Publications by authors named "Numminen Jura"

39 Publications

Lung function and side effects of Aspirin desensitization: a real world study.

Eur Clin Respir J 2021 Jan 11;8(1):1869408. Epub 2021 Jan 11.

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

: NSAID-exacerbated respiratory disease (N-ERD) is mainly treated with topical and oral corticosteroids, as well as acetylsalicylic acid (ASA) treatment after desensitization (ATAD). During desensitization and ATAD, it is common to experience an exacerbation of respiratory symptoms and other side effects, which may lead to cessation of treatment. : The aim of this retrospective follow-up study was to evaluate the effect of ATAD on lung functions and respiratory symptoms, and to clarify the occurrence of adverse events. s: We analysed the patient data of 67 patients treated with ASA desensitization between 2006 and 2016 in three hospitals, concerning adverse events, respiratory symptoms, lung function tests, and reasons for discontinuation. : 26 patients discontinued AD or ATAD. The most common reasons for discontinuation were lack of response (9%) and side effects (18%). ATAD did not affect lung function values in the follow-up of up to 5 years. Upper respiratory symptoms improved in 31 (52%) and lower respiratory symptoms (LRS) in 7 (10%) cases. Side effects occurred in 42 (63%) cases, the most common being dyspepsia and lower respiratory symptoms. : Our study suggests that ATAD has little effect on lower airway functions. Side effects were common, and discontinuation rates high.
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http://dx.doi.org/10.1080/20018525.2020.1869408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808387PMC
January 2021

Factors affecting upper airway control of NSAID-exacerbated respiratory disease: A real-world study of 167 patients.

Immun Inflamm Dis 2021 Mar 5;9(1):80-89. Epub 2021 Jan 5.

Inflammation Center, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Background: Nonsteroidal anti-inflammatory drug (NSAID) exacerbated respiratory disease (N-ERD) is a triad with asthma, chronic rhinosinusitis with nasal polyps, and NSAID intolerance. Uncontrolled N-ERD forms a major public health problem due to frequent and difficult-to-treat exacerbations and/or requiring putatively frequent endoscopic sinus surgeries (ESS). Our aim was to study factors affecting control of N-ERD.

Methods: Retrospective patient record data (patient characteristics, prior sinus surgeries, follow-up data in 2020) from 167 N-ERD patients undergoing consultation at three tertiary hospitals from 2001 to 2017 was used. Outcome measurements reflecting uncontrolled N-ERD were revision ESS, corticosteroids/biological therapy, and antibiotic courses during 2016-2020. Associations were analyzed by using nonparametric tests, Cox's proportional hazard, and binary logistic regression models.

Results: Nasal polyp eosinophilia increased the risk of revision surgery during the follow-up (adjusted hazard ratio [aHR] 3.21, confidence interval 1.23-8.38). Also baseline oral corticosteroids (OCS; HR, 1.73, 1.04-2.89) and baseline surgery without total ethmoidectomy increased the risk of revision ESS (HR, 2.17, 1.07-4.42) in unadjusted models. In addition, both baseline OCS (adjusted odds ratio [aOR] 2.78, 1.23-6.26) and a history of ≥4 previous ESS (aOR, 2.15, 0.98-4.70) were associated with the use of OCS/biological therapy during the follow-up, but not with high number of antibiotics.

Conclusions: Nasal polyp eosinophilia, baseline OCS, and a history of recurrent ESS predict uncontrolled N-ERD. These factors might be clinically useful in risk-estimation of uncontrolled disease and for organizing follow-ups. Prospective cohort studies with larger sample size are needed to further study the factors affecting the upper airway control of N-ERD.
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http://dx.doi.org/10.1002/iid3.347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7860608PMC
March 2021

The effect of inferior turbinate surgery on nasal symptoms and inferior turbinate contractility.

Am J Otolaryngol 2021 Jan - Feb;42(1):102778. Epub 2020 Oct 22.

Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland.

Objectives: The aim of this study was to compare radiofrequency ablation (RFA), diode laser, and microdebrider-assisted inferior turbinoplasty (MAIT) in the treatment of chronic nasal obstruction in a one-year follow-up, and to pay special attention to the effect of the procedures on the contractility capacity of the inferior turbinates.

Methods: The patients filled a Visual Analogue Scale (VAS) questionnaire regarding nasal symptoms pre- and postoperatively. Saccharin transit time (STT) evaluation and acoustic rhinometry were also performed. A total of 77 patients attended the one-year control visit and had technically reliable acoustic rhinometry results.

Results: All the examined techniques decreased the VAS score for the severity of nasal obstruction statistically significantly. There was no deterioration found in the symptoms of crusting, nasal discharge, and sneezing, nor in mucociliary function in any of the groups. All the three techniques increased the non-decongested total V2-5 cm values and decreased the decongested total V2-5 cm values statistically significantly. The V2-5 cm change (%) values decreased statistically significantly in the RFA, diode laser, and the MAIT groups following the operations, the mean changes being -57 percentage points (pp), -53 pp, and -73 pp respectively.

Conclusion: All three techniques decreased the severity of nasal obstruction significantly in the one-year follow-up. Although submucosal fibrosis seemed to increase, all the techniques increased the anterior nasal cavity volume significantly. Inferior turbinate contractility decreased to the normal level from the preoperative congested state following the surgery with every examined technique.
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http://dx.doi.org/10.1016/j.amjoto.2020.102778DOI Listing
October 2020

Factors Predictive of Outcome in Inferior Turbinate Surgery.

Ear Nose Throat J 2020 Oct 16:145561320966066. Epub 2020 Oct 16.

Department of Otorhinolaryngology, 60670Tampere University Hospital, Tampere, Finland.

Objectives: The purpose of the study was to examine the various preoperative predictive factors of inferior turbinate surgery and to find possible factors that predict an optimal subjective response using 3 common surgical techniques-radiofrequency ablation (RFA), diode laser, and microdebrider-assisted inferior turbinoplasty (MAIT)-in a randomized, prospective study with a 1-year follow-up.

Methods: The patients filled a visual analogue scale (VAS) questionnaire regarding the severity of nasal obstruction prior to and 1 year after surgery. A VAS score improvement of 3 points or more was chosen as an optimal subjective response. Univariate and multivariate regressions were used to evaluate the effect of the predictive factors. In total, 80 patients attended a 1-year control visit.

Results: In the multivariate analysis, patients without anterior septal deviation had a statistically significantly higher odds ratio of a satisfactory subjective response compared to patients with anterior septal deviation (5.6; 95% CI: 1.4-23.1; = .02). Patients treated with RFA had a statistically significantly higher odds ratio of an optimal subjective response compared to patients treated with MAIT (9.0; 95% CI: 1.5-54.2; = .02).

Conclusions: Anterior septal deviation seems to decrease the likelihood of an optimal subjective response to inferior turbinate surgery, which supports the consideration of concomitant septoplasty at least in clear cases to optimize the subjective response. Radiofrequency ablation had a significantly higher likelihood of an optimal subjective response compared to MAIT. Further investigations regarding the findings are needed.
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http://dx.doi.org/10.1177/0145561320966066DOI Listing
October 2020

High Discontinuation Rates of Peroral ASA Treatment for CRSwNP: A Real-World Multicenter Study of 171 N-ERD Patients.

J Allergy Clin Immunol Pract 2020 Nov - Dec;8(10):3565-3574. Epub 2020 Jul 18.

Inflammation Centre, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Medicum, Haartman Institute, University of Helsinki, Helsinki, Finland.

Background: Nonsteroidal anti-inflammatory drug (NSAID) exacerbated respiratory disease (N-ERD) consists of chronic rhinosinusitis with nasal polyposis (CRSwNP), asthma, and NSAID intolerance. Acetylsalicylic acid treatment after desensitization (ATAD) is a treatment option for uncontrolled N-ERD.

Objective: To evaluate peroral ATAD's long-term effectiveness on CRSwNP disease control.

Methods: The retrospective data (patient characteristics, sinus surgeries before ATAD, ATAD, follow-up data [2019]) were collected from patient records of 171 patients with N-ERD (102 ATAD patients, 69 controls with CRSwNP+N-ERD without ATAD) who underwent tertiary hospital consultation from 2001 to 2017. Outcome measurements were ATAD discontinuation, revision sinus surgery, and corticosteroid and antibiotic courses for airway infections during 2016-2019. Associations were analyzed by survival and nonparametric methods.

Results: The ATAD group had more tissue eosinophilia, symptoms, and sinus surgeries before ATAD than others. The ATAD discontinuation rate was 63%, independent of ATAD dose or duration, usually due to side effects. Compared with the N-ERD group without ATAD, ATAD (mean duration, 2.9 years) did not affect the revision endoscopic sinus surgery rate (P = .21, by the log-rank test) or the number of peroral corticosteroid courses per year (P > .05, by the Mann-Whitney U-test) during the follow-up (mean, 7.6 years) despite the dose or duration of ATAD.

Conclusions: The discontinuation rate of ATAD was high (63%), and ATAD did not affect revision sinus surgery rate nor the need of peroral corticosteroids during follow-up. However, the remaining 37% of the ATAD group did continue the treatment, indicating that they may have benefited from ATAD.
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http://dx.doi.org/10.1016/j.jaip.2020.06.063DOI Listing
July 2020

The Effect of Inferior Turbinate Surgery on Quality of Life: A Randomized, Placebo-Controlled Study.

Ear Nose Throat J 2020 May 26:145561320927944. Epub 2020 May 26.

Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland.

Objective: The purpose of this prospective, randomized, single-blinded, placebo-controlled study was to investigate the effects of radiofrequency ablation (RFA), diode laser, and microdebrider-assisted inferior turbinoplasty (MAIT) techniques on patients' quality of life (QOL) and to compare the techniques with a placebo procedure.

Methods: A total of 98 consecutive patients with enlarged inferior turbinates due to persistent year-round rhinitis were randomized into placebo, RFA, diode laser, and MAIT groups at a ratio of 1:2:2:2. All the procedures were carried out under local anesthesia with the patients' eyes covered. Assessments were conducted prior to surgery and 3 months subsequent to the surgery. Quality of life was assessed with the Glasgow Health Status Inventory (GHSI).

Results: The GHSI total score increased statistically significantly in all the groups, including placebo. There were no significant differences in the GHSI total score change between RFA, diode laser, and MAIT groups. The MAIT procedure improved the GHSI total score significantly more than the placebo procedure ( = .04).

Conclusion: All inferior turbinate surgery techniques lead to a significant improvement in the patients' QOL, and no significant differences were found between the techniques. The placebo treatment also improved the QOL significantly. Only the MAIT technique improved the QOL significantly more compared to placebo.
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http://dx.doi.org/10.1177/0145561320927944DOI Listing
May 2020

Ethmoidal drug-eluting stent therapy is not superior to nasal corticosteroid spray in the prevention of endoscopic sinus surgery: Results from a randomised, clinical trial.

Clin Otolaryngol 2020 05 10;45(3):402-408. Epub 2020 Mar 10.

Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland.

Objectives: To evaluate whether an ethmoidal drug-eluting stent (DES) (the Relieva Stratus™ MicroFlow Spacer) could better prevent endoscopic sinus surgery (ESS) than standard non-invasive therapy using corticosteroid nasal spray in patients suffering from chronic rhinosinusitis (CRS).

Design: Prospective, randomised clinical trial.

Setting: Tertiary referral centre.

Participants: Sixty-three adult patients with ethmoidal involvement in cone beam computerised tomography (CBCT) whose first-line medical treatment with topical corticosteroids had failed and who were candidates for ESS were randomised either to a DES group, which received triamcinolone acetonide stents (n = 34), or to a topical intranasal corticosteroid group (n = 29) that used optimally dosed triamcinolone acetonide nasal spray.

Outcome Measures: Patients were followed up prospectively for 6 months and at 36 months. Freedom from ESS was the primary endpoint. Further, we identified those factors predicting ESS.

Results: At 6 months, ESS could be prevented in almost half of the patients in both groups (DES 13/28, 46.4%, nasal spray 14/29, 48.3%). At 36 months, 20/28 (71.4%) patients in the DES group and 18/29 (62.1%) in the nasal spray group had been operated. The differences were not statistically significant at either timepoint. Patients who smoked (14/19, 73.7% vs 16/38, 42.1%) were more likely to be operated at 6 months.

Conclusion: Endoscopic sinus surgery can be prevented using both therapies in the medium term in almost half of cases with neither therapy being statistically superior. This effect was somewhat diminished in the long term with a trend towards more patients being operated in the DES group. Considering the additional costs, the need for general anaesthesia and the potential side effects associated with DES, its potential clinical role appears to be limited. Smoking was significantly associated with ESS.
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http://dx.doi.org/10.1111/coa.13515DOI Listing
May 2020

Employment status of young otorhinolaryngologists in Finland during a 10-year period.

Int J Circumpolar Health 2020 12;79(1):1715710

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

We determined the employment status of recently graduated otorhinolaryngologist-head and neck surgeons (ENT doctors) in Finland during the past 10 years. We also investigated the job vacancy rate of the Departments of Otorhinolaryngology-Head and Neck Surgery (Department of ORL-HNS). An electronic questionnaire was sent to all ENT doctors who had graduated during 2007-2017 and to chief physicians of all Departments of ORL-HNS. Chi-square and Fisher's test were used in the analyses. Altogether 129 ENT doctors had graduated and 125 (96.9%) responded. Thirty (24%) physicians had been employed in a position that did not correspond to their ENT doctor training. All 30 chief physicians responded and a total of 306 physicians were working at their departments (215 ENT doctors, 91 residents). However, there were only 241 available positions (197 for ENT doctors, 44 for residents). It was estimated that 65 ENT doctors would retire within 10 years. At the moment there does not seem to be a significant shortage of ENT doctors in Finland. The current national volume of resident intake in the ENT training programme is twofold in comparison with the estimated retirement rate in the public sector.
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http://dx.doi.org/10.1080/22423982.2020.1715710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006679PMC
December 2020

Observational cross-sectional study on Symptoms Associated to Moisture DAmage at Workplace: the SAMDAW study protocol.

BMJ Open 2019 06 25;9(6):e026485. Epub 2019 Jun 25.

Department of Occupational Medicine, Finnish Institute of Occupational Health, Tampere, Finland.

Introduction: Moisture damage (MD) exposure at work has been shown to increase the risk of new onset asthma and exacerbation of asthma. However, most of the studies in this field have been questionnaire studies. A small proportion of MD-exposed workers are diagnosed with asthma. Many patients with MD exposure at work referred to secondary healthcare report intermittent hoarseness, loss of voice or difficulty to inhale, referring to functional or organic problems of the larynx. For accurate treatment, proper differential diagnostics is paramount. We present an ongoing observational study in which we describe the prevalence of respiratory, voice and other symptoms related to MD at work in patients referred to secondary healthcare. Case-control setting will be used to evaluate the frequencies of the background factors, bronchial hyperreactivity and laryngeal findings.

Methods And Analysis: The study sample consists of patients with workplace MD exposure and associated respiratory tract and/or voice symptoms referred to Tampere University Hospital. The clinical tests conducted to the study patients included comprehensive lung function tests, laboratory and skin prick tests, imaging and clinical evaluation by specialists of respiratory medicine, oto-rhino-laryngology and phoniatrics. The exposure assessment was performed by an occupational physician. The study patients filled out a questionnaire on previous illnesses and other background factors, which for comparison was also sent to 1500 Finnish-speaking people in the same hospital district randomly selected by the Finnish Population Information System. To explore how common laryngeal disorders and voice symptoms are in general, a part of the tests will be conducted to 50 asymptomatic volunteers.

Ethics And Dissemination: The regional ethics committee of Tampere University Hospital approved the study. All study subjects gave their written informed consent, which is required also from the controls. The results will be communicated locally and internationally as conference papers and journal articles.
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http://dx.doi.org/10.1136/bmjopen-2018-026485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597744PMC
June 2019

Pituitary apoplexy following endoscopic nasal surgery: A case report.

SAGE Open Med Case Rep 2019 9;7:2050313X19855867. Epub 2019 Jun 9.

Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland.

Pituitary apoplexy develops as a consequence of acute haemorrhage and/or infarction in a pre-existing pituitary adenoma. Typical symptoms include sudden onset headache, visual acuity/field defects, and ocular palsies. We report a male patient with a known pituitary macroadenoma who underwent a right-sided endoscopic nasal surgery. Preoperatively, thickening of sphenoid mucosa was seen in computed tomography and magnetic resonance imaging. The patient developed pituitary apoplexy postoperatively. The presented report indicates that in patients with a pituitary adenoma, nasal surgery - like any other kind of surgery - is a possible precipitating factor for pituitary apoplexy. Isolated thickening of sphenoid mucosa is associated with pituitary apoplexy. It may also precede an apoplectic event.
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http://dx.doi.org/10.1177/2050313X19855867DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6558528PMC
June 2019

Hierarchical clustering in evaluating inflammatory upper airway phenotypes; increased symptoms in adults with allergic multimorbidity.

Asian Pac J Allergy Immunol 2020 Dec;38(4):239-250

Haartman Institute, Medicum, University of Helsinki, Helsinki, Finland.

Background: Inflammatory upper airway diseases cause significant morbidity. They include phenotypes with different treatment; allergic or non-allergic rhinitis (AR, nAR), and chronic rhinosinusitis with or without nasal polyps (CRSwNP, CRSsNP). In clinical practice, these phenotypes are often difficult to distinguish and may overlap.

Objective: To evaluate if hierarchical clustering can be used to distinguish these phenotypes based on the presence of nasal polyps, off-seasonal allergic symptoms, and self-reported background characteristics - e.g. atopic dermatitis (AD); and to further analyse the obtained clusters.

Methods: We studied a random sample of 74 CRS (chronic rhinosinusitis) patients, and a control group of 80 subjects without CRS with/without AR (tertiary hospitals, 2006-2012). All underwent interview and nasal examination, and filled a questionnaire. Variables regarding demographics, off-seasonal symptoms, and clinical findings were collected. Hierarchical clustering was performed, the obtained clusters were cross-tabulated and analysed.

Results: Four clusters were identified; 1: "Severe symptoms and CRSwNP" (n = 29), 2: "Asymptomatic AR and controls" (n = 39), 3: "Moderate symptoms and CRSsNP" (n = 36), and 4: "Symptomatic and AD" (n = 50). Cluster 1 had most sinonasal symptoms, cluster 3 had a high prevalence of facial pain. The presence of AR did not distinguish CRS groups. Of the AR subjects, 51 % belonged to cluster 4, where AR with off-seasonal airway symptoms and AD predominated.

Conclusions: Hierarchical clustering can be used to distinguish inflammatory upper airway disease phenotypes. The AR phenotype was subdivided by the presence of AD. Adult AR+ AD patients could benefit from active clinical care of the upper airways also off-season.
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http://dx.doi.org/10.12932/AP-170818-0395DOI Listing
December 2020

In vitro detection of common rhinosinusitis bacteria by the eNose utilising differential mobility spectrometry.

Eur Arch Otorhinolaryngol 2018 Sep 24;275(9):2273-2279. Epub 2018 Jul 24.

Department of Otorhinolaryngology, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital, PL 2000, 33521, Tampere, Finland.

Acute rhinosinusitis (ARS) is a sudden, symptomatic inflammation of the nasal and paranasal mucosa. It is usually caused by respiratory virus infection, but bacteria complicate for a small number of ARS patients. The differential diagnostics between viral and bacterial pathogens is difficult and currently no rapid methodology exists, so antibiotics are overprescribed. The electronic nose (eNose) has shown the ability to detect diseases from gas mixtures. Differential mobility spectrometry (DMS) is a next-generation device that can separate ions based on their different mobility in high and low electric fields. Five common rhinosinusitis bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Pseudomonas aeruginosa) were analysed in vitro with DMS. Classification was done using linear discriminant analysis (LDA) and k-nearest neighbour (KNN). The results were validated using leave-one-out cross-validation and separate train and test sets. With the latter, 77% of the bacteria were classified correctly with LDA. The comparative figure with KNN was 79%. In one train-test set, P. aeruginosa was excluded and the four most common ARS bacteria were analysed with LDA and KNN; the correct classification rate was 83 and 85%, respectively. DMS has shown its potential in detecting rhinosinusitis bacteria in vitro. The applicability of DMS needs to be studied with rhinosinusitis patients.
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http://dx.doi.org/10.1007/s00405-018-5055-8DOI Listing
September 2018

A prospective, randomized, placebo-controlled study of inferior turbinate surgery.

Laryngoscope 2018 09 2;128(9):1997-2003. Epub 2018 Feb 2.

Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland.

Objectives/hypothesis: The purpose of this study was to compare radiofrequency ablation, diode laser, and microdebrider-assisted inferior turbinoplasty techniques in the treatment of chronic nasal obstruction caused by inferior turbinate enlargement, and to compare these techniques with a placebo procedure.

Study Design: Prospective, randomized, single-blinded, placebo-controlled study.

Methods: A total of 98 consecutive patients with enlarged inferior turbinates due to persistent year-round rhinitis were randomized into a placebo, radiofrequency ablation, diode laser, and microdebrider-assisted inferior turbinoplasty groups in a ratio of 1:2:2:2. All the procedures were carried out under local anesthesia with the patients' eyes covered. Assessments were conducted prior to surgery and 3 months subsequent to the surgery.

Results: The severity of nasal obstruction measured by visual analog scale score decreased statistically significantly in all the groups, including placebo. Radiofrequency ablation (P = .03), diode laser (P = .02), and microdebrider-assisted inferior turbinoplasty (P = .04) all decreased the symptom score of the severity of nasal obstruction statistically significantly more compared to the placebo procedure.

Conclusions: The placebo effect had a large role in the overall improvement of the severity of nasal obstruction after the inferior turbinate surgery. However, all three techniques provided a statistically significant additional reduction of the severity of nasal obstruction compared to the placebo procedure.

Level Of Evidence: 1b. Laryngoscope, 128:1997-2003, 2018.
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http://dx.doi.org/10.1002/lary.27103DOI Listing
September 2018

Allergic rhinitis.

Authors:
Jura Numminen

Duodecim 2017;133(5):473-8

There have been no major changes in the pharmacological treatment of allergic rhinitis in recent years. Treatment is symptomatic and tailored individually, taking into account the type and severity of symptoms. Few new products have entered the market, and treatment is still largely based on antihistamines and nasally administered glucocorticoids. However, the general strategies for treating allergic rhinitis have developed over the last decade due to the introduction of the Finnish National Allergy Program. The treatment should aim at improving tolerance. Avoiding allergens is not necessary but it may help in controlling the symptoms. Hyposensitization, the only disease-modifying therapy, is a recommended, effective and safe form of treatment. New, practical sublingual hyposensitization products have facilitated treatment implementation and moved it from outpatient clinics into homes, which is a more patient-oriented approach and also cost-effective in the long term. However, the unit costs of treatment are relatively high for the patients.
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January 2018

Eustachian Tube Dysfunction-Related Symptoms in Chronic Nasal Obstruction Caused by Inferior Turbinate Enlargement.

Ann Otol Rhinol Laryngol 2017 Dec 4;126(12):798-803. Epub 2017 Oct 4.

1 Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland.

Objective: The aim of this study was to evaluate the relationship between chronic nasal obstruction caused by inferior turbinate enlargement and Eustachian tube dysfunction-related symptoms using the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) as an assessment method.

Methods: A total of 80 adults were enrolled. Group 1 comprised consecutive patients with enlarged inferior turbinates and group 2 comprised healthy controls. The ETDQ-7 scores and tympanometry results of both groups were analyzed and compared.

Results: The median total scores of the ETDQ-7 in groups 1 and 2 were 1.9 (interquartile range, 1.4-2.8) and 1.1 (interquartile range, 1.0-1.7), respectively ( P < .001). There was no significant difference in the abnormal tympanometry results between the groups. There was no significant difference in the ETDQ-7 total score between the patients with allergic sensitization and other patients in group 1.

Conclusions: Patients with inferior turbinate enlargement have more symptoms related to Eustachian tube dysfunction than healthy controls. Most patients with Eustachian tube dysfunction had normal tympanometry and normal otoscopy, which indicates a baro-challenge-induced Eustachian tube dysfunction. Whether the patient has allergic sensitization or not does not seem to cause a difference in symptoms related to Eustachian tube dysfunction.
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http://dx.doi.org/10.1177/0003489417735538DOI Listing
December 2017

The effect of inferior turbinate surgery on ear symptoms.

Laryngoscope 2018 03 22;128(3):568-572. Epub 2017 Aug 22.

Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland.

Objective: The aim of this placebo-controlled study was to evaluate the effect of various inferior turbinate surgery techniques on Eustachian tube dysfunction-related symptoms.

Study Design: Outcomes were evaluated using the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and tympanometry results.

Methods: A total of 72 consecutively blinded and randomized adult patients with enlarged inferior turbinates due to persistent year-round rhinitis underwent either a radiofrequency ablation, diode laser, microdebrider-assisted inferior turbinoplasty, or sham surgery procedure. Assessments were conducted prior to surgery and 3 months subsequent to the surgery.

Results: In the evaluation of all patients, radiofrequency ablation, microdebrider-assisted inferior turbinoplasty, and sham surgery procedures decreased the ETDQ-7 total score significantly. In a three-way analysis of covariance, there were no significant differences in the results between sham surgery and any of the active treatment procedures. Allergic sensitization, sex, and age also had no effect on the results. There were no significant changes in the pre- and postoperative amounts of abnormal tympanometry curves or in the pre- and postoperative tympanometric peak pressure values in the actively treated patients or in the sham surgery group.

Conclusion: The improvement of Eustachian tube dysfunction-related symptoms due to surgery of the anterior half of the inferior turbinate was found to be equal to placebo. The findings of this study do not support the use of reduction of the anterior half of the inferior turbinate as a sole procedure intended to treat the ear symptoms assessed by the ETDQ-7 questionnaire.

Level Of Evidence: 1b. Laryngoscope, 128:568-572, 2018.
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http://dx.doi.org/10.1002/lary.26823DOI Listing
March 2018

Inter-observer agreement of paranasal sinus computed tomography scans.

Acta Otolaryngol 2017 Jun 16;137(6):611-617. Epub 2016 Dec 16.

a Transplantation Laboratory , Haartman Institute, University of Helsinki , Helsinki , Finland.

Conclusion: The study demonstrated considerable inter-observer variation in certain surgically important structures. This would indicate the significance for consultation when evaluating sinus CT scans of CRS patients for planned advanced sinus surgery.

Objectives: After the failure of medical treatment of chronic rhinosinusitis (CRS), the need for surgery and the pre-operative planning of safe surgery is based on computed tomography (CT) findings. The aim of this prospective study was to compare inter-observer agreement of anatomical and surgical structures of sinus CT scans. The hypothesis was that the agreement between observers is good.

Methods: Of these 57 CRS patients, Lund-Mackay (LM) scores and 43 other structural parameters were analyzed blinded. The reproducibility of the findings between three observers, a radiologist, an Ear, nose and throat (ENT) surgeon, and an ENT resident, were compared.

Results: In general, there was moderate inter-observer agreement of the structures by Cohen's kappa coefficient. Poor reproducibility was observed in the following structures: optic nerve, insertion of the uncinated process, anterior ethmoidal artery, and Keros class.
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http://dx.doi.org/10.1080/00016489.2016.1262552DOI Listing
June 2017

Treatment of rhinosinusitis and histopathology of nasal mucosa: A controlled, randomized, clinical study.

Laryngoscope 2016 12 3;126(12):2652-2658. Epub 2016 Jun 3.

Department of Otorhinolaryngology and Oral Diseases, Tampere University and University Hospital of Tampere, Tampere, Finland.

Objectives/hypothesis: To study the pathology of upper airway mucosa, as well as valuate and compare changes in pathology after the treatment of chronic rhinosinusitis (CRS) patients with balloon sinuplasty versus uncinectomy.

Methods: A prospective randomized controlled trial in patients with CRS of the maxillary sinuses without severe pathology of other sinuses. Patients were randomized into two groups: uncinectomy and balloon sinuplasty. The main variables in our study are histopathology of nasal mucosa and expression of metalloproteinase-9 protein. These parameters were analyzed preoperatively and at 3 months, 6 months, and 12 months postoperatively.

Results: Thickened epithelium, absence of cilia, metaplasia of epithelium, hyperplasia of mucosal glands, angiogenesis, and increased inflammatory cells were observed in the majority of preoperative samples. History of allergy was associated with a higher number of goblet cells, and shedding of epithelium was associated with worse quality of life. A higher number of inflammatory cells were associated with an increased number of goblet cells preoperatively, as well as after treatment. Both treatments resulted in a decrease of inflammation in the mucosa and epithelium. Hypertrophy of the mucosal glands, hyperplasia of blood vessels, and mucosal edema decreased after treatment. These changes were more noticeable in uncinectomy group. Balloon sinuplasty was associated with a higher number of inflammatory cells at 6 months after treatment (P = 0.05).

Level Of Evidence: 1b. Laryngoscope, 126:2652-2658, 2016.
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http://dx.doi.org/10.1002/lary.26072DOI Listing
December 2016

Myxoinflammatory fibroblastic sarcoma of the nose: First reported case at an unusual location (nasal dorsum), with a review of the literature.

Ear Nose Throat J 2016 Mar;95(3):E32-5

Department of Ear and Oral Diseases, Tampere University Hospital, PO Box 2000, 33 521 Tampere, Finland.

Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare, low-grade, malignant, soft-tissue tumor that typically affects the distal extremities of middle-aged patients. In most cases, it presents as a painless, slowly growing mass within the subcutaneous tissue. It is associated with a low rate of metastasis but a high rate of local recurrence. In addition to the distal extremities, MIFS has been reported in the thigh, arm, forearm, groin, upper back, neck, and temporal area. As far as we know, no case has been previously reported in the nasal area. We report for the first time a case of MIFS presenting on the dorsum of the nose. The painless, 3.0-cm tumor was initially mistaken for reticular erythematous mucinosis, a benign skin condition that occurs when fibroblasts produce abnormally large amounts of mucopolysaccharides. The tumor was surgically removed in its entirety with surgical margins of 3 to 5 mm. During 4 years of follow-up, no clinical or radiologic evidence of a recurrence or metastasis was seen. We discuss the imaging and histologic features of MIFS, as well as its clinical management and follow-up, and we review related reports in the literature.
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http://dx.doi.org/10.1177/014556131609500304DOI Listing
March 2016

A Controlled, Randomized Clinical Study on the Impact of Treatment on Antral Mucociliary Clearance: Uncinectomy Versus Balloon Sinuplasty.

Ann Otol Rhinol Laryngol 2016 May 26;125(5):408-14. Epub 2015 Nov 26.

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

Objectives: To find out the effect of minimal invasive sinus surgery and balloon sinuplasty on mucociliary clearance and compare different methods of measuring mucociliary clearance.

Methods: Twenty-nine patients with chronic rhinosinusitis were randomized in 2 operative groups (uncinectomy or balloon sinuplasty). Before and 6 months after the treatment, patients filled out a quality of life questionnaire (Sino Nasal Outcome Test-22 [SNOT-22]), and mucociliary clearance was measured with endoscope and gamma camera after 0.03 ml of saccharine, methylene-blue dye, and human albumin labeled with Tc99m was introduced to the bottom of maxillary sinuses.

Results: In uncinectomy group, SNOT-22 score decreased, but treatment had no effect on mucociliary clearance. Based on saccharine test, smoking was associated with worse mucociliary clearance (r = 0.618, P < .05). Methylene blue test results associated with saccharine test (r = 0.434, P < .05) and Tc99m-labeled tracer technique (r = 0.261, P = .039) separately.

Conclusion: Treatment positively affects patients' quality of life; however, it has no effect on mucociliary clearance. There was a statistically significant correlation between the Tc99m-labeled tracer technique and the methylene blue technique. The saccharine technique was even less accurate, but it can be useful in clinical practice because it is a quick, easy, and safe technique.
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http://dx.doi.org/10.1177/0003489415618676DOI Listing
May 2016

The Experience of Treating Drooling with Repeated Botulinum Toxin Injections.

ORL J Otorhinolaryngol Relat Spec 2015 30;77(6):333-8. Epub 2015 Sep 30.

Department of Otorhinolaryngology, Head and Neck Surgery, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland.

Botulinum toxin A (BTX-A) injections to the salivary glands are effective in the treatment of drooling, and complications are rare. However, there are only a few previous reports on the long-term use of BTX-A injections. This study retrospectively analyzes our experience of treating drooling with repeated BTX-A injections in patients with neurodegenerative diseases. All patients who received repeated BTX-A injections to the submandibular glands at Tampere University Hospital in 2004-2013 were included in the analysis. Six patients, aged from 6 to 21 years, were included in the study, and a total of 41 bilateral BTX-A injections were administered to their submandibular glands. The average number of injections per patient was 6 (range: 3-11). The average interval between the injections was 9.8 months (range: 4-18), and 95% (39/41) of the injections were performed with good response. The complication rate of the BTX-A injections was 2.4% (1/41), since one of the patients had swallowing problems after an injection. BTX-A injections to the submandibular glands are effective and have a low morbidity rate, and repeated injections can be recommended as long-term treatment of drooling.
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http://dx.doi.org/10.1159/000439175DOI Listing
September 2016

Retrospective analysis of a combined endoscopic and transcutaneous technique for the management of parotid salivary gland stones.

ORL J Otorhinolaryngol Relat Spec 2014 5;76(5):282-7. Epub 2014 Dec 5.

Department of Ear and Oral Diseases, Tampere University Hospital, Tampere, Finland.

Sialendoscopy is used in the diagnosis and treatment of various symptoms relating to the salivary gland, e.g. chronic swelling or obstruction and inflammation of the salivary duct. Small intraductal stones can be removed with various instruments during sialendoscopy, whereas larger ones can be fragmented with extracorporeal shockwave lithotripsy or laser. However, 5-10% of the patients with parotid stones cannot be treated with these methods. In patients with large impacted stones or stones in a hilus area, a combined endoscopic and transcutaneous technique can be employed. The stone is approached endoscopically, a skin flap is raised over or a small incision is made through the illuminated area, and the stone is removed by an external route with minimal morbidity. This retrospective study analysed the cases of 8 patients treated using the combined technique, 6 of whom became symptom free. Superficial parotidectomy was performed in 1 patient. No complications were observed, and ductal stents were not used. The average diameter of the stones was 7.6 mm (range 7.0-10.2). The combined technique is recommended for the removal of large and impacted intraductal stones in the parotid gland. No major complications have been reported.
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http://dx.doi.org/10.1159/000368719DOI Listing
July 2015

Image-guided, navigation-assisted Relieva Stratus MicroFlow Spacer insertion into the ethmoid sinus.

Eur Arch Otorhinolaryngol 2015 Sep 18;272(9):2335-40. Epub 2014 Oct 18.

Department of Ear and Oral Diseases, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland,

Anatomical complexity presents the main challenge in the administration of topical corticosteroid therapy to the paranasal sinus mucosa. This often leads to suboptimal drug delivery due to low concentrations of the therapeutic agent to the intended target area. The Relieva Stratus™ MicroFlow Spacer (Relieva Stratus) is a drug-eluting stent that is temporarily implanted into the ethmoid sinus. The reservoir of the stent is filled with triamcinolone acetonide, which is then slowly released from the device into the ethmoid sinus mucosa. The Relieva Stratus provides local and targeted delivery of the anti-inflammatory agent to the diseased mucosa. This minimally invasive implant is an option when treating ethmoid sinusitis. From January 2011 to November 2013, a total of 52 Relieva Stratus implantations into the ethmoidal cells were performed at the Department of Ear and Oral Diseases at Tampere University Hospital, Finland. C-arm fluoroscopy guidance was employed for 26 sinuses (13 patients) and optical image-guided surgery (IGS)-assisted insertions were performed on another 26 sinuses (13 patients). The accuracy of fluoroscopic insertion is not optimal, but this method is accurate enough to prevent the violation of the skull base and lamina papyracea. IGS enables the precise treatment of the diseased cells. From a technical perspective, IGS-guided insertion is a faster, safer and more exact procedure that guarantees the optimal positioning and efficacy of the implant. Moreover, IGS guidance does not entail the use of ionizing radiation.
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http://dx.doi.org/10.1007/s00405-014-3334-6DOI Listing
September 2015

Adipose stem cells used to reconstruct 13 cases with cranio-maxillofacial hard-tissue defects.

Stem Cells Transl Med 2014 Apr 20;3(4):530-40. Epub 2014 Feb 20.

Institute of Biosciences and Medical Technology (BioMediTech), University of Tampere, Tampere, Finland; Department of Oral and Maxillofacial Surgery, University of Oulu, Oulu, Finland; Oulu University Hospital, Oulu, Finland; Department of Otolaryngology, Head and Neck Surgery and Oral Diseases and Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland; Department of Oral and Maxillofacial Surgery, Central Hospital of Central Finland Health Care District, Jyväskylä, Finland; Department of Biomedical Engineering, Tampere University of Technology, Tampere, Finland.

Although isolated reports of hard-tissue reconstruction in the cranio-maxillofacial skeleton exist, multipatient case series are lacking. This study aimed to review the experience with 13 consecutive cases of cranio-maxillofacial hard-tissue defects at four anatomically different sites, namely frontal sinus (3 cases), cranial bone (5 cases), mandible (3 cases), and nasal septum (2 cases). Autologous adipose tissue was harvested from the anterior abdominal wall, and adipose-derived stem cells were cultured, expanded, and then seeded onto resorbable scaffold materials for subsequent reimplantation into hard-tissue defects. The defects were reconstructed with either bioactive glass or β-tricalcium phosphate scaffolds seeded with adipose-derived stem cells (ASCs), and in some cases with the addition of recombinant human bone morphogenetic protein-2. Production and use of ASCs were done according to good manufacturing practice guidelines. Follow-up time ranged from 12 to 52 months. Successful integration of the construct to the surrounding skeleton was noted in 10 of the 13 cases. Two cranial defect cases in which nonrigid resorbable containment meshes were used sustained bone resorption to the point that they required the procedure to be redone. One septal perforation case failed outright at 1 year because of the postsurgical resumption of the patient's uncontrolled nasal picking habit.
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http://dx.doi.org/10.5966/sctm.2013-0173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973720PMC
April 2014

[Update on Current Care Guideline: Sinusitis].

Duodecim 2013 ;129(21):2294-5

Suomalaisen Lääkäriseuran Duodecimin ja Suomen Otolaryngologiyhdistys ry:n asettama työryhmä.

Patients with common cold have often symptoms similar to sinusitis. These symptoms often resolve in time, but symptomatic treatment (e.g. analgesics, decongestants) may be used. If symptoms continue for over 10 days, or severe symptoms continue for over 3 days, or symptoms turn worse in the course of the disease, bacterial sinusitis should be suspected. Diagnosis is based on clinical findings, and can be confirmed with ultrasound examination. Amoxicillin, penicillin or doxicyclin are recommended for bacterial sinusitis. Patients with chronic or recurrent sinusitis should be referred to specialist care.
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January 2014

[Combined technique in the removal of parotid gland stones].

Duodecim 2013 ;129(11):1181-5

Satakunnan keskussairaala, korva-, nenä- ja kurkkutautien klinikka.

Sialendoscopy is used in the diagnostics and treatment of salivary gland swelling. Small intraductal stones can be removed with various instruments during sialendoscopy. In cases with larger fixed stones a combined technique can be applied. The stone is approached endoscopically, skin flap is raised or a small incision is made through the illuminated area and the stone is removed via the external route with minimal morbidity. In this series five out of seven patients treated by the combined technique became symptomless. Superficial parotidectomy was performed on one patient. The combined technique is recommended in the removal of stones that are large, fixed in the duct or located in the gland's hilus.
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August 2013

[Airways dysfunction syndromes RADS and RUDS].

Duodecim 2013 ;129(6):615-9

Työterveyslaitos, Tampere, TAYS:n työlääketieteen poliklinikka.

RADS is an airways dysfunction syndrome caused by a sudden, massive exposure to an irritative chemical. RADS is considered a subtype of occupational asthma. RADS patient may cure within months, but RADS may also become a permanent disability. RUDS is a dysfunction syndrome in upper airways caused by exposure to an irritative chemical. It seems that in RUDS there are problems in olfactory function in addition to inflammation of upper airways. We present a patient, who was suddenly exposed to chemical vapours in her workplace. She had RADS-like symptoms and was diagnosed with RUDS.
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July 2013

Towards a defined, serum- and feeder-free culture of stratified human oral mucosal epithelium for ocular surface reconstruction.

Acta Ophthalmol 2013 Dec 11;91(8):744-50. Epub 2012 Sep 11.

Institute of Biomedical Technology, University of Tampere, Tampere, FinlandBioMediTech, Tampere, FinlandDepartment of Eye, Ear, and Oral Diseases, Tampere University Hospital, Tampere, FinlandSILK, Department of Ophthalmology, University of Tampere, Tampere, FinlandEye Center, Tampere University Hospital, Tampere, Finland.

Purpose: Ocular surface reconstruction with cultivated oral mucosal epithelial transplantation technique is a viable treatment option for severe ocular surface injuries and diseases with limbal stem cell deficiency. Currently, this technique is based on utilization of xenogenic, allogenic or undefined components such as murine 3T3 feeders, serum and amniotic membrane. In this study, we aimed to find a more defined culture method to generate stratified human oral mucosal epithelium.

Methods: In this study, we have examined the formation of stratified cell sheets from human oral mucosal epithelial cells under serum-free culture environment both in the absence and presence of fibroblast-conditioned culture medium and elevated epidermal growth factor (EGF) concentration.

Results: In all examined culture conditions, the cultivated oral epithelial cells formed a stratified tissue, which was positive for keratins K3/12, K4 and K13. The tissue-engineered oral epithelia also expressed proliferation and progenitor markers Ki67 and p63 in the basal layer of the cell sheets, suggesting that the epithelia still had regenerative capacity. The cultures presented expression of tight junction proteins ZO-1 and occludin and high transepithelial electrical resistance values.

Conclusion: In this culture method, we have been able to produce stratified cell sheets successfully without serum, conditioning of the medium or increased EGF concentration. We provide a novel protocol to produce tight multi-layered epithelium with proliferative potential, which can be easily adapted for cultivated oral mucosal epithelial transplantation.
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http://dx.doi.org/10.1111/j.1755-3768.2012.02523.xDOI Listing
December 2013

[Osler's disease or hereditary hemorrhagic telangiectasia].

Duodecim 2012 ;128(6):590-7

TAYS, Silmä, Korva-ja Suusairauksein Vastuualue.

According to current knowledge, Osler's disease may be caused by gene defects of several distinct genes, causing vascular fragility and lack of contractility. The most typical symptoms are recurrent spontaneous nose bleedings. Other target organs of the disease include skin, lungs, intestinal tract, brain and liver, but symptoms in these organs are less common. The diagnosis is based on clinical findings, family history and can, if necessary, be confirmed by a gene test. Osler's disease is treated symptomatically. There is no curative treatment.
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May 2012

[Pott's puffy tumor--a rare complication of frontal sinusitis].

Duodecim 2012 ;128(1):94-7

Tampereen yliopistollinen sairaala, korva-, nenä ja kurkkutaudit ja Tampereen yliopisto.

Pott's puffy tumor is an extremely rare complication of frontal sinusitis. It is most typically found in young men. Streptococci, staphylococci or anaerobic bacteria are usually the causative agents. In our patients the inflammation was caused by Streptococcus milleri and Streptococcus pneumoniae. The treatment should be started with broad-spectrum antibiotics. The antibiotics are administered intravenously for 1 to 2 weeks and thereafter orally for at least four weeks. Paranasal sinuses must be operated, and if necessary, intracranial abscesses are treated neurosurgically.
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April 2012