/0145561320986030DOI Listing
February 2021

SARS-CoV-2 infections among healthcare workers at Helsinki University Hospital, Finland, spring 2020: Serosurvey, symptoms and risk factors.

Travel Med Infect Dis 2021 Jan-Feb;39:101949. Epub 2020 Dec 13.

Department of Virology, Medicum, Faculty of Medicine, University of Helsinki, Finland; Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 66, 00014 University of Helsinki, Finland.

Background: Exposure, risks and immunity of healthcare workers (HCWs), a vital resource during the SARS-CoV-2 pandemic, warrant special attention.

Methods: HCWs at Helsinki University Hospital, Finland, filled in questionnaires and provided serum samples for SARS-CoV-2-specific antibody screening by Euroimmun IgG assay in March-April 2020. Positive/equivocal findings were confirmed by Abbott and microneutralization tests. Positivity by two of the three assays or RT-PCR indicated a Covid-19 case (CoV+).

Results: The rate of CoV(+) was 3.3% (36/1095) and seropositivity 3.0% (33/1095). CoV(+) was associated with contact with a known Covid-19 case, and working on a Covid-19-dedicated ward or one with cases among staff. The rate in the Covid-19-dedicated ICU was negligible. Smoking and age <55 years were associated with decreased risk. CoV(+) was strongly associated with ageusia, anosmia, myalgia, fatigue, fever, and chest pressure. Seropositivity was recorded for 89.3% of those with prior documented RT-PCR-positivity and 2.4% of those RT-PCR-negative. The rate of previously unidentified cases was 0.7% (8/1067) and asymptomatic ones 0% (0/36).

Conclusion: Undiagnosed and asymptomatic cases among HCWs proved rare. An increased risk was associated with Covid-19-dedicated wards. Particularly high rates were seen for wards with liberal HCW-HCW contacts, highlighting the importance of social distancing also among HCWs.
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http://dx.doi.org/10.1016/j.tmaid.2020.101949DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833655PMC
March 2021

Patient injuries in the treatment of superficial venous insufficiency registered in Finland between 2004 and 2017.

Phlebology 2021 May 12;36(4):260-267. Epub 2020 Oct 12.

Department of Vascular Surgery, Turku University Hospital, University of Turku, Turku, Finland.

Objectives: This study aimed to identify the unintended incidents that led to patient injuries (PIs) in the treatment of superficial venous insufficiency (SVI).

Methods: PI claims filed with the Finnish Patient Insurance Centre between 2004 and 2017 involving SVI were reviewed. Factors contributing to PI were identified and classified.

Results: Eighteen (13.2%) of 136 compensated PIs in the specialty of vascular surgery were related to SVI. Only 4.7% of 383 SVI claims were compensated. The incidence of PIs was 9.9 per 100 000 patients. Fifteen patients had open surgery (83.3%) and three (16.7%) endovenous treatment. Two (11.1%) patients had necrotising fasciitis, four (22.1%) had deep vein injuries and two (11.1%) had a permanent nerve injury. Two (11.1%) patients had retained endovenous material that required surgical removal.

Conclusions: PIs were identifiable during all stages of care, perioperative injuries related to open surgery being the most common.
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http://dx.doi.org/10.1177/0268355520964294DOI Listing
May 2021

Odontogenic causes complicating the chronic rhinosinusitis diagnosis.

Clin Oral Investig 2021 Mar 4;25(3):947-955. Epub 2020 Jun 4.

Department of Virology, University of Helsinki, Helsinki, Finland.

Objectives: Chronic rhinosinusitis (CRS) frequently stems from a dental origin, although odontogenic sinusitis (OS) remains underdiagnosed amongst different professionals. This study aimed to explore how often odontogenic causes are considered when diagnosing CRS.

Materials And Methods: Patient records from 374 new CRS patients treated at a tertiary-level ear, nose, and throat (ENT) clinic were selected. Entries and radiological reports were assessed exploring how often dentition was mentioned and OS was suspected, how often radiologists reported maxillary teeth, and how commonly typical OS microbial findings and unilateral symptoms occurred.

Results: Although 10.1% of the CRS diagnoses were connected to possible dental issues, teeth were not mentioned for 73.8% of patients. Radiological reports were available from 267 computed or cone beam computed tomographies, of which 25.1% did not mention the maxillary teeth. The reported maxillary teeth pathology was not considered in 31/64 (48.4%) cases. Unilateral symptoms associated with apical periodontitis (OR = 2.49, 95% CI 1.27-4.89, p = 0.008). Microbial samples were available from 88 patients, for whom Staphylococcus aureus was the most common finding (17% of samples).

Conclusions: Odontogenic causes are often overlooked when diagnosing CRS. To provide adequate treatment, routine assessment of patient's dental history and status, careful radiograph evaluation, and utilization of microbial findings should be performed. Close cooperation with dentists is mandatory.

Clinical Relevance: Dental professionals should be aware of difficulties medical professionals encounter when diagnosing possible OS. Thus, sufficient knowledge of OS pathology is essential to both medical and dental professionals.
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http://dx.doi.org/10.1007/s00784-020-03384-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878247PMC
March 2021

Peritonsillar abscess may not always be a complication of acute tonsillitis: A prospective cohort study.

PLoS One 2020 3;15(4):e0228122. Epub 2020 Apr 3.

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

The present study aimed to specify diagnostics for peritonsillar abscesses (PTAs) and to clarify the role of minor salivary glands. This prospective cohort study included 112 patients with acute tonsillitis (AT) and PTA recruited at a tertiary hospital emergency department between February and October 2017. All patients completed a questionnaire concerning their current disease. Serum amylase (S-Amyl) and C-reactive protein (S-CRP) levels, tonsillar findings, and pus aspirate samples and throat cultures were analyzed. Eight of 58 PTA patients (13.8%) had no signs of tonsillar infection. The absence of tonsillar erythema and exudate was associated with low S-CRP (p<0.001) and older age (p<0.001). We also observed an inverse correlation between S-Amyl and S-CRP levels (AT, r = -0.519; PTA, r = -0.353). Therefore, we observed a group of PTA patients without signs of tonsillar infection who had significantly lower S-CRP levels than other PTA patients. These findings support that PTA may be caused by an etiology other than AT. Variations in the S-Amyl levels and a negative correlation between S-Amyl and S-CRP levels may indicate that minor salivary glands are involved in PTA development.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228122PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7122714PMC
July 2020

Patient Injuries in Treatment of Peripheral Arterial Disease in Finland: Review of National Patient Insurance Charts.

Ann Vasc Surg 2020 Jul 16;66:225-232. Epub 2019 Dec 16.

Department of Vascular Surgery, Turku University Hospital and University of Turku, Turku, Finland.

Background: Patient injury claim data and insurance records constitute detailed sources of information on patient injuries and their contributing or causal factors. This study aimed to identify the unintended incidents that lead to patient injuries in vascular surgery in the treatment of peripheral arterial disease (PAD) in Finland.

Methods: The records of all accepted patient injury claims involving PAD between 2004 and 2017 inclusive were obtained from the nationwide Finnish Patient Insurance Centre registry and were reviewed. Factors contributing to injury were classified by patient careflow.

Results: Sixty-nine patient injury incidents were identified in 60 treated patients with PAD. Sixteen injuries (23.2%) were related to outpatient or preoperative care. Twenty-seven injuries (39.1%) were caused by incidents in performing open or endovascular procedures, and 26 injuries (37.7%) were related to postoperative care. Delay in treatment affected 11 (18.3%) patients. Incidents involving surgical technique were identified in the treatment of 13 (21.7%) patients. Retained foreign material caused injuries to four (6.7%) patients. Five (8.3%) patients suffered from postoperative hemorrhage and eleven (18.3%) from infection damage. Delay in treatment resulted in two major amputations. Technical problems in bypass operations led to the loss of the bypass graft and to reoperation. Three nerve injuries led to permanent disability. One (1.7%) patient died because of fatal postoperative bleeding after being discharged from the hospital.

Conclusions: Compensated patient injuries in the treatment of PAD are rare. Injuries occur during all stages of care and are caused by both surgical system procedural failures and common complications.
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http://dx.doi.org/10.1016/j.avsg.2019.12.003DOI Listing
July 2020

Cauliflower ear among Finnish high-level male wrestlers and judokas is prevalent and symptomatic deformity.

Scand J Med Sci Sports 2019 Dec 16;29(12):1952-1956. Epub 2019 Aug 16.

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

Our research aimed to study the prevalence, concerns, and treatment practices related to cauliflower ear among Finnish wrestlers and judokas. In total, 32 Finnish wrestlers and 31 judokas completed a questionnaire at training sessions or at a competition. All participants were adults competing at the national or international levels. We also took lateral digital photographs of participants' ears. A senior author graded the overall appearance of the auricles on a scale from 0 to 5 (0 = normal auricle, 5 = extreme cauliflower ear). Cauliflower ear was more prevalent among male athletes (84%, 46/55) than female athletes (0%, 0/8, P < .001). Almost all (96%) had sought treatment for an auricular hematoma. The most prevalent treatment modality was needle aspiration (96%). Most (76%) had received treatment from individuals not representing the healthcare profession. Only one athlete reported receiving successful treatment. No complications from treatment were reported. Almost all participants (96%) reported some symptom from the cauliflower ear, typically pain. None regretted their cauliflower ear(s), and 41% of athletes with cauliflower ear considered it desirable. Cauliflower ear is a common and symptomatic deformity among high-level Finnish wrestlers and judokas. Despite the symptoms, it is accepted and sometimes even desired among the athletes.
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http://dx.doi.org/10.1111/sms.13530DOI Listing
December 2019

Acute rhinosinusitis - are we forgetting the possibility of a dental origin? A retrospective study of 385 patients.

Acta Otolaryngol 2019 Sep 3;139(9):783-787. Epub 2019 Jul 3.

c Department of Virology, University of Helsinki , Helsinki , Finland.

Odontogenic sinusitis (OS) is a common but underdiagnosed form of acute rhinosinusitis (ARS). OS carries no specific characteristics, but unilateral symptoms and certain microbiological as well as radiological findings indicate odontogenic origin. We studied the proportion of OS in ARS patients, the presence and associations of unilateral symptoms, and possible OS microbial and radiological findings. In addition, we investigated how this condition is recognised among ear, nose and throat specialists and radiologists. All 676 ARS patients treated in the Department of Otorhinolaryngology at Helsinki University Hospital in 2013 were retrospectively enrolled. The data were collected from patients' hospital medical records, the laboratory database and radiological reports. Odontogenic origin of ARS was suspected in 59 (15.3%) patients. Altogether (29.9%) 115 patients complained of unilateral symptoms and these were found to associate with probable oral microbial findings ( < .001). These findings covered 20.2% of isolates. Teeth were mentioned in 89.6% of the radiological reports. OS is common among patients with ARS, and good diagnostic tools already exist in routine practice. Microbial and radiological findings should be carefully evaluated, especially in cases of unilateral symptoms.
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http://dx.doi.org/10.1080/00016489.2019.1634837DOI Listing
September 2019

Smoking or poor oral hygiene do not predispose to peritonsillar abscesses changes in oral flora.

Acta Otolaryngol 2019 Sep 26;139(9):798-802. Epub 2019 Jun 26.

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

The purpose of this prospective study was to determine if there is a difference in number and distribution of salivary bacteria between patients with tonsillar infection and healthy volunteers. The etiology of peritonsillar abscess (PTA) is unclear. Smoking, periodontal disease, and infection of minor salivary glands have been suggested as predisposing factors for PTA. : Patients with acute tonsillitis (AT) ( = 54), peritonsillitis (PT) ( = 36), PTA ( = 58), and healthy volunteers ( = 52) were prospectively recruited and evaluated. Saliva bacteria were analyzed with flow cytometry. Patients and their treating physicians completed a questionnaire about patients' current disease, smoking habits, alcohol consumption, and oral health. There were no differences in the total number of saliva bacteria between patients with acute throat infection and healthy volunteers ( = .104) or between AT, PT, and PTA patients ( = .273). Smoking habits, alcohol consumption, oral hygiene, or prior antibiotics had no effect on total amount of salivary bacteria in patients with acute throat infection. The effects of smoking on salivary bacteria do not seem to be the mechanism that promotes development of PTA in smokers.
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http://dx.doi.org/10.1080/00016489.2019.1631479DOI Listing
September 2019

Patient injuries in pediatric otorhinolaryngology.

Int J Pediatr Otorhinolaryngol 2019 May 3;120:36-39. Epub 2019 Feb 3.

Department of Vascular Surgery, Turku University Hospital and University of Turku, Turku, Finland.

Objectives: Patient injuries in children can have lifelong effects on the patient and a marked impact on the whole family. The aim of this study was to identify the errors and incidents leading to patient injuries in pediatric otorhinolaryngology (ORL) by evaluating accepted patient injury claims.

Methods: The records of all accepted patient injury claims in ORL between 2001 and 2011 were searched from the nationwide Patient Insurance Centre registry. Pediatric injuries were reviewed and evaluated in detail, and factors contributing to injury were identified.

Results: In the 10-year study period, 17 (7.6%) of the 223 patient injuries occurred in children, and of these, 15 (88%) were considered operative care. The median age of the patients was 8 years (range 3-16 years). All operations were performed as daytime elective surgery and by a fully trained specialist in 93% of the cases. One-half of the cases were routine surgeries for common ORL diseases. The most common incidences were incomplete surgery, retained gauze or foreign body, injury to adjacent anatomic structure, and insufficient charts or instructions (each occurred in 3 cases). The most frequent consequence was burn (n = 4). One child died because of post-tonsillectomy hemorrhage.

Conclusions: Patient injuries in pediatric ORL are strongly related to surgery. Most injuries occurred after routine operations by a fully trained specialist. Clinicians should be aware of the most likely scenarios resulting in claims.
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http://dx.doi.org/10.1016/j.ijporl.2019.02.007DOI Listing
May 2019

Iatrogenic patient injuries in otology during a 10-year period: review of national patient insurance charts.

Acta Otolaryngol 2018 Jan 14;138(1):16-20. Epub 2017 Sep 14.

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

Objective: To assess patient injury characteristics and contributing factors in otology.

Methods: Data on the accepted patient-injury claims involving otorhinolaryngology (ORL), closed between 2001 and 2011, from the Finnish Patient Insurance Centre registry was retrieved. We included all injuries concerning otology, with evaluation and classification of their causes and types.

Results: During the 10-year study period, a total of 44 claims were accepted as compensated patient injuries in otology. From a total of 233 patient injuries in all ORL, this amounted to 19%. In outpatient care, occurred 12 (27%) injuries and in surgical procedures 32 (73%). Five (11%) patients were children. Errors in surgical technique were identified as the primary cause of the injury in 22 (69%) operation-related cases. Failure to remove all auricular tampons or packing in postoperative control was a contributing factor in 4 (13%) injuries, a facial nerve was damaged in 9 (28%) operations, and in 12 (38%) patients, the injury resulted in severe hearing loss or deafness. Six patients (21%) needed one or more re-operations related to the injury, of which two were due to an incomplete primary operation.

Conclusion: Typical compensated patient injuries in operative otology resulted from common complications of common operations in high volume centres.
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http://dx.doi.org/10.1080/00016489.2017.1375153DOI Listing
January 2018

The presence of minor salivary glands in the peritonsillar space.

Eur Arch Otorhinolaryngol 2017 Nov 12;274(11):3997-4001. Epub 2017 Sep 12.

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

Peritonsillar abscess (PTA) is traditionally considered only a purulent complication of acute tonsillitis (AT), but may be related to infection of minor salivary glands. We analysed the presence of peritonsillar minor salivary glands and inflammation patterns in 114 adult tonsils representing three patient groups: recurrent AT, chronic tonsillitis (CT), and PTA. Samples acquired from elective tonsillectomies were stored in formalin, and after preparation were microscopically examined for inflammation and fibrotic changes. Clinical features and histological characteristics were compared between the groups. Of all tonsils, the minor salivary glands were present in 77 (67.5%). Glands located near the tonsillar tissue showed signs of infection in 73 (94.8%), while only 3 (15.0%) of 20 glands located deeper in the peritonsillar space were infected. Compared to patients with recurrent AT and CT, those with PTA more often presented with periductal inflammation, p < 0.011 (PTA 82.1%, AT 42.9%, and CT 63.6%). The majority of our 114 tonsillectomy specimens, collected from patients with AT, CT, or PTA, presented with infected minor salivary glands, and inflammation of the peritonsillar space glands was evident. To further elucidate the association between these glands and PTA, tonsillar samples should be collected and analysed from patients during the acute phase of infection.
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http://dx.doi.org/10.1007/s00405-017-4738-xDOI Listing
November 2017

Topical Ropivacaine in Prevention of Post-Tonsillectomy Pain in Adults.

Anesth Analg 2017 05;124(5):1459-1466

From the *Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, †Division of Otorhinolaryngology, Department of Head and Neck Surgery, and ‡Division of Pain Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Background: Post-tonsillectomy pain is 1 of the most intense postoperative pain conditions. However, optimal and sufficient postoperative analgesic treatment remains unclear. We investigated the effect of topical ropivacaine for post-tonsillectomy pain in 160 adult outpatient surgery patients over 2 postoperative weeks.

Methods: At the end of tonsillectomy, 2 swabs soaked in either 1% ropivacaine or saline were packed into the tonsillar beds for 5 minutes. We used ibuprofen and a combination of acetaminophen (500 mg)-codeine (30 mg) tablets as postoperative analgesics for 2 weeks. The primary outcome was pain intensity on swallowing measured on a numeric rating scale (NRSs) during the first postoperative week expressed as area under curve (AUC). The secondary endpoints included the worst pain experienced during the 2-hour follow-up in the postanesthesia care unit, pain intensity during the second postoperative week, and the number of ibuprofen and acetaminophen-codeine tablets consumed during the 2 postoperative weeks.

Results: During the first postoperative week, 120 patients out of 160 (75%) provided complete results, including data on their use of analgesics according to the instructions as well as completed and returned a questionnaire daily. A total of 101 patients (63%) did the same during the second postoperative week.Median (interquartile range [IQR]) of the primary outcome NRSs (AUC) was 38 (19) for the ropivacaine group and 37 (24) for the control group during the first postoperative week (P = .77, -1.0 estimated difference; 95% confidence interval [CI] for the difference, -7.0 to 5.0); no difference was found. Median (IQR) of NRS at rest (NRSr) (AUC) was 24.5 (19) for the ropivacaine group and 24 (22) for the control group during the first postoperative week (P = .96, 0.0 estimated difference; 95% CI for the difference, -5.0 to 5.0); no difference was found. Median (IQR) of the worst pain intensity values (NRSs or NRSr) (AUC) was 5 (3) for the ropivacaine group and 5 (3) for the control group (P = .44, 0.0 estimated difference; 95% CI for the difference, -1.0 to 0.5); no difference was found. During the second postoperative week, median (IQR) of the NRSs (AUC) was 17 (13) for the ropivacaine group and 21 (23) for the control group (P = .05, -4.0 estimated difference; 95% CI for the difference, -9.0 to 0.0) and median (IQR) of the NRSr (AUC) 10.5 (10) for ropivacaine group and 11 (13) for the control group (P = .42, -1.0 estimated difference; 95% CI for the difference, -5.0 to 2.0); no difference was found.The number of rescue analgesics (acetaminophen-codeine tablets) consumed during the second postoperative week was lower in the ropivacaine group than in the control group (median [IQR] of the consumption [AUC] was 10 [12] for the ropivacaine group and 16 [12] for the control group; P = .0008, -7.0 estimated difference; 95% CI of difference, -10 to -3.0). The groups showed no differences in overall risk for post-tonsillectomy bleeding. However, bleeding requiring hemostasis under local anesthesia was more common in the ropivacaine group (18% vs 8%, P = .048, 10% estimated difference; 95% CI for the difference, 0%-21%).

Conclusions: Topical ropivacaine failed to reduce pain intensity during the first postoperative week. We observed no major adverse effects.
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http://dx.doi.org/10.1213/ANE.0000000000002015DOI Listing
May 2017

Immune Defense in Upper Airways: A Single-Cell Study of Pathogen-Specific Plasmablasts and Their Migratory Potentials in Acute Sinusitis and Tonsillitis.

PLoS One 2016 29;11(4):e0154594. Epub 2016 Apr 29.

Department of Medicine, University of Helsinki, Helsinki, Finland.

Background: Despite the high frequency of upper respiratory tract (URT) infections and use of the nasal mucosa as route for vaccination, the local immune mechanism and dissemination of effector lymphocytes from the URT have been insufficiently characterized. To devise a single-cell approach for studying the mucosal immune response in the URT, we explored URT-originating B effector lymphocytes in the circulation of patients with one of two common respiratory infections, acute sinusitis or tonsillitis.

Methods: Patients with acute sinusitis (n = 13) or tonsillitis (n = 11) were investigated by ELISPOT for circulating pathogen-specific antibody-secreting cells (ASCs) of IgA, IgG and IgM isotypes approximately one week after the onset of symptoms. These cells' potential to home into tissues was explored by assessing their expression of tissue-specific homing receptors α4β7, L-selectin, and cutaneous lymphocyte antigen (CLA).

Results: Pathogen-specific ASCs were detected in the circulation of all patients, with a geometric mean of 115 (95% CI 46-282) /106 PBMC in sinusitis, and 48 (27-88) in tonsillitis. These responses were mainly dominated by IgG. In sinusitis α4β7 integrin was expressed by 24% of the ASCs, L-selectin by 82%, and CLA by 21%. The proportions for tonsillitis were 15%, 80%, and 23%, respectively. Healthy individuals had no ASCs.

Conclusions: URT infections-acute sinusitis and tonsillitis-both elicited a response of circulating pathogen-specific plasmablasts. The magnitude of the response was greater in sinusitis than tonsillitis, but the homing receptor profiles were similar. Human nasopharynx-associated lymphoid structures were found to disseminate immune effector cells with a distinct homing profile.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0154594PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851416PMC
April 2017

Metronidazole in conjunction with penicillin neither prevents recurrence nor enhances recovery from peritonsillar abscess when compared with penicillin alone: a prospective, double-blind, randomized, placebo-controlled trial.

J Antimicrob Chemother 2016 06 10;71(6):1681-7. Epub 2016 Mar 10.

Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, PO Box 263, FI-00290, Helsinki, Finland Faculty of Medicine, University of Helsinki, Helsinki, Finland.

Objectives: The objectives of this study were to evaluate the efficacy of metronidazole in conjunction with penicillin in preventing the recurrence of peritonsillar abscess (PTA) and to learn whether metronidazole enhances the recovery from PTA when compared with penicillin alone.

Methods: In this prospective, double-blind, randomized, placebo-controlled trial, 200 adult outpatients with PTA at our ear, nose and throat emergency department received either penicillin (1 000 000IU) × 3 and metronidazole (400 mg) × 3 for 10 and 7 days orally (combination group, N = 100) or penicillin and placebo (penicillin group, N = 100) after incision and drainage of the PTA. Afterwards they received a symptom questionnaire via e-mail daily for 2 weeks, then weekly for 6 weeks. The primary outcome was efficacy of metronidazole in conjunction with penicillin in preventing PTA recurrence in 56 days; the secondary outcome was ability of metronidazole plus penicillin to enhance recovery from PTA in 28 days. All healthcare contacts were registered during follow-up. Registered on www.clinicaltrials.gov with the identifier NCT01255670.

Results: Of the 200 patients, 20 returned to hospital with recurrent symptoms, 10 in each group (P = 1.00). In the combination group, the mean (SD) duration of throat-related symptoms was 5.6 (5.0) days and in the penicillin group it was 5.3 (2.7) days, values for fever were 1.5 (0.9) and 1.6 (1.0) days, respectively, and those for poor overall physical condition were 4.0 (3.9) and 4.5 (4.9) days; there were no significant differences between groups. The adverse effects nausea and diarrhoea lasted longer in the combination group (P = 0.01).

Conclusions: For healthy adult PTA patients treated with incision and drainage, metronidazole neither prevents recurrence nor enhances recovery when combined with penicillin compared with penicillin alone, but instead leads to increased adverse effects.
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http://dx.doi.org/10.1093/jac/dkw038DOI Listing
June 2016

How patients experience antral irrigation.

Clin Med Insights Ear Nose Throat 2015 14;8:13-7. Epub 2015 May 14.

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

Background: Antral irrigation earlier had an important role in the diagnosis and treatment of rhinosinusitis. Nowadays, it is often considered too unpleasant. However, the experience of patients of this procedure has been very seldom evaluated. Nor has the effect on pain in rhinosinusitis been evaluated. The aim of this study was to evaluate patients' experience of discomfort and pain during antral irrigation. We also assessed facial pain caused by rhinosinusitis before the procedure and pain soon after the procedure.

Methods: Doctors and 121 patients completed their questionnaires independently after antral irrigation in a university clinic, in a private hospital, and at a communal health center.

Results: Patients experienced mild pain during antral irrigation (mean and median visual analog scale score: <3). Their experience of pain during antral irrigation was closely comparable to pain during dental calculus scaling. Facial pain assessed before antral irrigation decreased quickly after the procedure.

Conclusions: Antral irrigation was well tolerated as an outpatient procedure. The procedure seems to relieve facial pain caused by the disease quickly. The role of antral irrigation in the treatment of acute rhinosinusitis will need further investigation.
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http://dx.doi.org/10.4137/CMENT.S24419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4433062PMC
May 2015

Impact of tonsillectomy on health-related quality of life and healthcare costs in children and adolescents.

Int J Pediatr Otorhinolaryngol 2014 Sep 23;78(9):1508-12. Epub 2014 Jun 23.

Department of Otorhinolaryngology, Helsinki University Central Hospital, P.O. Box 220, 00029, HUS, Helsinki, Finland. Electronic address:

Background: Tonsillectomy is a common surgical intervention in children, but its efficacy is under debate. We studied whether tonsillectomy is a cost-effective intervention with a positive impact on health-related quality of life (HRQoL).

Methods: Children (aged 7-11 years) and adolescents (aged 12-15 years) undergoing tonsillectomy answered the 17D or 16D HRQoL questionnaires before tonsillectomy and at 6 and 12 months postoperatively. At the same time-points, data on the use of healthcare services and school absenteeism were collected by questionnaire.

Results: Altogether 49 children and 42 adolescents returned all HRQoL questionnaires. Tonsillectomy improved the mean total HRQoL score clinically and statistically significantly in both children (from 0.935 at baseline to 0.958 at 12 months, p = 0.002) and adolescents (from 0.930 to 0.957, p = 0.004). The mean direct self-reported healthcare service costs diminished after tonsillectomy in both groups. The mean number of days on sick leave due to oropharyngeal problems during the preceding 3 months decreased from the preoperative 4.6 days to postoperative 0.5 days (p < 0.001) in children, and from 4.9 days to 0.8 days (p < 0.001) in adolescents at 12 months.

Conclusions: Tonsillectomy improves HRQoL in both school-aged children and adolescents and reduces healthcare service needs and school absenteeism due to oropharyngeal symptoms.
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http://dx.doi.org/10.1016/j.ijporl.2014.06.021DOI Listing
September 2014

Variations in treatment of peritonsillar abscess in four Nordic countries.

Acta Otolaryngol 2014 Aug 16;134(8):813-7. Epub 2014 Jun 16.

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

Conclusion: In four Nordic countries, peritonsillar abscess (PTA) patients are treated rather differently.

Objectives: To study how such patients are treated in those countries.

Methods: The 81 chief physicians of otorhinolaryngology departments of all central hospitals in Denmark (n = 15), Norway (n = 19), Sweden (n = 27), and Finland (n = 20) received a multiple-choice questionnaire.

Results: A total of 73 physicians (90%) replied. The largest differences arose in treating patients with intravenous versus per oral antibiotics, and treating as inpatients versus outpatients. In Finland, 50% of PTA patients aged >16 years were treated as inpatients and 50% as outpatients, whereas the respective quotas in Sweden were 9 and 91%, Norway 19 and 81%, and Denmark 33 and 67%. Of Finnish physicians, 30% treated their patients primarily with oral antibiotics, 70% with intravenous antibiotics; in Sweden 91 vs 9%, Norway 53 vs 47%, and Denmark 18 vs 82%. In Denmark, almost all patients were operated on immediately, whereas in the other three countries, especially Sweden, operations more often were performed after a recovery period. Combining metronidazole with penicillin or cephalosporins was most common in Denmark: 58% reported usage, compared with 30% in Finland, 16% in Norway, and 4% in Sweden.
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http://dx.doi.org/10.3109/00016489.2014.905702DOI Listing
August 2014

Effect of tonsillectomy on health-related quality of life and costs.

Acta Otolaryngol 2013 May;133(5):499-503

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

Conclusion: Tonsillectomy (TE) seems to be a cost-saving procedure with a positive effect on a patient's health-related quality of life (HRQoL).

Objectives: The aim of this study was to explore how TE affects health-related quality of life (HRQoL) and the costs due to health service use and absence from work.

Methods: All 557 patients over the age of 15 years undergoing scheduled TE in the Helsinki University Central Hospital's Otorhinolaryngological Department between February 2008 and June 2009 were asked to participate and to complete the 15D HRQoL questionnaire as well as a questionnaire exploring the use of health-care services during the preceding 3 months. Follow-up questionnaires were sent 6 and 12 months after the operation.

Results: Of the 557 patients, 124 (22%) answered all three questionnaires. Preoperatively the patients were significantly worse off than the age- and gender-standardized general population. TE improved their HRQoL on 6 of the 15 dimensions, and overall (15D score improved from baseline 0.939 to 0.959 at 12 months, p < 0.001). The most marked improvement (p < 0.001) occurred on the dimensions of breathing, sleeping, and discomfort and symptoms. Self-reported costs due to health service use and absence from work distinctly diminished.
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http://dx.doi.org/10.3109/00016489.2012.728716DOI Listing
May 2013

WHO Surgical Safety Checklist in otorhinolaryngology-head and neck surgery: specialty-related aspects of check items.

Acta Otolaryngol 2012 Dec 7;132(12):1334-41. Epub 2012 Oct 7.

Department of Surgery, Turku University Hospital, Turku, Finland.

Conclusion: The WHO surgical checklist is well suited to otorhinolaryngology-head and neck surgery (ORL-HNS) and the users are satisfied with its content.

Objectives: Use of the checklist will improve safety in operating rooms (ORs). The checklist has been taken into use in ORL-HNS, and preliminary experiences are promising. However, the checklist must be specific to the specialty in which it is used. The aim of this study was to evaluate the utility of the check items for ORL-HNS operations, with special reference to outpatient surgery.

Methods: The questionnaire study for the OR personnel was conducted at a tertiary academic hospital. Every item on the WHO checklist was evaluated and responders could provide freehand comments on the subject.

Results: In all, 101 responses were received from OR staff; the response rate was 95.3%. The users were mainly satisfied with the checklist's content for ORL-HNS operations. Mean scores of the importance of check items varied from 4.08 to 4.89 on a five-point scale. The item 'Allergy' had the highest score and 'Team members introduced' the lowest. A need to modify the checklist for in-hospital patients did not emerge. However, a more compact checklist for outpatient surgery carried out under local anaesthesia was suggested.
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http://dx.doi.org/10.3109/00016489.2012.700121DOI Listing
December 2012

[Emergency rhinology].

Duodecim 2012 ;128(2):213-8

Oulun yliopisto, Lapin keskussairaala, korva-, nenä- ja kurkkutautien klinikka.

The nose counteracts chemical, biological and mechanical insults from the outside word. Mechanical injuries to the nose are usually managed within few days. Fracture of the nasal septum and possible hematoma should be managed within one day. Nasal or paranasal infection will in most cases heal by symptomatic treatment or antibiotic medication. Sometimes the condition gets rapidly complicated, resulting even in a life-threatening infection. Nose-bleeding originates in most cases from the frontal part of the nose, whereby treatment with silver nitrate is simple and effective. Gauze packing or anterior-posterior tamponade with a balloon serve as first aid for bleeding of the posterior part.
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April 2012

Human bocavirus in the nasopharynx of otitis-prone children.

Int J Pediatr Otorhinolaryngol 2012 Feb 26;76(2):206-11. Epub 2011 Nov 26.

Institute of Biomedicine, Department of Pharmacology, University of Helsinki, PO Box 63, 00014 University of Helsinki, Finland.

Objectives: Human bocavirus (HBoV) is frequently identified in children with respiratory tract infections, and its role in acute otitis media (AOM) has been suggested. The disease associations for the closely related bocaviruses HBoV2-4 remain unknown. Increasing evidence shows that probiotics may reduce the risk of AOM of viral origin. Objectives of the study was to examine the prevalence and persistence of bocaviruses in consecutive nasopharyngeal samples (NPS) of otitis-prone children, and whether an association exists between HBoV and the child's characteristics, respiratory symptoms, and AOM pathogens, and whether probiotics reduce the occurrence of HBoV.

Methods: In a double-blind, placebo-controlled, randomized, 6-month intervention study, 269 otitis-prone children (aged 9 months to 5.6 years), consumed daily either one capsule of probiotics (Lactobacillus rhamnosus GG, L. rhamnosus Lc705, Bifidobacterium breve 99 and Propionibacterium freudenreichii JS) or placebo. After a clinical examination and NPS collected at three-time points, the presence and persistence of HBoV1-4 DNA in NPS was determined by RT-qPCR at the baseline, after 3, and 6 months.

Results: A high load (>10,000 copies/ml) of HBoV DNA was detected in 26 (17.1%) of 152 children, and 16 (10.5%) showed a prolonged presence of HBoV for at least 3 months. None had DNA of HBoV2-4. Higher number of siblings associated with increased HBoV prevalence (p=0.029). Prevalence or persistence of HBoV was not significantly associated with other characteristics, respiratory symptoms, or AOM pathogens. Probiotic intervention significantly reduced the number of HBoV DNA-positive samples (probiotic vs. placebo: 6.4% vs. 19.0%, OR=0.25, CI 95%=0.07-0.94, p=0.039).

Conclusions: HBoV, but not HBoV2-4, DNA occurs often in the nasopharynx of otitis-prone children, and may persist for 3-6 months. Probiotic treatment possibly reduced the presence of HBoV.
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http://dx.doi.org/10.1016/j.ijporl.2011.10.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7172510PMC
February 2012

Who ends up having tonsillectomy after peritonsillar infection?

Eur Arch Otorhinolaryngol 2012 Apr 29;269(4):1281-4. Epub 2011 Oct 29.

Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Helsinki University Central Hospital, Helsinki University, P.O. Box 220, 00290 Helsinki, Finland.

We wanted to explore how many patients will undergo tonsillectomy during the first 5 years after peritonsillar abscess or peritonsillar cellulitis, and why. In addition we sought predictive factors as to who would benefit from tonsillectomy. Medical records of 809 patients with peritonsillar infection (ICD-10 J36) aged over six were analyzed, and data on the history of tonsil infections and differences in treatment were collected. Data on patients who underwent tonsillectomy during the next 5 years were compared with data on patients needing no tonsillectomy. An abscess or planned interval tonsillectomy was performed on 159 patients. Of the conservatively treated 7- to 16.9-year-old patients, 42.5% required surgery later, of those aged 17-29.9 years, 31.3%, and those over 30, 13.2% (p < 0.001). Previous tonsillar infections led to increased (p = 0.067) probability of delayed tonsillectomy. Re-opening of the abscess cavity at the polyclinics, use of broad-spectrum antibiotics in the acute phase of infection, or being an outpatient or inpatient had no influence on the probability of later surgery. Overall one-fourth of the patients with peritonsillar infection underwent tonsillectomy during the next 5 years, even without being originally planned. Young age and previous tonsillar infections caused increased probability of delayed tonsillectomy.
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http://dx.doi.org/10.1007/s00405-011-1807-4DOI Listing
April 2012

[Acute external otitis].

Authors:
Karin Blomgren

Duodecim 2011 ;127(13):1331-4

HYKS, korvaklinikka, PL 220, 00029 HUS.

Acute external otitis is a painful inflammation of the skin of the ear canal, usually caused by bacteria. It occurs typically in the summer time, predisposed by humidity and heat. Cleaning and corticosteroid/antibiotic drops almost always ease swelling and pain in the ear canal in a couple of days. Proper treatment also involves effective analgesic medication and advice for a correct dosing technique of ear drops. Antibiotics are necessary only if the patient is immunologically compromised or the inflammation is spreading outside the ear canal.
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September 2011

[Diagnosis and treatment of peritonsillar abscess].

Authors:
Karin Blomgren

Duodecim 2010 ;126(7):810-4

HYKS:n korvaklinikka, HUS.

Peritonsillar abscess (PTA) is a painful, deep infection. With appropriate treatment, complete resolution is usually achieved. Symptoms of PTA are, in most cases very typical, but diagnosis and especially locating the abscess cavity may be more challenging. Although any age group can be affected, PTA is most common in adolescents and young adults. Pus from the abscess cavity has to be removed with either needle aspiration, incision and drainage, or in conjunction with tonsillectomy. Antibiotics and pain killers are also required. Most cases can be treated as an outpatient. If inadequately treated abscess can spread to neck and mediastinum, and infection may require emergent surgical treatment. When adequate equipment and knowledge available, most PTAs can be managed in primary health care as well.
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July 2010

[Not Available].

Duodecim 2007 ;123(16):2032

HYKS:n korvaklinikka, HUS.

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April 2008

[Not Available].

Authors:
Karin Blomgren

Duodecim 2007 ;123(16):2029

HYKS:n korvaklinikka, HUS.

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April 2008

[Not Available].

Duodecim 2007 ;123(16):2027-8

HYKS:n korvaklinikka, HUS.

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April 2008

[Not Available].

Duodecim 2007 ;123(16):2019-25

HYKS:n korvaklinikka, HUS.

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April 2008

Treatment of acute otitis media with probiotics in otitis-prone children-a double-blind, placebo-controlled randomised study.

Clin Nutr 2007 Jun 13;26(3):314-21. Epub 2007 Mar 13.

Valio Ltd, R&D, FIN-00039 Helsinki, Finland.

Background & Aims: To examine whether probiotics would reduce the occurrence or duration of acute otitis media (AOM), or the nasopharyngeal carriage of otitis pathogens in otitis-prone children.

Methods: During this double-blind, placebo-controlled, randomised, 24-week intervention, 309 otitis-prone children (10 months-6 years) consumed either one probiotic capsule (Lactobacillus rhamnosus GG and LC705, Bifidobacterium breve 99 and Propionibacterium freudenreichii JS) (n=155) or placebo (n=154) daily. Clinical examinations were carried out and nasopharyngeal samples taken three times. Parents recorded the symptoms of upper respiratory infection (URI) in a diary.

Results: Probiotic treatment did not reduce the occurrence (probiotic vs. placebo: 72% vs. 65%, OR=1.48, 95% CI 0.87-2.52, p=n.s.) or the recurrence ( three) of AOM episodes (18% vs. 17%, OR=1.04, 95% CI 0.55-1.96, p=n.s.). The median duration of AOM episodes was 5.6 (IQR 3.5-9.4) vs. 6.0 (IQR 4.0-10.5) days, respectively (p= n.s.). There was a tendency showing a reduction in the occurrence of recurrent (4 to 6) respiratory infections in the probiotic group (OR for 4 URIs: 0.56, 95%CI 0.31-0.99, p=0.046; OR for 6 URIs: 0.59, 95% CI 0.34 to 1.03, p=n.s.). Probiotics did not affect the carriage of Streptococcus pneumoniae or Haemophilus influenzae, but increased the prevalence of Moraxella catarrhalis (OR=1.79, 95% CI 1.06-3.00, p=0.028).

Conclusions: Probiotics did not prevent the occurrence of AOM or the nasopharyngeal carriage of otitis pathogens in otitis-prone children. A tendency showing a reduction in recurrent respiratory infections must be confirmed in further studies.
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http://dx.doi.org/10.1016/j.clnu.2007.01.003DOI Listing
June 2007