Juvenile parotitis

In parotitis, one or both of the parotid glands swell, causing pain while eating, reduced mouth opening, and in some cases fever. Before the vaccination era, mumps was the commonest cause of childhood parotitis. Nowadays acute pediatric parotitis is rare, and the causative agent(s) are not fully known. It is assumed that other viruses in addition to mumps virus are capable of causing similar symptoms. Some children develop recurrent symptoms i.e. juvenile recurrent parotitis (JRP). If symptoms are frequent, this condition can be quite life-disruptive. Fortunately, JRP often resolves in puberty. The etiology and pathophysiology of this juvenile recurrent parotid inflammation are other aspects currently not completely understood. The aim of the present study was to assess the epidemiology, etiology, clinical picture, and outcome for pediatric parotitis at present. In addition, it addresses differential diagnosis and complications. A group of 41 children aged ≤17 with acute parotid inflammation was collected prospectively for this study that reported clinical characteristics, treatment, outcome and complications. Another group of 133 children was collected retrospectively with the clinical picture of their disease reported, as well. The serine protease inhibitor Kazal-type 1 (SPINK-1) genotype was tested in 88 parotitis patients, since mutation of this gene disposes to pancreatitis, and salivary glands bear some resemblance to the pancreas in function. To map the etiology of parotitis, a questionnaire about history of parotitis, and parotid gland -related symptoms went to 1,000 adolescents randomly selected. In addition, human herpes viruses (HHVs) from saliva samples of children with acute parotid inflammation, and from healthy controls were tested. To assess the differential diagnosis and complications of parotitis, the database of Helsinki University Central Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, was searched according to ICD-10 codes in order to find all children diagnosed and treated due to osteomyelitis or parotid abscess. All prospectively studied children with acute parotitis were in good general condition, and most episodes of parotitis in childhood seem to have a benign course. Half these children were treated only with non-steroidal anti-inflammatory drugs. However, parotid symptoms have a tendency to recur in about half the cases. About 1% of the respondents to the epidemiologic survey had suffered from parotitis. Heredity similar to pancreatitis could not be shown, since no difference emerged in SPINK-1 genotype in children with parotitis compared to controls. HHVs seem to play no role in acute juvenile parotitis, but are instead common findings in saliva. Osteomyelitis of the head and neck region is rare, but important in differential diagnosis of children with recurrent parotid symptoms. Parotitis-related complications are rare. Parotid abscesses are multi-bacterial infections with intravenous antibiotic therapy being the cornerstone of treatment. Surgical drainage assists in recovery and does not lead to fistula formation. In conclusion, according to this study juvenile parotitis has a frequency close to 1%, it has a tendency to recur, and in most cases the overall condition of the child is good during the infection. Osteomyelitis as a differential diagnosis must be kept in mind when treating recurrent symptoms of the parotid area. Abscesses related to parotitis are rare. The full etiology of juvenile parotitis still remains to be discovered.Korvasylkirauhastulehduksessa poski on kipeä ja turvonnut. Suun aukaiseminen on usein rajoittunutta ja syöminen pahentaa kipua. Tautiin voi liittyä kuumetta. Ennen kattavia kansallisia rokotuksia sikotauti oli yleinen ja tavallisin korvasylkirauhastulehduksen aiheuttaja. Nykyään lasten korvasylkirauhastulehdukset ovat harvinaisia eikä kaikkia taudinaiheuttajia tunneta. Sikotautiviruksen lisäksi myös muut virukset voivat aiheuttaa korvasylkirauhastulehduksen. Osa lapsista kärsii toistuvasta korvasylkirauhastulehduksesta, jonka oireet helpottavat tai häviävät yleensä murrosiässä. Myöskään toistuvan korvasylkirauhastulehduksen etiologiaa tai patofysiologiaa ei tällä hetkellä tunneta tarkasti. Tämän väitöskirjatyön tarkoituksena oli selvittää lasten korvasylkirauhastulehdusten epidemiologiaa, etiologiaa, taudin kuvaa ja hoitoa. Lisäksi tutkittiin erotusdiagnostiikkaa ja komplikaatioita. Prospektiivinen tutkimusryhmä koostui 41 korvasylkirauhastulehdusta sairastavasta alle 17-vuotiaasta lapsesta. Taudinkuva, hoito ja komplikaatiot selvitettiin. Toinen tutkimusryhmä koostui 133 retrospektiivisesti kerätystä lapsesta, joiden taudinkuva ja hoito rekisteröitiin. Seriiniproteaasin estäjä Kazal tyyppi 1:n (SPINK-1) genotyyppi testattiin 88 lapselta, koska tiedetään, että tämän geenin mutaatiot altistavat haimatulehduksille. Sylkirauhasten ja haiman toiminnassa on paljon samankaltaista. Epidemiologian selvittämiseksi tuhannelle satunnaisesti valitulle nuorelle lähetettiin kysely sairastetuista korvasylkirauhastulehduksista ja muista mahdollisista korvasylkirauhasoireista. Lisäksi korvasylkirauhastulehdusta sairastavien lasten, verrokkilasten ja terveiden aikuisverrokkien syljestä testattiin herpesviruksia osana etiologisia selvittelyjä. Helsingin yliopistollisen keskussairaalan Silmä-korvasairaalan potilastietokannasta etsittiin kaikki lapset ja nuoret, jotka olivat olleet hoidossa pään ja kaulan alueen luutulehduksen tai korvasylkirauhaspaiseen vuoksi. Pään ja kaulan alueen luutulehduksen ja korvasylkirauhastulehduksen oireet voivat muistuttaa toisiaan, ja paise on korvasylkirauhastulehduksen harvinainen komplikaatio. Kaikkien 41 prospektiivisesti tutkitun lapsen yleistila oli korvasylkirauhastulehduksen aikana hyvä. Suurin osa lasten tulehduksista parantui hyvin, vaikka noin puolet lapsista hoidettiin pelkällä tulehduskipulääkityksellä. Noin puolella lapsista korvasylkirauhastulehdus uusi. Noin joka sadannella kyselytutkimukseen osallistuneesta lapsesta oli ollut korvasylkirauhastulehdus. Tässä tutkimuksessa ei pystytty osoittamaan korvasylkirauhastulehduksissa samanlaista SPINK-1 genotyyppiin liittyvää perinnöllisyyttä kuin haimatulehduksissa. Herpesvirukset olivat yleisiä kaikkien testiryhmien syljessä, eikä yhteyttä äkilliseen korvasylkirauhastulehdukseen löydetty. Pään ja kaulan alueen luutulehdus on harvinainen, mutta tärkeä erotusdiagnostinen vaihtoehto. Korvasylkirauhastulehduksiin liittyvät komplikaatiot ovat harvinaisia. Korvasylkirauhasen paiseet ovat usean bakteerin aiheuttamia infektioita, joiden hoidon perusta on suonensisäinen antibioottilääkitys. Paiseen puhkaisu tai avaaminen on usein välttämätöntä, eikä johda sylkifistelin muodostumiseen. Tämän tutkimuksen perusteella lasten korvasylkirauhastulehdukset ovat luultua yleisempiä, niillä on taipumus uusiutua, ja lapsen yleistila on tulehduksen aikana yleensä hyvä. Komplikaatiot ovat harvinaisia. Toistuvia korvasylkirauhastulehduksia hoidettaessa on muistettava myös pään ja kaulan alueen luutulehduksen mahdollisuus. Kaikkia korvasylkirauhastulehduksen aiheuttajia ei tunneta

Fertility and family planning in India and Kenya

This article compares the fertility pattern and the attitudes towards family planning in two culturally and geographically different societies, the growing slum area in Calcutta, India and Taita-Taveta, an agricultural area under high population pressure in Kenya. The studies are partly demographic and partly based on in-depth interviews

Effects of social distancing on the incidence of Bell's palsy and sudden sensorineural hearing loss

Background The aetiology of idiopathic facial nerve palsy (Bell's palsy, BP) and sudden sensorineural hearing loss (SSNHL) are not known. It has been proposed that common respiratory tract viruses play a part in the pathophysiology of these diseases. Objectives The incidence of many infectious diseases decreased during the lockdown of the society that took place during the COVID-19 pandemic. We investigated a possible change in the incidence of BP and SSNHL during the lock-down. Material and Methods We searched the patient records for all BP and SSNHL cases between 1 Jan 2017 - 31 Aug 2020 at the hospital district of Helsinki and Uusimaa that covers a population of about 1.2 million. Results The mean monthly incidence on BP decreased during the COVID-19 pandemic lock-down. No change in the SSNHL incidence was discovered. Conclusions and Significance There is reason to speculate that one aetiologic reason for BP are transmittable respiratory tract pathogens.Peer reviewe

Sialendoscopy under local anaesthesia

Conclusions: In most cases, both diagnostic and interventional sialendoscopy are well tolerated under local anaesthesia (LA) or under local anaesthesia with sedation (LAS), with reasonably low patient-reported discomfort. Sialendoscopy can be considered a patient-friendly and relatively painless, gland-preserving, minimally invasive procedure suitable for day surgery. Objective: To investigate patient experience and compliance in sialendoscopy under LA/LAS. Methods: This prospective study was conducted at an academic tertiary-care university hospital. During a period of 22 months, 89 patients between ages 16-81 years underwent diagnostic or interventional sialendoscopy under LA (20%) or LAS (80%). After the operation the patients filled in a questionnaire formulated by the authors concerning their procedure-related experiences. Patients' demographic data, ASA status score, pre- and intra-operative blood pressure and heart rate measurements, affected gland, operation time, intervention type, as well as pre-, peri-, and postoperative medication were gathered later from the medical records. Results: The level of discomfort and pain experienced during the operation was assessed as 'mild' or 'none' by 85% and 89% of the patients, respectively. The level of pain experienced after the operation was 'major' in 4% of patients and 'mild' or 'none' in the majority (87%) of patients. The patients' estimations showed no significant difference between the diagnostic and interventional procedures, although it seems that patients who underwent stone removal by transoral incision experienced the operation as a bit more uncomfortable and painful than other patients. Afterwards 97% of patients stated that they would agree to a new LA/LAS sialendoscopy in the future if needed.Peer reviewe

Sialendoscopy in treatment of adult chronic recurrent parotitis without sialolithiasis

The aim of this prospective study was to evaluate the efficacy of sialendoscopy in the management of adult chronic recurrent parotitis without sialolithiasis. In addition, preliminary results of an initial randomized placebo-controlled trial of single-dose intraductal steroid injection given concurrently with sialendoscopy, are presented. Forty-nine adult patients with chronic recurrent parotitis without sialoliths were included in this study. They underwent sialendoscopy and were randomized to receive either a concurrent intraductal injection of isotonic saline solution or 125 mg of hydrocortisone. Symptom severity was evaluated with visual analogue scale (VAS) and by recording symptom frequency and course with a multiple-choice questionnaire completed preoperatively and at 3, 6, and 12 months after the procedure. The mean VAS score was 5.6 preoperatively and dropped to 2.9 at 3 months, 3.0 at 6 months, and 2.7 at 12 months after the procedure. The VAS score and the frequency of symptoms were significantly lower at 3 (p <0.001), 6 (p <0.001) and 12 (p <0.001) months after the procedure when compared with the preoperative scores indicating that sialendoscopy reduces the symptoms of recurrent parotitis. However, complete permanent resolution of symptoms was rare. Single-dose steroid injection concomitant to sialendoscopy provided no additional benefit, but the current study is not sufficiently powered to determine a clinical difference between the steroid and non-steroid groups. Sialendoscopy appears to reduce the symptoms of chronic recurrent parotitis. While total permanent symptom remission is rare, sialendoscopy can be considered a safe and relatively efficacious treatment method for this patient group.Peer reviewe

Kivi sylkirauhasessa - mikä neuvoksi?

Vertaisarvioitu. Näin hoidan.Ahtauttava sylkirauhastulehdus on suurten sylkirauhasten yleisin hyvänlaatuinen sairaus. Tukos estää syljen virtausta aiheuttaen kipua ja turvotusta. Ylivoimaisesti tavallisin tiehyttukoksen syy on sylkikivi. Noin 80 % sylkikivistä sijaitsee leuanalussylkirauhasessa ja loput korvasylkirauhasessa. Kielenalussylkirauhasen kivitauti on erittäin harvinainen. Sylkirauhastulehdusten diagnostiikka perustuu pitkälti anamneesiin, kliiniseen tutkimukseen sekä kaikukuvaukseen, joka on ensisijainen kuvantamistutkimus. Kivitaudin oireita voidaan helpottaa tulehduskipulääkkeellä ja rauhasta lypsämällä. Palpoituvat distaaliset leuanalussylkirauhastiehyen kivet sekä korvasylkirauhastiehyen papillassa näkyvät kivet voidaan poistaa polikliinisesti avaamalla papilla tai tiehyt. Sylkirauhasen tähystyksen eli sialendoskopian yleistyminen on parantanut sylkikivitaudin hoitoa, ja suurin osa tiehyen liikkuvista kivistä voidaan poistaa tähystyksen yhteydessä. Myös kiinnittyneitä ja suuria kiviä voidaan poistaa tähystintä apuna käyttäen avoimesti limakalvon tai ihon kautta

Gaze-Direction-Based MEG Averaging During Audiovisual Speech Perception

To take a step towards real-life-like experimental setups, we simultaneously recorded magnetoencephalographic (MEG) signals and subject's gaze direction during audiovisual speech perception. The stimuli were utterances of /apa/ dubbed onto two side-by-side female faces articulating /apa/ (congruent) and /aka/ (incongruent) in synchrony, repeated once every 3 s. Subjects (N = 10) were free to decide which face they viewed, and responses were averaged to two categories according to the gaze direction. The right-hemisphere 100-ms response to the onset of the second vowel (N100m’) was a fifth smaller to incongruent than congruent stimuli. The results demonstrate the feasibility of realistic viewing conditions with gaze-based averaging of MEG signals

Patient-Reported Control of Asthma, Nasal Polyposis, and Middle-Ear Symptoms in NSAID-Exacerbated Respiratory Disease

Peer reviewe

Costs of sialendoscopy and impact on health-related quality of life

PurposeTo analyse costs related to the diagnosis and treatment of patients with sialolithiasis and sialadenitis managed with sialendoscopy, and to prospectively evaluate the impact of sialendoscopy on health-related quality of life (HRQoL) in a longitudinal follow-up study.MethodsAll patients undergoing sialendoscopy or sialendoscopy-assisted surgery at a tertiary care university hospital between January 2014 and May 2016 were identified from a surgical database, and the direct hospital costs were retrospectively evaluated from 1year before to 1year after the sialendoscopy. The 15D HRQoL questionnaire and a questionnaire exploring the use of health care services during the preceding 3months were mailed to the patients before sialendoscopy as well as at 3 and 12months after the operation.ResultsA total of 260 patients were identified. Mean total hospital costs, costs related to the sialendoscopy, and complications were significantly higher in sialolithiasis patients than in patients with other diagnoses. 74 patients returned the baseline 15D questionnaire, and 51 patients all three 15D questionnaires. At baseline, the dimensions discomfort and symptoms and distress were lower in patients than in age- and gender-standardised general population, but the total 15D score did not differ significantly. The dimension discomfort and symptoms improved significantly at 3 and 12months postoperatively, and the mean total HRQoL score improved in patients with sialolithiasis at 3months postoperatively.ConclusionsThe costs related to sialendoscopy are substantial and the cost-effectiveness of sialendoscopy warrants further studies. However, sialendoscopy seems to reduce patients' discomfort and ailments and to improve HRQoL at least in patients with sialolithiasis.Peer reviewe

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

Objective: To assess patient injury characteristics and contributing factors in otology. Methods: Data on the accepted patient-injury claims involving otorhinolaryngology (ORL), closed between 2001 and 2011, from the Finnish Patient Insurance Centre registry was retrieved. We included all injuries concerning otology, with evaluation and classification of their causes and types. Results: During the 10-year study period, a total of 44 claims were accepted as compensated patient injuries in otology. From a total of 233 patient injuries in all ORL, this amounted to 19%. In outpatient care, occurred 12 (27%) injuries and in surgical procedures 32 (73%). Five (11%) patients were children. Errors in surgical technique were identified as the primary cause of the injury in 22 (69%) operation-related cases. Failure to remove all auricular tampons or packing in postoperative control was a contributing factor in 4 (13%) injuries, a facial nerve was damaged in 9 (28%) operations, and in 12 (38%) patients, the injury resulted in severe hearing loss or deafness. Six patients (21%) needed one or more re-operations related to the injury, of which two were due to an incomplete primary operation. Conclusion: Typical compensated patient injuries in operative otology resulted from common complications of common operations in high volume centres.Peer reviewe