Therese Ovesen | Aarhus University (original) (raw)
Papers by Therese Ovesen
Heliyon, 2022
Background The standard treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) consti... more Background The standard treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) constitutes of systemic oral corticosteroid. Although oral corticosteroid might revert the acute deafness, some patients with ISSNHL display a more treatment refractory course. For these patients, corticosteroid installed directly into the middle ear has become a more frequent treatment, due to the potential benefits of a high, local concentration compared to a systemic administration. As such, for patients being refractory to standard treatment, intratympanic injection of a high dosage of corticosteroid as salvage therapy may be beneficial. Objectives To evaluate the efficacy of intratympanic corticosteroid (ITC) as a salvage treatment of ISSNHL. Methods A systematic literature search was performed in relevant databases. Both randomized trials and observational studies were considered for inclusion. The risk of bias was evaluated using the Cochrane risk of bias tool (randomized trials) or ROBINS-I tool (observational studies). Meta-analysis was performed to investigate the improvement of PTA (dB) and number of patients displaying recovery following salvage ITC injections. Occurrence of serious side effects was investigated. Finally, the certainty of the evidence was evaluated using the GRADE approach. Results Eleven relevant studies were identified (4 randomized trials and 7 observational studies). Both observational and randomized trials showed that salvage ITC significantly increased the number of patients displaying recovery. No serious adverse events were identified in any of the included studies. The certainty of evidence ranged from moderate to very low, due to risk of bias, imprecision, and heterogeneity. Conclusion Collectively, our findings indicate that salvage ITC treatment may be a beneficial and safe treatment for patients with sudden hearing loss, who otherwise are refractory to standard treatment approaches. However, the evidence level indicates need for a cautious interpretation of especially the magnitude of effect and thus the extrapolation on how much the individual may improve from this treatment. Furthermore, it remains to be investigated whether treatment outcomes may vary across different patient groups presenting with ISSNHL. This potential variation in treatment response should be kept in mind, when counselling the patient. Trial registration number The protocol is registered in PROSPERO. Registration number: CRD42019130586.
Ugeskrift for Læger, 2009
European Journal of Cancer, 2021
BACKGROUND We aimed to compare the predictive performance of pN-categories in oral squamous cell ... more BACKGROUND We aimed to compare the predictive performance of pN-categories in oral squamous cell carcinoma (OSCC) encompassing the most recent 8th edition (TNM8), its predecessor (TNM7), and a newly proposed algorithm (pN-N+), which classifies patients according to the number of positive lymph nodes and extranodal extension. METHODS Consecutive, primary OSCC patients from seven previously published cohorts were included and classified according to the three pN-classifications: TNM7, TNM8 and pN-N+. Overall survival probabilities were summarised with the Kaplan-Meier method. We added each of the three metrics to a Cox regression adjusted for pT-category, lymph nodal yield, age, sex, radiotherapy and chemotherapy, and trained these models in one institution. We evaluated the predictive performance in the remaining six institutions and assessed the predicted 5-year risk of death using the area under the receiver operating characteristics curve (AUC) and Brier scores. RESULTS All 1,905 included patients were classified according to TNM7 and pN-N+. A subset of 1,575 patients was additionally classified according to TNM8, leading to upstaging in 27.0%. The pN-N+ ranked overall best determined by the obtained AUC and Brier scores. In contrast to pN-N+, TNM7 and TNM8 both suffered from disproportionate patient distribution across pN-categories and poor pN-categorial discrimination on overall survival. CONCLUSIONS The TNM8 pN-classification designates a larger subset to more advanced disease stages but failed to show improvement of its predictive performance compared to TNM7. The pN-categories of TNM7/8 are disproportionate and inconsistently discriminated. The pN-N+ conveyed the best measures of prognosis and should be considered in future TNM iterations.
Hearing, Balance and Communication, 2019
Purpose: Adolescents presenting with vertigo can be a diagnostic challenge. Video head impulse te... more Purpose: Adolescents presenting with vertigo can be a diagnostic challenge. Video head impulse testing (vHIT) offers examination of the semicircular canals in adolescents with few drawbacks. It quantifies the vestibular ocular reflex as a gain-value. However, there is no standardized method to calculate the gain-value. The aim of this article is to define which gain measure is the most optimal and whether the test is clinically tolerable and feasible in diagnostics of adolescents. Methods: Thrity-three Danish healthy adolescents aged 13-16 years, had their lateral semicircular canals examined with vHIT. Gain calculations were obtained at 40, 60, 80, 0-100 ms and as a regression gain. Results: Mean gain values for the right side were: 40 ms: 1.04, 60 ms: 0.98, 80 ms: 0.93, 0-100 ms: 1.08 and regression: 1.04. For the left-side gain values were 40 ms: 0.96, 60 ms: 0.96, 80 ms: 0.98, 0-100 ms: 1.00 and regression: 1.01. T-tests on 60 ms, 0-100 ms and regressions gain showed that 60 ms differed significantly from 0 to100 ms and regression gain. No complaints of discomfort were reported by any of the test subjects. Conclusions: vHIT proved to be a highly applicable procedure with many advantages, but also some potential pitfalls. In healthy adolescents, 0-100 ms and regression gain produce the most reliable results.
International Journal of Pediatric Otorhinolaryngology, 2019
Vestibular dysfunction, which may lead to delayed motor development and reduced quality of life, ... more Vestibular dysfunction, which may lead to delayed motor development and reduced quality of life, is an overlooked entity among children and adolescents. Vestibular evoked myogenic potential (VEMP) is a common, safe diagnostic tool in adults with vestibular disorders. No normative data exist for children and adolescents. Our objective was to collect and assess normative VEMP data for adolescents. Methods: Cervical VEMP (cVEMP) with air-conducted sound. Endpoints were peak latencies after 13 and 23 ms (P13 and N23) and amplitude. Ocular VEMP (oVEMP) with bone-conducted vibration on the mastoid. Endpoints were latencies (N10 and P15) and amplitude. A meta-analysis of existing cVEMP data in children. Results: cVEMP response rate (RR) was 85%, mean P13 and N23 latencies were 15.44 and 25.55 ms, respectively, and the asymmetry ratio (AR) was 14%. oVEMP RR was 100%, mean N10 and P15 were 10.61 and 16.58 ms, respectively, and the AR was 12%. In the meta-analysis, the pooled mean P13 and N23 were 12.75 and 21.8 ms, respectively. Head elevation (HE) gave shorter latencies than head rotation (HR). Conclusion: The oVEMP data represents normal values for adolescents aged 13-16 years. Height should be considered more important than age when interpreting cVEMP in adolescents. Separate normative cVEMP data should be established for HE and HR.
Danish medical journal, 2013
The objective was to evaluate the long-term results of outpatient tonsillectomy in Danish ear, no... more The objective was to evaluate the long-term results of outpatient tonsillectomy in Danish ear, nose and throat (ENT) practices in terms of satisfaction, quality of life (QoL) and relief of symptoms. A telephone interview was carried out at least three years after tonsillectomy. Alternatively, a questionnaire was filled in by the patients. The answers were compared to a pre-operative questionnaire. The response rate was 63% (386/614). No differences were found between the responders and the non-responders except that the proportion of smokers was higher in the non-responder group. QoL improved significantly and 93% were satisfied with having chosen tonsillectomy. 95% experienced complete or partial relief from their former throat-related symptoms. Eight to 11% had developed new symptoms from the throat including sleep-disordered breathing. With regard to QoL, satisfaction and relief of symptoms, the long-term results of outpatient tonsillectomy in Danish ENT practices are comparable ...
Ugeskrift for laeger, Jan 12, 2010
In Danish healthcare there are increasing demands in the field of hospital care on performance an... more In Danish healthcare there are increasing demands in the field of hospital care on performance and outcome measurement and quality improvement in relation to a number of diseases. Hitherto, corresponding measurements of quality have not been carried out among private specialized practitioners. The present project describes the development and selection of evidence-based national indicators, standards, and case mix factors in terms of prognostic factors with the purpose of measuring quality of out-patient tonsillectomy in Danish ear, nose & throat practices.
Dysphagia, 2005
The purpose of this prospective study was to determine if fiberoptic endoscopic evaluation of swa... more The purpose of this prospective study was to determine if fiberoptic endoscopic evaluation of swallowing (FEES) maintains high intra- and interrater reliability in detecting pharyngeal dysphagia and aspiration without the addition of FD&C Blue No. 1 to food. Twenty consecutive adults referred for a swallow evaluation participated. Nine subjects received blue-dyed food and 11 subjects received regular nondyed food, i.e., yellow pudding and white skim milk. Four variables were rated: (1) the stage transition characterized by depth of bolus flow to at least the vallecula prior to the pharyngeal swallow; (2) evidence of bolus retention in the vallecula or pyriform sinuses after the pharyngeal swallow; (3) laryngeal penetration defined as material in the laryngeal vestibule but not passing below the level of the true vocal folds either before or after the pharyngeal swallow; and (4) tracheal aspiration defined as material below the level of the true vocal folds either before or after the pharyngeal swallow. Three speech-language pathologists experienced in interpreting FEES results independently and blindly reviewed the digitized videotape three times. Intrarater agreements for the four variables with blue-dyed and non-blue-dyed food trials were 100% and monochrome trials ranged from 95% to 100%. Average kappa values for interrater reliability ranged from moderate to excellent agreement (0.61-1.00) for all viewing conditions. Kappa values for blue-dyed trials versus monochrome trials were 0.83 and for non-blue-dyed trials versus monochrome trials were 0.88, indicative of excellent reliability under both viewing conditions. FEES maintains both high intra- and interrater reliability in detecting the critical features of pharyngeal dysphagia and aspiration using either blue-dyed or non-blue-dyed foods. The endoscopist, therefore, can be assured of reliable FEES results using regular, non-dyed food trials.
International Journal of Pediatric Otorhinolaryngology
Acute leukemia is a well known childhood cancer. The relation between leukemia and otological sym... more Acute leukemia is a well known childhood cancer. The relation between leukemia and otological symptoms has long been established but is highly rare as a debut symptom of leukemia. External otitis is a common condition affecting many children, and most cases are successively treated with topical medicine. Here we present a child with acute external otitis later shown to be the debut symptom of acute myeloid leukemia, to our knowledge the first specific case described. We have reviewed the literature to find red flags for suspicion of severe disease in case of acute external otitis.
Ugeskrift for Læger, 2013
Acta Paediatrica, 2021
It has been suggested that adolescents diagnosed with ADHD have an unhealthier diet compared to t... more It has been suggested that adolescents diagnosed with ADHD have an unhealthier diet compared to their peers without ADHD. The association between chemosensation (smell and taste) and dietary patterns remains unknown. The aim is to investigate unhealthy food preferences and food neophobic behaviour among adolescents diagnosed with ADHD. Additionally, it is to investigate the relationship between dietary patterns and chemosensory function.
Infectious Diseases, 2017
Background: Necrotizing fasciitis in the head and neck (NF-HN) is a rare and potentially life-thr... more Background: Necrotizing fasciitis in the head and neck (NF-HN) is a rare and potentially life-threatening condition. The use of hyperbaric oxygen therapy (HBOT) in the acute regimen is disputed and there is a lack of evidence of therapeutic effect. This study aims to describe a retrospective cohort of patients with NF-HN and investigate the use of HBOT and consequences thereof. Methods: All patients treated for NF-HN at Aarhus University Hospital (AUH) between 2002 and 2014 were included in this retrospective cohort. Data regarding demographics, treatment and a one-year follow-up was registered. A review of the literature on NF-HN and HBOT was performed. Results: Forty-three patients were consecutively treated for NF-HN during the period. All patients were treated in accordance with current guidelines with HBOT as a variable. Thirty patients received HBOT, and 13 patients were omitted from HBOT for different reasons. In the HBOT group were no mortalities vs. three mortalities in the non-HBOT group two late deaths due to precursory underlying cancer of the head and neck, and one early death shortly after admittance. We found higher rates of complications (63% vs. 25%) and sequelae (77% vs. 40%) among the HBOT group compared to the non-HBOT group. Conclusions: Our findings suggest that HBOT for NF-HN may only be optional and that the decision relies on an individual assessment of each patient. Further research is needed concerning the evidence of HBOT and towards selecting the patients benefitting from HBOT. KEYWORDS Necrotizing fasciitis head and neck hyperbaric oxygen treatment complications sequelae ARTICLE HISTORY
Ugeskrift for laeger, Jan 13, 2014
In this study literature search was performed on tinnitus guidelines and treatment. Tinnitus can ... more In this study literature search was performed on tinnitus guidelines and treatment. Tinnitus can be described as the perception of sound in the absence of external acoustic stimulation, and validated questionnaires, oto-neurological examination, audiometry tests, MRI and angiography are necessary as diagnostic tools. Antidepressants, melatonin and cognitive behavioural therapy have no effect on tinnitus, whereas sound generators, hearing aids and tinnitus retraining therapy show some but limited improvement. National recommendations are required to ensure a homogenous and optimum offer for all patients.
Danish medical journal, 2014
In Denmark, it is compulsory to report post-operative infections (PI) to the Danish Health and Me... more In Denmark, it is compulsory to report post-operative infections (PI) to the Danish Health and Medicines Authority. The aims of the present study were to determine, firstly, the incidence of PI following elective ear, nose and throat (ENT) surgery as well as the number of cases reported to the Danish health authorities; secondly, the PI distribution in various surgical subgroups; and, thirdly, the extent to which the guidelines on prophylactic antibiotics had been followed. The study was carried out prospectively at the ENT department, Aarhus University Hospital, Denmark, from 1 February to 30 April 2011. A total of 362 elective surgical procedures were evaluated in order to identify signs of PI. In case of PI, the following were registered: diagnosis, type of operative procedure and whether the patient had received prophylactic antibiotics according to instructions given at the Department. The ENT doctors were to hand in completed PI reporting schedules to one of the authors. PI oc...
Pediatrics international : official journal of the Japan Pediatric Society, 2014
The aim of this retrospective case study at a tertiary referral center was to investigate the out... more The aim of this retrospective case study at a tertiary referral center was to investigate the outcome of cochlear implantation (CI) in children with sensorineural hearing loss due to meningitis compared to CI in children with deafness due to other reasons. This post-meningial group (PMG) consisted of 22 children undergoing CI due to deafness induced by meningitis, between December 1996 and January 2012. Five children had bilateral simultaneous implantation. None was excluded and the children were followed for at least 3 years. Operations were carried out by one of two surgeons using similar techniques in all cases. Each patient from the PMG was matched 2:1 with children having implantation for other reasons according to age and follow up (control group). Overall, the median category of auditory performance (CAP) and speech intelligibility rating (SIR) score were not statistically significantly different between the two groups. The presence of additional central nervous system (CNS) ...
Danish medical journal, 2012
The objective of this study was to evaluate whether the increased use of angiotensin-converting e... more The objective of this study was to evaluate whether the increased use of angiotensin-converting enzyme inhibitors (ACEI) has affected the rate of upper airway angio-oedema (AE). In addition, we evaluated the presentation and treatment of patients with upper airway AE. This was a ten-year retrospective study of 112 patients presenting with upper airway AE at The Department of Otorhinolaryngology, Aarhus University Hospital, Denmark. Incidence, presentation and treatment in the 2000-2004-period were compared to those of the 2005-2009-period. In the ten-year period, we found 112 AE patients of whom 39% were using ACEI. The relative risk of AE was 7.7 (p < 0.0001) among ACEI users. We found a 67% increase in AE in 2005-2009 compared with 2000-2004 which corresponds to a similar increase in ACEI use in the Danish population. The most frequent anatomic sites of involvement were the floor of the mouth and/or oropharynx including the base of the tongue. Two patients required intubation u...
International Journal of Pediatric Otorhinolaryngology Extra, 2010
Infantile myofibromatosis is a common fibrous tumor of infancy, however still considered a rarity... more Infantile myofibromatosis is a common fibrous tumor of infancy, however still considered a rarity. A newborn boy was examined due to inspiratory stridor and subcostal retractions since birth. Several subcutaneous nodules were present on the trunk and legs. Transnasal fiberoptic laryngoscopy and trachea-laryngoscopy showed discrete edema of the anterior part of the vocal cords but no other apparent abnormality. MRI
International Journal of Pediatric Otorhinolaryngology, 2006
The database at the ENT-Department, Aarhus University Hospital describing the specific local flor... more The database at the ENT-Department, Aarhus University Hospital describing the specific local flora of acute otitis media (AOM) and acute mastoiditis (AM) in Aarhus County has become the key element in securing a rational and specific antibiotic treatment. We present our data concerning AOM, mastoidismus and AM. Our purpose is to determine (I) clinical presentation, (II) causative pathogens, (III) resistance patterns, (IV) type of antibiotic treatment, and (V) accuracy of the antibiotic treatment. Patients under the age of 18 years, treated for AOM with extensive affected well-being and AM, at the ENT-Department, Aarhus University Hospital during 3 years from January 2001 to December 2003. A total of 106 patients were identified. Sixty-seven patients with AOM and 39 patients with AM. The overall bacterial flora found is dominated by S. pneumococci all 100% susceptible to penicillin. However, Staphylococcus aureus is the primary bacterial pathogens cultured from patients treated with preadmission antibiotics. If a specimen from an AOM patient is obtained after the initiation of antibiotic treatment one should consider the possibility of the culture found being a result of the initial led treatment and not the causative AOM pathogen. Our data suggest that a restricted use of antibiotics in children with AOM may be associated with a higher incidence of acute mastoiditis. Significant higher leucocytes count and CRP are found in the acute mastoiditis group compared to the AOM group.
Scandinavian Journal of Infectious Diseases, 2014
The Centor criteria and the streptococcal rapid antigen detection test (RADT) are commonly used t... more The Centor criteria and the streptococcal rapid antigen detection test (RADT) are commonly used to differentiate sore throat patients with group A streptococci (GAS) from patients with other pathogens. We aimed to investigate if procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC), and absolute neutrophil count (ANC) could increase the diagnostic accuracy when added to the Centor score and RADT, or be used instead of the RADT, in the differential diagnosis. A 6-month prospective study was carried out in a Danish general practice with 8 physicians. One hundred acute tonsillitis patients aged 15 to 40 y were included. The prevalence of GAS was 26%. The sensitivity (90%) and specificity (97%) of the RADT were high. Mean values of CRP, WBC, and ANC were significantly higher in patients with GAS compared to non-GAS patients (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). However, the sensitivities (66-90%) and specificities (45-75%) were low. No difference in PCT levels was found (p = 0.334). CRP was the most reliable infection marker (sensitivity 90% and specificity 45%) for GAS aetiology. The sensitivity, specificity, and area under the curve of the RADT were higher than those of the 4 measured infection markers in the differentiation between GAS and non-GAS acute tonsillitis patients. The infection markers did not increase the diagnostic accuracy when added to the Centor score and RADT. When RADT is not available, measurement of CRP or ANC may increase the diagnostic accuracy in the detection of GAS-positive patients.
Heliyon, 2022
Background The standard treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) consti... more Background The standard treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) constitutes of systemic oral corticosteroid. Although oral corticosteroid might revert the acute deafness, some patients with ISSNHL display a more treatment refractory course. For these patients, corticosteroid installed directly into the middle ear has become a more frequent treatment, due to the potential benefits of a high, local concentration compared to a systemic administration. As such, for patients being refractory to standard treatment, intratympanic injection of a high dosage of corticosteroid as salvage therapy may be beneficial. Objectives To evaluate the efficacy of intratympanic corticosteroid (ITC) as a salvage treatment of ISSNHL. Methods A systematic literature search was performed in relevant databases. Both randomized trials and observational studies were considered for inclusion. The risk of bias was evaluated using the Cochrane risk of bias tool (randomized trials) or ROBINS-I tool (observational studies). Meta-analysis was performed to investigate the improvement of PTA (dB) and number of patients displaying recovery following salvage ITC injections. Occurrence of serious side effects was investigated. Finally, the certainty of the evidence was evaluated using the GRADE approach. Results Eleven relevant studies were identified (4 randomized trials and 7 observational studies). Both observational and randomized trials showed that salvage ITC significantly increased the number of patients displaying recovery. No serious adverse events were identified in any of the included studies. The certainty of evidence ranged from moderate to very low, due to risk of bias, imprecision, and heterogeneity. Conclusion Collectively, our findings indicate that salvage ITC treatment may be a beneficial and safe treatment for patients with sudden hearing loss, who otherwise are refractory to standard treatment approaches. However, the evidence level indicates need for a cautious interpretation of especially the magnitude of effect and thus the extrapolation on how much the individual may improve from this treatment. Furthermore, it remains to be investigated whether treatment outcomes may vary across different patient groups presenting with ISSNHL. This potential variation in treatment response should be kept in mind, when counselling the patient. Trial registration number The protocol is registered in PROSPERO. Registration number: CRD42019130586.
Ugeskrift for Læger, 2009
European Journal of Cancer, 2021
BACKGROUND We aimed to compare the predictive performance of pN-categories in oral squamous cell ... more BACKGROUND We aimed to compare the predictive performance of pN-categories in oral squamous cell carcinoma (OSCC) encompassing the most recent 8th edition (TNM8), its predecessor (TNM7), and a newly proposed algorithm (pN-N+), which classifies patients according to the number of positive lymph nodes and extranodal extension. METHODS Consecutive, primary OSCC patients from seven previously published cohorts were included and classified according to the three pN-classifications: TNM7, TNM8 and pN-N+. Overall survival probabilities were summarised with the Kaplan-Meier method. We added each of the three metrics to a Cox regression adjusted for pT-category, lymph nodal yield, age, sex, radiotherapy and chemotherapy, and trained these models in one institution. We evaluated the predictive performance in the remaining six institutions and assessed the predicted 5-year risk of death using the area under the receiver operating characteristics curve (AUC) and Brier scores. RESULTS All 1,905 included patients were classified according to TNM7 and pN-N+. A subset of 1,575 patients was additionally classified according to TNM8, leading to upstaging in 27.0%. The pN-N+ ranked overall best determined by the obtained AUC and Brier scores. In contrast to pN-N+, TNM7 and TNM8 both suffered from disproportionate patient distribution across pN-categories and poor pN-categorial discrimination on overall survival. CONCLUSIONS The TNM8 pN-classification designates a larger subset to more advanced disease stages but failed to show improvement of its predictive performance compared to TNM7. The pN-categories of TNM7/8 are disproportionate and inconsistently discriminated. The pN-N+ conveyed the best measures of prognosis and should be considered in future TNM iterations.
Hearing, Balance and Communication, 2019
Purpose: Adolescents presenting with vertigo can be a diagnostic challenge. Video head impulse te... more Purpose: Adolescents presenting with vertigo can be a diagnostic challenge. Video head impulse testing (vHIT) offers examination of the semicircular canals in adolescents with few drawbacks. It quantifies the vestibular ocular reflex as a gain-value. However, there is no standardized method to calculate the gain-value. The aim of this article is to define which gain measure is the most optimal and whether the test is clinically tolerable and feasible in diagnostics of adolescents. Methods: Thrity-three Danish healthy adolescents aged 13-16 years, had their lateral semicircular canals examined with vHIT. Gain calculations were obtained at 40, 60, 80, 0-100 ms and as a regression gain. Results: Mean gain values for the right side were: 40 ms: 1.04, 60 ms: 0.98, 80 ms: 0.93, 0-100 ms: 1.08 and regression: 1.04. For the left-side gain values were 40 ms: 0.96, 60 ms: 0.96, 80 ms: 0.98, 0-100 ms: 1.00 and regression: 1.01. T-tests on 60 ms, 0-100 ms and regressions gain showed that 60 ms differed significantly from 0 to100 ms and regression gain. No complaints of discomfort were reported by any of the test subjects. Conclusions: vHIT proved to be a highly applicable procedure with many advantages, but also some potential pitfalls. In healthy adolescents, 0-100 ms and regression gain produce the most reliable results.
International Journal of Pediatric Otorhinolaryngology, 2019
Vestibular dysfunction, which may lead to delayed motor development and reduced quality of life, ... more Vestibular dysfunction, which may lead to delayed motor development and reduced quality of life, is an overlooked entity among children and adolescents. Vestibular evoked myogenic potential (VEMP) is a common, safe diagnostic tool in adults with vestibular disorders. No normative data exist for children and adolescents. Our objective was to collect and assess normative VEMP data for adolescents. Methods: Cervical VEMP (cVEMP) with air-conducted sound. Endpoints were peak latencies after 13 and 23 ms (P13 and N23) and amplitude. Ocular VEMP (oVEMP) with bone-conducted vibration on the mastoid. Endpoints were latencies (N10 and P15) and amplitude. A meta-analysis of existing cVEMP data in children. Results: cVEMP response rate (RR) was 85%, mean P13 and N23 latencies were 15.44 and 25.55 ms, respectively, and the asymmetry ratio (AR) was 14%. oVEMP RR was 100%, mean N10 and P15 were 10.61 and 16.58 ms, respectively, and the AR was 12%. In the meta-analysis, the pooled mean P13 and N23 were 12.75 and 21.8 ms, respectively. Head elevation (HE) gave shorter latencies than head rotation (HR). Conclusion: The oVEMP data represents normal values for adolescents aged 13-16 years. Height should be considered more important than age when interpreting cVEMP in adolescents. Separate normative cVEMP data should be established for HE and HR.
Danish medical journal, 2013
The objective was to evaluate the long-term results of outpatient tonsillectomy in Danish ear, no... more The objective was to evaluate the long-term results of outpatient tonsillectomy in Danish ear, nose and throat (ENT) practices in terms of satisfaction, quality of life (QoL) and relief of symptoms. A telephone interview was carried out at least three years after tonsillectomy. Alternatively, a questionnaire was filled in by the patients. The answers were compared to a pre-operative questionnaire. The response rate was 63% (386/614). No differences were found between the responders and the non-responders except that the proportion of smokers was higher in the non-responder group. QoL improved significantly and 93% were satisfied with having chosen tonsillectomy. 95% experienced complete or partial relief from their former throat-related symptoms. Eight to 11% had developed new symptoms from the throat including sleep-disordered breathing. With regard to QoL, satisfaction and relief of symptoms, the long-term results of outpatient tonsillectomy in Danish ENT practices are comparable ...
Ugeskrift for laeger, Jan 12, 2010
In Danish healthcare there are increasing demands in the field of hospital care on performance an... more In Danish healthcare there are increasing demands in the field of hospital care on performance and outcome measurement and quality improvement in relation to a number of diseases. Hitherto, corresponding measurements of quality have not been carried out among private specialized practitioners. The present project describes the development and selection of evidence-based national indicators, standards, and case mix factors in terms of prognostic factors with the purpose of measuring quality of out-patient tonsillectomy in Danish ear, nose & throat practices.
Dysphagia, 2005
The purpose of this prospective study was to determine if fiberoptic endoscopic evaluation of swa... more The purpose of this prospective study was to determine if fiberoptic endoscopic evaluation of swallowing (FEES) maintains high intra- and interrater reliability in detecting pharyngeal dysphagia and aspiration without the addition of FD&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;C Blue No. 1 to food. Twenty consecutive adults referred for a swallow evaluation participated. Nine subjects received blue-dyed food and 11 subjects received regular nondyed food, i.e., yellow pudding and white skim milk. Four variables were rated: (1) the stage transition characterized by depth of bolus flow to at least the vallecula prior to the pharyngeal swallow; (2) evidence of bolus retention in the vallecula or pyriform sinuses after the pharyngeal swallow; (3) laryngeal penetration defined as material in the laryngeal vestibule but not passing below the level of the true vocal folds either before or after the pharyngeal swallow; and (4) tracheal aspiration defined as material below the level of the true vocal folds either before or after the pharyngeal swallow. Three speech-language pathologists experienced in interpreting FEES results independently and blindly reviewed the digitized videotape three times. Intrarater agreements for the four variables with blue-dyed and non-blue-dyed food trials were 100% and monochrome trials ranged from 95% to 100%. Average kappa values for interrater reliability ranged from moderate to excellent agreement (0.61-1.00) for all viewing conditions. Kappa values for blue-dyed trials versus monochrome trials were 0.83 and for non-blue-dyed trials versus monochrome trials were 0.88, indicative of excellent reliability under both viewing conditions. FEES maintains both high intra- and interrater reliability in detecting the critical features of pharyngeal dysphagia and aspiration using either blue-dyed or non-blue-dyed foods. The endoscopist, therefore, can be assured of reliable FEES results using regular, non-dyed food trials.
International Journal of Pediatric Otorhinolaryngology
Acute leukemia is a well known childhood cancer. The relation between leukemia and otological sym... more Acute leukemia is a well known childhood cancer. The relation between leukemia and otological symptoms has long been established but is highly rare as a debut symptom of leukemia. External otitis is a common condition affecting many children, and most cases are successively treated with topical medicine. Here we present a child with acute external otitis later shown to be the debut symptom of acute myeloid leukemia, to our knowledge the first specific case described. We have reviewed the literature to find red flags for suspicion of severe disease in case of acute external otitis.
Ugeskrift for Læger, 2013
Acta Paediatrica, 2021
It has been suggested that adolescents diagnosed with ADHD have an unhealthier diet compared to t... more It has been suggested that adolescents diagnosed with ADHD have an unhealthier diet compared to their peers without ADHD. The association between chemosensation (smell and taste) and dietary patterns remains unknown. The aim is to investigate unhealthy food preferences and food neophobic behaviour among adolescents diagnosed with ADHD. Additionally, it is to investigate the relationship between dietary patterns and chemosensory function.
Infectious Diseases, 2017
Background: Necrotizing fasciitis in the head and neck (NF-HN) is a rare and potentially life-thr... more Background: Necrotizing fasciitis in the head and neck (NF-HN) is a rare and potentially life-threatening condition. The use of hyperbaric oxygen therapy (HBOT) in the acute regimen is disputed and there is a lack of evidence of therapeutic effect. This study aims to describe a retrospective cohort of patients with NF-HN and investigate the use of HBOT and consequences thereof. Methods: All patients treated for NF-HN at Aarhus University Hospital (AUH) between 2002 and 2014 were included in this retrospective cohort. Data regarding demographics, treatment and a one-year follow-up was registered. A review of the literature on NF-HN and HBOT was performed. Results: Forty-three patients were consecutively treated for NF-HN during the period. All patients were treated in accordance with current guidelines with HBOT as a variable. Thirty patients received HBOT, and 13 patients were omitted from HBOT for different reasons. In the HBOT group were no mortalities vs. three mortalities in the non-HBOT group two late deaths due to precursory underlying cancer of the head and neck, and one early death shortly after admittance. We found higher rates of complications (63% vs. 25%) and sequelae (77% vs. 40%) among the HBOT group compared to the non-HBOT group. Conclusions: Our findings suggest that HBOT for NF-HN may only be optional and that the decision relies on an individual assessment of each patient. Further research is needed concerning the evidence of HBOT and towards selecting the patients benefitting from HBOT. KEYWORDS Necrotizing fasciitis head and neck hyperbaric oxygen treatment complications sequelae ARTICLE HISTORY
Ugeskrift for laeger, Jan 13, 2014
In this study literature search was performed on tinnitus guidelines and treatment. Tinnitus can ... more In this study literature search was performed on tinnitus guidelines and treatment. Tinnitus can be described as the perception of sound in the absence of external acoustic stimulation, and validated questionnaires, oto-neurological examination, audiometry tests, MRI and angiography are necessary as diagnostic tools. Antidepressants, melatonin and cognitive behavioural therapy have no effect on tinnitus, whereas sound generators, hearing aids and tinnitus retraining therapy show some but limited improvement. National recommendations are required to ensure a homogenous and optimum offer for all patients.
Danish medical journal, 2014
In Denmark, it is compulsory to report post-operative infections (PI) to the Danish Health and Me... more In Denmark, it is compulsory to report post-operative infections (PI) to the Danish Health and Medicines Authority. The aims of the present study were to determine, firstly, the incidence of PI following elective ear, nose and throat (ENT) surgery as well as the number of cases reported to the Danish health authorities; secondly, the PI distribution in various surgical subgroups; and, thirdly, the extent to which the guidelines on prophylactic antibiotics had been followed. The study was carried out prospectively at the ENT department, Aarhus University Hospital, Denmark, from 1 February to 30 April 2011. A total of 362 elective surgical procedures were evaluated in order to identify signs of PI. In case of PI, the following were registered: diagnosis, type of operative procedure and whether the patient had received prophylactic antibiotics according to instructions given at the Department. The ENT doctors were to hand in completed PI reporting schedules to one of the authors. PI oc...
Pediatrics international : official journal of the Japan Pediatric Society, 2014
The aim of this retrospective case study at a tertiary referral center was to investigate the out... more The aim of this retrospective case study at a tertiary referral center was to investigate the outcome of cochlear implantation (CI) in children with sensorineural hearing loss due to meningitis compared to CI in children with deafness due to other reasons. This post-meningial group (PMG) consisted of 22 children undergoing CI due to deafness induced by meningitis, between December 1996 and January 2012. Five children had bilateral simultaneous implantation. None was excluded and the children were followed for at least 3 years. Operations were carried out by one of two surgeons using similar techniques in all cases. Each patient from the PMG was matched 2:1 with children having implantation for other reasons according to age and follow up (control group). Overall, the median category of auditory performance (CAP) and speech intelligibility rating (SIR) score were not statistically significantly different between the two groups. The presence of additional central nervous system (CNS) ...
Danish medical journal, 2012
The objective of this study was to evaluate whether the increased use of angiotensin-converting e... more The objective of this study was to evaluate whether the increased use of angiotensin-converting enzyme inhibitors (ACEI) has affected the rate of upper airway angio-oedema (AE). In addition, we evaluated the presentation and treatment of patients with upper airway AE. This was a ten-year retrospective study of 112 patients presenting with upper airway AE at The Department of Otorhinolaryngology, Aarhus University Hospital, Denmark. Incidence, presentation and treatment in the 2000-2004-period were compared to those of the 2005-2009-period. In the ten-year period, we found 112 AE patients of whom 39% were using ACEI. The relative risk of AE was 7.7 (p < 0.0001) among ACEI users. We found a 67% increase in AE in 2005-2009 compared with 2000-2004 which corresponds to a similar increase in ACEI use in the Danish population. The most frequent anatomic sites of involvement were the floor of the mouth and/or oropharynx including the base of the tongue. Two patients required intubation u...
International Journal of Pediatric Otorhinolaryngology Extra, 2010
Infantile myofibromatosis is a common fibrous tumor of infancy, however still considered a rarity... more Infantile myofibromatosis is a common fibrous tumor of infancy, however still considered a rarity. A newborn boy was examined due to inspiratory stridor and subcostal retractions since birth. Several subcutaneous nodules were present on the trunk and legs. Transnasal fiberoptic laryngoscopy and trachea-laryngoscopy showed discrete edema of the anterior part of the vocal cords but no other apparent abnormality. MRI
International Journal of Pediatric Otorhinolaryngology, 2006
The database at the ENT-Department, Aarhus University Hospital describing the specific local flor... more The database at the ENT-Department, Aarhus University Hospital describing the specific local flora of acute otitis media (AOM) and acute mastoiditis (AM) in Aarhus County has become the key element in securing a rational and specific antibiotic treatment. We present our data concerning AOM, mastoidismus and AM. Our purpose is to determine (I) clinical presentation, (II) causative pathogens, (III) resistance patterns, (IV) type of antibiotic treatment, and (V) accuracy of the antibiotic treatment. Patients under the age of 18 years, treated for AOM with extensive affected well-being and AM, at the ENT-Department, Aarhus University Hospital during 3 years from January 2001 to December 2003. A total of 106 patients were identified. Sixty-seven patients with AOM and 39 patients with AM. The overall bacterial flora found is dominated by S. pneumococci all 100% susceptible to penicillin. However, Staphylococcus aureus is the primary bacterial pathogens cultured from patients treated with preadmission antibiotics. If a specimen from an AOM patient is obtained after the initiation of antibiotic treatment one should consider the possibility of the culture found being a result of the initial led treatment and not the causative AOM pathogen. Our data suggest that a restricted use of antibiotics in children with AOM may be associated with a higher incidence of acute mastoiditis. Significant higher leucocytes count and CRP are found in the acute mastoiditis group compared to the AOM group.
Scandinavian Journal of Infectious Diseases, 2014
The Centor criteria and the streptococcal rapid antigen detection test (RADT) are commonly used t... more The Centor criteria and the streptococcal rapid antigen detection test (RADT) are commonly used to differentiate sore throat patients with group A streptococci (GAS) from patients with other pathogens. We aimed to investigate if procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC), and absolute neutrophil count (ANC) could increase the diagnostic accuracy when added to the Centor score and RADT, or be used instead of the RADT, in the differential diagnosis. A 6-month prospective study was carried out in a Danish general practice with 8 physicians. One hundred acute tonsillitis patients aged 15 to 40 y were included. The prevalence of GAS was 26%. The sensitivity (90%) and specificity (97%) of the RADT were high. Mean values of CRP, WBC, and ANC were significantly higher in patients with GAS compared to non-GAS patients (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). However, the sensitivities (66-90%) and specificities (45-75%) were low. No difference in PCT levels was found (p = 0.334). CRP was the most reliable infection marker (sensitivity 90% and specificity 45%) for GAS aetiology. The sensitivity, specificity, and area under the curve of the RADT were higher than those of the 4 measured infection markers in the differentiation between GAS and non-GAS acute tonsillitis patients. The infection markers did not increase the diagnostic accuracy when added to the Centor score and RADT. When RADT is not available, measurement of CRP or ANC may increase the diagnostic accuracy in the detection of GAS-positive patients.