15 research outputs found
Toimenpiteiden alueellinen vaihtelu korva-, nenä- ja kurkkutautien erikoisalalla
Lähtökohdat Useilla erikoisaloilla sekä sairauksien lääkkeellinen hoito että toimenpiteiden taajuudet vaihtelevat terveydenhuollon yksiköissä. Tämä ei välttämättä kuvaa sairauksien epätasaista jakautumista, vaan epäyhtenäisiä hoitoperusteita. Tässä tutkimuksessa selvitettiin korva-, nenä- ja kurkkutautien erikoisalan tavallisten toimenpiteiden määrien muutoksia 2000-luvulla ja vertailtiin sairaanhoitopiirien suoritteita väestöön suhteutettuna. Samalla arvioitiin Terveyden ja hyvinvoinnin laitoksen hoitoilmoitusrekisterin (Hilmo) luotettavuutta toimenpidejaksojen kuvaajana. Menetelmät Hilmo-rekisteristä kerättiin sairaanhoitopiireittäin aikuisia koskevat tiedot nielurisojen poiston, nenän väliseinän oikaisun ja nenän sivuonteloiden tähystysleikkauksen suoritemääristä vuosilta 2002–12. Näitä lukumääriä verrattiin sairaaloiden anestesia- ja leikkaustoiminnan vertaisarviointitietokannan (BM-OR) sekä Helsingin ja Uudenmaan sairaanhoitopiirin (HUS) leikkaussalien toiminnanohjausjärjestelmän (OPERA) tietoihin. Tulokset Aikuisten nielurisaleikkaukset ovat vähentyneet 2000-luvulla vajaat 20 % ja nenän väliseinän oikaisuleikkaukset runsaat 30 %. Sivuonteloiden tähystyskirurgian kokonaismäärä on säilynyt ennallaan. Leikkaushoidon todennäköisyys vaihteli sairaanhoitopiireittäin. Konservatiivisimman ja aktiivisimman sairaanhoitopiirin välinen ero oli aikuispotilaan nielurisaleikkauksessa yli kaksinkertainen, sivuonteloiden tähystyskirurgiassa nelinkertainen ja nenän väliseinän oikaisuleikkauksessa yli kymmenkertainen. Hilmo- ja BM-OR-tietokantojen välinen korrelaatio vuosina 2010–12 oli erittäin hyvä. Päätelmät Aikuisille suoritetut nenän väliseinän oikaisu, nielurisaleikkaus ja sivuonteloiden tähystyskirurgia edustavat toimenpiteitä, joita tehdään kaikissa erikoissairaanhoidon yksiköissä. Kunkin toimenpiteen yleisyys vaihteli sairaanhoitopiiristä toiseen ja väestöön suhteutettu ero saattoi olla moninkertainen. Todennäköisesti hoitoon ohjaus, mielipiteet ja resurssit määrittelevät leikkausaiheita oletettua enemmän.Peer reviewe
Voice rest and sick leave after phonosurgical procedures : surveys among European laryngologists and phoniatricians
PurposeAfter surgery of vocal folds, almost every patient will need some voice rest. It is common to recommend total silence for some days, followed by less restricted voice use for variable periods. By now, we do not know how voice rest affects the healing process or the current practise in Europe.MethodsMembers of the European Laryngological Society (2012) and the Union of European Phoniatrics (2018) were sent a web-based questionnaire which included two patient cases with a short history and a still picture. The respondents were asked about the postoperative recommendation of absolute voice rest and sick leave.ResultsOver 90% of the respondents would recommend absolute voice rest after removing a polyp or after mucosal repair of Reinke's oedema. For both cases, the mean length of recommended absolute voice rest among UEP members was 4days (range 0-10days) and among ELS members was 5days (range 0-14days). The recommended sick leave ranged from 0 to 35days. The mean figures suggested by ELS members for the receptionist with Reinke's oedema were 12days and for the teacher with a polyp 13days. On average, UEP members recommended 14days of sick leave for both cases.ConclusionThe present scientific evidence is scant, but does not support for prolonged (over 3days) absolute voice rest after simple phonosurgery. So far, there are no studies that could show absolute voice rest to be superior over relative voice rest. According to the present survey, there is considerable variation in recommending voice rest and sick leave after the removal of benign mucosal lesions. Many European laryngologists suggest voice rest that is longer and stricter than the present scientific literature supports.Peer reviewe
Long-term outcome of endoscopic shortening and stiffening of the vocal folds to raise the pitch
In this study, we aimed to assess the long-term effects of the mucosal layer plastic surgery of the vocal folds performed on the voices of male-to-female transgenders. This retrospective cohort study enrolled 22 patients who were operated during 2004-2010 by a combined technique of transmucosal anterior suturing and stiffening of the vocal folds through a longitudinal cordotomy incision using CO2 laser. Long-term effects were assessed based on completed questionnaires on four different categories including subjective evaluation of patient's own voice perception and a standardized voice inventory (VHI), as well as an acoustic assessment and videolaryngoscopic examination. Out of the 22 patients contacted, 16 returned the questionnaires, and 13 of them participated in the subsequent acoustic analysis and videolaryngoscopic assessment. Results of the study were as follows: The total VHI score, after the procedure, was 32. F0 increased significantly for both the vowel/a/ and text from 157 to 207 Hz and 139 to 162 Hz, respectively. Perturbation measures did not show a significant change. F0 did not correlate with the VHI score. One patient had symptomatic anterior perforation that needed re-operation. The combination of transmucosal anterior suturing and stiffening of the vocal folds by laser cordectomy results in significant elevation of the F0 in the long term and in acceptable levels of VHI score compared to other reports. In conclusion, the results of the procedures show that it is enough to get the mucosal edges sutured together without the need to suture either the ligaments or the muscle of the vocal folds. The need for revision is minimal with this procedure.Peer reviewe
Work-up of globus : assessing the benefits of neck ultrasound and videofluorography
Globus patients with normal ear, nose, and throat ( ENT) status are a diagnostic challenge. The symptom may be long lasting and cause concern about malignancy, leading to possibly unnecessary further investigation. The aim of the study was to assess whether radiological examinations are useful in globus diagnostics, how often patients suffer from persistent globus, and whether globus patients with normal ENT status develop a malignancy during a follow-up. We reviewed medical records of all 76 globus patients referred to Helsinki University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery in 2009. Patient history and findings in physical and radiological examinations were registered. A questionnaire concerning patients' present pharyngeal symptoms was sent 3 and 6 years after their initial visit. Data from the Finnish Cancer Registry revealed whether patients developed malignancies within a 3-year follow-up. Based on medical records, neck ultrasound was performed for 37 (49 %) and videofluorography for 22 patients (29 %), with nonsignificant findings. After a 3- and 6-year follow-up, half patients indicated that they were asymptomatic or had fewer symptoms, whereas the rest had persistent symptoms. The Finnish Cancer Registry data confirmed that globus patients developed no head and neck malignancies during a 3-year follow-up. In the present study, neck ultrasound and videofluorography showed no additional benefit to evaluate the globus etiology in patients whose ENT status was normal. Half the globus patients suffered from persistent symptoms after a 3- and 6-year follow-up, indicating that globus may cause discomfort chronically. However, no patients developed malignancies during a 3-year follow-up.Peer reviewe
Treatment of recurrent respiratory papillomatosis and adverse reactions following off-label use of cidofovir (Vistide®)
Recurrent respiratory papillomatosis (RRP) is caused by a human papilloma virus (HPV). It is a rare, sometimes debilitating disease compromising voice and airway. RRP is characterized by a variable course of disease, potentially leading to frequent annual surgical procedures, the number of which may exceed a hundred during the life time. The therapy focuses on surgical removal of the mucosal lesions in order to keep the airway open and the voice satisfactory. Till now, there is no curative therapy for the virus infection in itself. As recurrent surgery alone has proven to be insufficient in many cases, adjuvant therapy is increasingly being used. One of the mainstays of adjuvant therapy is the administration of intralesional cidofovir (Vistide Ò). Cidofovir is an antiviral agent, registered for the treatment of cytomegalovirus (CMV) retinitis in patients wit
Regional differences in endoscopic sinus surgery in Finland : a nationwide register-based study
Objectives Endoscopic sinus surgery (ESS) is a common operation typically performed due to chronic rhinosinusitis (CRS). There are limited data on the nationwide ESS rate and factors contributing to its regional variation. The aim was to evaluate factors causing variation of ESS rate. Design Cross-sectional nationwide observational study. Setting A II patients undergoing ESS in Finland 2013-2015. Population Nationwide Finnish population aged 15 years or over. Main outcome measures ESS rate per 1000 inhabitants between 2013 and 2015 in all 21 hospital districts and independent factors for multilevel model analyses. Methods We used the Finnish register data of all patients with CRS who underwent ESS in 2013-2015. Patients aged under 15 years and those with ESS due to neoplasia were excluded. The age and gender standardised ESS rates were calculated, and multilevel Poisson regression models were used to evaluate variation in ESS in the 21 hospital districts. The likelihood ratio test was applied to assess the statistical significance of random components in the models. Results The nationwide annual rate of ESS is 0.71 per 1000 people in Finland. Hospital district rates varied from 0.25/1000 (95% CI 0.18 to 0.32) to 1.15/1000 (95% CI 1.09 1.21). Compared with males, females undergo ESS significantly more frequently (57% of the procedures), more often due to CRS without nasal polyps, and at a younger age (mean age 44.2 and 46.2 years, correspondingly). Multilevel analyses showed that lower age (between 24 years and 45 years) and availability/ease of medical services were independently associated with higher ESS rates. Conclusions This study confirms marked regional variation in the ESS rate in Finland, explained only in part by patients' age and differing availability of medical services. To analyse ESS across different CRS phenotypes or to compare quality registers on ESS properly, more research on regional variation is needed.Peer reviewe