Compensated and non-compensated patient injury claims in internal carotid artery interventions in Finland, 2004-2017.

OBJECTIVES: Analysis of patient injuries offers possibilities for improving quality in patient care. The aim of this study was to identify errors and adverse events leading to patient injuries in the treatment of internal carotid artery stenosis (ICAS). METHODS: A retrospective analysis was performed on data from Finnish patient injury claims and patient insurance center decisions in the treatment of ICAS, 2004-2017. Contributing factors to injury were identified and evaluated. RESULTS: During the 14-year study period, 42 patient injury claims involving ICAS treatment were closed in Finland. One claim involved carotid artery stenting, and the other operations were carotid artery endarterectomies. Nine of the claims were compensated (seven for operations and two for evaluations). Fully trained vascular surgeons had carried out all the operations and evaluations. Stroke was the most common complaint in the claims (n = 12). Six of the compensated patients were symptomatic prior to the interventions. Injuries were related to errors in decision-making and patient selection in two cases. Four patients received compensation for nerve injury and three for stroke. No deaths were compensated as patient injuries. Most negative claim decisions were related to the injury having been unavoidable. CONCLUSION: Compensated patient injuries involving the treatment of ICAS are rare but often serious and mostly involve open surgery. Patient injury claims provide a valuable source of information for recognizing errors in care and offer possibilities to improve patient safety.

Compensated Patient Injuries in the Treatment of Abdominal Aortic and Iliac Artery Aneurysms in Finland: A Nationwide Patient Insurance Registry Study.

OBJECTIVES: Patient injury claims data and insurance records provide detailed information on patient injuries. This study aimed to identify the errors and adverse events that led to patient injuries in vascular surgery for the treatments of abdominal aortic aneurysms (AAA) and iliac artery aneurysms (IAA) in Finland. The study also assessed the severity and preventability of the injuries. MATERIALS AND METHODS: A retrospective analysis of Finnish Patient Insurance Centre's insurance charts of compensated patient injuries in the treatment of AAA and IAA. Records of all compensated patient injury claims involving AAA and IAA between 2004 and 2017 inclusive were reviewed. Contributing factors to injury were identified and classified. The injuries were assessed for their preventability by using the WHO Surgical Safety Checklist correctly. The degree of harm was graded by Clavien-Dindo classification. RESULTS: Twenty-six patient injury incidents were identified in the treatment of 23 patients. Typical injuries involved delays in diagnosis or treatment, errors in surgical technique or injuries to adjacent anatomic organs. Three (13.0%) patients died due to patient injury. Two deaths were caused by delays in diagnosis of ruptured abdominal aortic aneurysm (RAAA) and the third death was due to missed diagnosis of post-operative myocardial infarction. Retained foreign material caused injuries to two (8.7%) patients. One (4.3%) patient had a severe postoperative infection. Three (13.0%) patients experienced an injury to an adjacent organ. One patient had a bilateral and another a unilateral above-the-knee amputation due to patient injury. Three injuries were considered preventable. Most harms were grade IIIb Clavien-Dindo classification in which injured patients required a surgical intervention under general anesthesia. CONCLUSIONS: Compensated patient injuries involving the treatment of AAA and IAA are rare, but are often serious. Injuries were identified during all stages of care. Most injuries involved open surgical procedures.

Effect of alar nasal valve stent on nasal breathing.

PURPOSE: Lateral nasal wall insufficiency has previously been a surgical challenge. In 2018, the Alar Nasal Valve Stent (Medtronic) was taken into use at Helsinki University Hospital. The alar cartilages are repositioned and locked into position with the Alar Nasal Valve Stent on the mucosa. The stent gives support and widens the alar valve while cartilages scar into their new position presumably facilitating breathing after removal of the stent. The aim of this prospective, observational study was to investigate whether the Alar Nasal Valve Stent has an effect on nasal breathing in patients with lateral nasal wall insufficiency. MATERIALS AND METHODS: Symptom questionnaires (Sino-Nasal Outcome Test-22, Nasal Obstruction Symptom Evaluation, five-step symptom score) were analyzed preoperatively and at 3, 6, and 12 months postoperatively. Acoustic rhinometry, rhinomanometry, and peak nasal inspiratory flow were analyzed preoperatively and 3 months postoperatively. The patients performed a stress ergometry preoperatively and 3 months postoperatively, with their noses being photographed and filmed. RESULTS: In a series of 18 patients, a significant positive difference was seen in subjective symptom scores preoperatively versus postoperatively. The difference remained stable throughout the follow-up. No difference in objective symptom measurements was observed. CONCLUSIONS: Patients suffering from lateral nasal wall insufficiency experience a significant subjective improvement in nasal breathing after Alar Nasal Valve Stent surgery.

One dose of preoperative, intravenous, prophylactic antibiotics significantly lowers postoperative infection rate in septoplasty-a study of 772 operations.

OBJECTIVES: Postoperative infection is the most common complication after septoplasty. Pre- or postoperative prophylactic antibiotics are commonly used, although no official guidelines exist. DESIGN: We retrospectively collected data on postoperative infections from 772 septoplasties performed in 2015, 2016 and 2018, and classified the infections according to surgical site infection (SSI) criteria by the Centers for Disease Control and Prevention (CDC). We evaluated the infections according to antibiotic use (preoperative or postoperative, both, or none) and accounted for patient and surgical confounding factors. We compared the results with three previous studies from our department to find out the trend in the occurrence of postoperative infections and in the use of antibiotics. RESULTS: Twenty-nine cases (3.8%) fulfilled CDC infection criteria. Any kind of antibiotic prophylaxis reduced the risk of SSI (p = .018). One dose of intravenous cefuroxime before incision was the most effective preventive measure (p = .045). We found no significant effect of postoperative antibiotics. However, postoperative antibiotics lowered the infection rate to 1.8% compared to 6.1% among those not treated with any antibiotics. The only other factor reducing the risk of SSI was local anaesthesia compared with general anaesthesia. CONCLUSION: Preoperative antibiotic prophylaxis effectively reduced postoperative infection rate after septoplasty.

Dizzy triathlete-evidence supporting vestibular etiology.

Dizziness during or after the swimming leg is a common complaint among triathletes. We hypothesized that the dizziness is caused by asymmetrical cooling of the vestibular organ. This caloric response is characterized by involuntary eye movements called nystagmus. Altogether, 125 triathletes completed an electronic questionnaire. Fifteen triathletes who had frequently experienced dizziness during the swimming leg agreed to take part in a cold water swimming test. The test comprised two cold water swimming legs, first without earplugs and then with earplugs to prevent a potential caloric response. Eye movements and possible nystagmus were recorded immediately after the swimming legs. A majority (87%, 109/125) of athletes had experienced dizziness during triathlon races or training. Of these, almost all (97%, 106/109) experienced it during or after swimming. Dizziness affected the triathlon performance in half of the athletes with dizziness (50%, 51/102). Fifteen athletes participated in a cold water swimming test. During the first leg (without earplugs), 11/15 athletes (73%) experienced dizziness. Of these, six had nystagmus (55%), four had uncertain nystagmus (36%), and one did not have nystagmus (9%). Only one of these athletes experienced dizziness during the second leg with earplugs. The prevalence of dizziness among triathletes is notable. A large part of the dizziness is likely to be caused by caloric reaction of the vestibular organ. We recommend earplug usage for triathletes suffering from dizziness during the swimming leg.

Odontogenic causes complicating the chronic rhinosinusitis diagnosis.

OBJECTIVES: Chronic rhinosinusitis (CRS) frequently stems from a dental origin, although odontogenic sinusitis (OS) remains underdiagnosed amongst different professionals. This study aimed to explore how often odontogenic causes are considered when diagnosing CRS. MATERIALS AND METHODS: Patient records from 374 new CRS patients treated at a tertiary-level ear, nose, and throat (ENT) clinic were selected. Entries and radiological reports were assessed exploring how often dentition was mentioned and OS was suspected, how often radiologists reported maxillary teeth, and how commonly typical OS microbial findings and unilateral symptoms occurred. RESULTS: Although 10.1% of the CRS diagnoses were connected to possible dental issues, teeth were not mentioned for 73.8% of patients. Radiological reports were available from 267 computed or cone beam computed tomographies, of which 25.1% did not mention the maxillary teeth. The reported maxillary teeth pathology was not considered in 31/64 (48.4%) cases. Unilateral symptoms associated with apical periodontitis (OR = 2.49, 95% CI 1.27-4.89, p = 0.008). Microbial samples were available from 88 patients, for whom Staphylococcus aureus was the most common finding (17% of samples). CONCLUSIONS: Odontogenic causes are often overlooked when diagnosing CRS. To provide adequate treatment, routine assessment of patient's dental history and status, careful radiograph evaluation, and utilization of microbial findings should be performed. Close cooperation with dentists is mandatory. CLINICAL RELEVANCE: Dental professionals should be aware of difficulties medical professionals encounter when diagnosing possible OS. Thus, sufficient knowledge of OS pathology is essential to both medical and dental professionals.

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

BACKGROUND: Patient injury claim data and insurance records constitute detailed sources of information on patient injuries and their contributing or causal factors. This study aimed to identify the unintended incidents that lead to patient injuries in vascular surgery in the treatment of peripheral arterial disease (PAD) in Finland. METHODS: The records of all accepted patient injury claims involving PAD between 2004 and 2017 inclusive were obtained from the nationwide Finnish Patient Insurance Centre registry and were reviewed. Factors contributing to injury were classified by patient careflow. RESULTS: Sixty-nine patient injury incidents were identified in 60 treated patients with PAD. Sixteen injuries (23.2%) were related to outpatient or preoperative care. Twenty-seven injuries (39.1%) were caused by incidents in performing open or endovascular procedures, and 26 injuries (37.7%) were related to postoperative care. Delay in treatment affected 11 (18.3%) patients. Incidents involving surgical technique were identified in the treatment of 13 (21.7%) patients. Retained foreign material caused injuries to four (6.7%) patients. Five (8.3%) patients suffered from postoperative hemorrhage and eleven (18.3%) from infection damage. Delay in treatment resulted in two major amputations. Technical problems in bypass operations led to the loss of the bypass graft and to reoperation. Three nerve injuries led to permanent disability. One (1.7%) patient died because of fatal postoperative bleeding after being discharged from the hospital. CONCLUSIONS: Compensated patient injuries in the treatment of PAD are rare. Injuries occur during all stages of care and are caused by both surgical system procedural failures and common complications.

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

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

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

BACKGROUND: Post-tonsillectomy pain is 1 of the most intense postoperative pain conditions. However, optimal and sufficient postoperative analgesic treatment remains unclear. We investigated the effect of topical ropivacaine for post-tonsillectomy pain in 160 adult outpatient surgery patients over 2 postoperative weeks. METHODS: At the end of tonsillectomy, 2 swabs soaked in either 1% ropivacaine or saline were packed into the tonsillar beds for 5 minutes. We used ibuprofen and a combination of acetaminophen (500 mg)-codeine (30 mg) tablets as postoperative analgesics for 2 weeks. The primary outcome was pain intensity on swallowing measured on a numeric rating scale (NRSs) during the first postoperative week expressed as area under curve (AUC). The secondary endpoints included the worst pain experienced during the 2-hour follow-up in the postanesthesia care unit, pain intensity during the second postoperative week, and the number of ibuprofen and acetaminophen-codeine tablets consumed during the 2 postoperative weeks. RESULTS: During the first postoperative week, 120 patients out of 160 (75%) provided complete results, including data on their use of analgesics according to the instructions as well as completed and returned a questionnaire daily. A total of 101 patients (63%) did the same during the second postoperative week.Median (interquartile range [IQR]) of the primary outcome NRSs (AUC) was 38 (19) for the ropivacaine group and 37 (24) for the control group during the first postoperative week (P = .77, -1.0 estimated difference; 95% confidence interval [CI] for the difference, -7.0 to 5.0); no difference was found. Median (IQR) of NRS at rest (NRSr) (AUC) was 24.5 (19) for the ropivacaine group and 24 (22) for the control group during the first postoperative week (P = .96, 0.0 estimated difference; 95% CI for the difference, -5.0 to 5.0); no difference was found. Median (IQR) of the worst pain intensity values (NRSs or NRSr) (AUC) was 5 (3) for the ropivacaine group and 5 (3) for the control group (P = .44, 0.0 estimated difference; 95% CI for the difference, -1.0 to 0.5); no difference was found. During the second postoperative week, median (IQR) of the NRSs (AUC) was 17 (13) for the ropivacaine group and 21 (23) for the control group (P = .05, -4.0 estimated difference; 95% CI for the difference, -9.0 to 0.0) and median (IQR) of the NRSr (AUC) 10.5 (10) for ropivacaine group and 11 (13) for the control group (P = .42, -1.0 estimated difference; 95% CI for the difference, -5.0 to 2.0); no difference was found.The number of rescue analgesics (acetaminophen-codeine tablets) consumed during the second postoperative week was lower in the ropivacaine group than in the control group (median [IQR] of the consumption [AUC] was 10 [12] for the ropivacaine group and 16 [12] for the control group; P = .0008, -7.0 estimated difference; 95% CI of difference, -10 to -3.0). The groups showed no differences in overall risk for post-tonsillectomy bleeding. However, bleeding requiring hemostasis under local anesthesia was more common in the ropivacaine group (18% vs 8%, P = .048, 10% estimated difference; 95% CI for the difference, 0%-21%). CONCLUSIONS: Topical ropivacaine failed to reduce pain intensity during the first postoperative week. We observed no major adverse effects.

The presence of minor salivary glands in the peritonsillar space.

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

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

OBJECTIVES: The objectives of this study were to evaluate the efficacy of metronidazole in conjunction with penicillin in preventing the recurrence of peritonsillar abscess (PTA) and to learn whether metronidazole enhances the recovery from PTA when compared with penicillin alone. METHODS: In this prospective, double-blind, randomized, placebo-controlled trial, 200 adult outpatients with PTA at our ear, nose and throat emergency department received either penicillin (1 000 000IU) × 3 and metronidazole (400 mg) × 3 for 10 and 7 days orally (combination group, N = 100) or penicillin and placebo (penicillin group, N = 100) after incision and drainage of the PTA. Afterwards they received a symptom questionnaire via e-mail daily for 2 weeks, then weekly for 6 weeks. The primary outcome was efficacy of metronidazole in conjunction with penicillin in preventing PTA recurrence in 56 days; the secondary outcome was ability of metronidazole plus penicillin to enhance recovery from PTA in 28 days. All healthcare contacts were registered during follow-up. Registered on www.clinicaltrials.gov with the identifier NCT01255670. RESULTS: Of the 200 patients, 20 returned to hospital with recurrent symptoms, 10 in each group (P = 1.00). In the combination group, the mean (SD) duration of throat-related symptoms was 5.6 (5.0) days and in the penicillin group it was 5.3 (2.7) days, values for fever were 1.5 (0.9) and 1.6 (1.0) days, respectively, and those for poor overall physical condition were 4.0 (3.9) and 4.5 (4.9) days; there were no significant differences between groups. The adverse effects nausea and diarrhoea lasted longer in the combination group (P = 0.01). CONCLUSIONS: For healthy adult PTA patients treated with incision and drainage, metronidazole neither prevents recurrence nor enhances recovery when combined with penicillin compared with penicillin alone, but instead leads to increased adverse effects.

Dental findings frequently overlooked in sinus computed tomography reports.

OBJECTIVES: Computed tomography (CT) and cone beam computed tomography (CBCT) represent the main imaging modalities used in rhinosinusitis patients and are also important in odontogenic sinusitis (OS) diagnostics. Reports, however, often lack information on dentition. Here, we aimed to determine how maxillary dentition is initially interpreted in rhinosinusitis patients' CT/CBCT reports and which dental findings in particular are potentially missed, thus needing more attention. STUDY DESIGN: CT/CBCT scans and radiological reports from 300 rhinosinusitis patients were analysed focusing specifically on dental findings. An experienced oral and maxillofacial radiologist re-evaluated the scans and the assessment was compared to the original reports using the McNemar test. RESULTS: From the 300 original reports, 233 (77.7%) mentioned the maxillary teeth. The most frequent statement (126/300, 42.0%) was 'no apical periodontitis'. Apical periodontitis and severe alveolar bone loss were significantly overlooked (p < 0.001). Amongst the 225 patients for whom the CT/CBCT report initially lacked information on dental pathology, 22 patients were diagnosed with apical periodontitis and 16 with severe alveolar bone loss upon re-evaluation. CONCLUSIONS: Dental pathology remains underreported in rhinosinusitis patients' CT/CBCT reports. Because these reports affect OS diagnostics, a routine and structured review of the maxillary teeth by a radiologist is necessary. Such examinations should encompass the maxillary teeth.

The effect of single kinetic oscillation stimulation treatment on nonallergic rhinitis.

Objective: Kinetic oscillation stimulation (KOS) is a new treatment method for nonallergic rhinitis (NAR), usually delivered twice with a 2- to 4-week interval, and thought to stabilize autonomous dysregulation in the nasal mucosa. We aimed to assess the long-term (1 year) results following one KOS treatment amongst patients with NAR. Methods: KOS was administered through a latex balloon placed in the patient's nasal cavity. The balloon is connected to a device that fills the balloon with air pulses, thus vibrating the balloon for 10 min per side. Outcomes were evaluated through patient-reported outcome measures (Sino-Nasal Outcome Test 22 [SNOT-22], Total Nasal Symptom Score [TNSS], Nasal Obstruction Symptom Evaluation [NOSE], and 15D) and measures of patency (rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow [PNIF], and clinical inferior turbinate size). Pre-treatment actions were repeated at 1, 3, 6, and 12 months. Results: In all 49 patients, we found significant improvement in the SNOT-22, NOSE, and TNSS scores. At 12 months, SNOT-22 improved from 44 to 34, NOSE from 60 to 45, TNSS from 8 to 7, and PNIF from 80 to 100 L/min (p < .005 for all). We observed no major complications. Conclusion: One KOS treatment appears to provide NAR patients with a subjective symptom improvement for at least 1 year, thus possibly decreasing the need for invasive treatment methods. Level of Evidence: III.

Frontal Sinus Balloon Sinuplasty-Patient Satisfaction and Factors Predicting Reoperation.

Objective: To explore predictive factors of postoperative outcome of frontal sinus balloon dilation. Study Design: Retrospective questionnaire study. Setting: Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Finland. Methods: We reviewed electronic records of all patients who underwent frontal sinus balloon dilatation (successful or attempted) in our clinic from 2008 to 2019. We documented patient characteristics, preoperative imaging results, intraoperative factors, possible complications, and reoperations. Those who underwent frontal sinus balloon sinuplasty were sent a questionnaire regarding their current symptoms and long-term satisfaction with surgery. Results: In total, 258 operations (404 frontal sinuses) were reviewed, with a technical success rate of 93.6% (n = 378). The revision rate was 15.7% (n = 38). Previous sinonasal surgery predicted a higher revision rate (p = .004, odds ratio [OR] = 3.03, 95% confidence interval [CI] 1.40-6.56). Patients with hybrid surgery had significantly fewer reoperations compared to the balloon only group (p = .002, OR = 0.33, 95% CI 0.16-0.67). The response rate of the questionnaire was 64.5% (n = 156), of which 88.5% (n = 138) reported a long-term benefit from the balloon sinuplasty. Patient satisfaction was higher (p = .02, OR = 8.26, 95% CI 1.06-64.24) among patients using nasal corticosteroids. Conclusion: Technical success rate and patient satisfaction after frontal sinus balloon sinuplasty are high. Balloon sinuplasty seems insufficient in reoperations. A hybrid approach appears to result in fewer reoperations than a balloon only approach.

Effect of head impacts and chemical irritation on elite athletes' olfaction.

Limited research exists on athletes' olfaction. As diet is an elementary part of an athlete's lifestyle and training, it is important to know whether the sport discipline itself carries a risk for olfactory impairment. The aim of this study was to evaluate whether elite swimmers (chemical irritation), boxers (head impact) or soccer players (head impact) are at risk for impaired olfaction. Elite-level male swimmers (n = 30), boxers (n = 35) and soccer players (n = 30) aged 18-40 years were recruited from Finnish sport clubs. Floorball players (n = 30) were recruited as a control group. All participants filled in a questionnaire about their training history, nasal and sinonasal diseases, asthma, nasal operations and traumas, smoking and self-evaluation of olfaction and taste function. Sniffin' Sticks odour identification test with 12 different odorants and anterior rhinoscopy were performed on all participants. The mean score from the smelling test did not differ between the sport groups. Sinonasal diseases and bronchial asthma were more common among swimmers than among the other athletes. Rhinitis symptoms were common among all athletes. Boxing, soccer or swimming does not seem to affect sense of smell. The majority of our participating elite athletes had normal olfaction, even if they had had a long history of active sports.Highlights Boxing, soccer or swimming does not seem to affect sense of smell.Rhinitis symptoms were prevalent among all elite athlete groups in our study.Athletes with hyposmia can perceive their own decreased olfaction.Swimmers have more bronchial asthma and sinus diseases than other athlete groups.

Acute versus late endoscopic dacryocystorhinostomy in treatment of acute dacryocystitis: A prospective randomised trial with an 18-month follow-up.

PURPOSE: To compare the long-term symptom resolution and use of resources of performing endoscopic dacryocystorhinostomy (enDCR) in acute or delayed phase in patients with acute dacryocystitis (AD). METHODS: This prospective, randomised controlled trial was conducted in Helsinki University tertiary Eye and Ear, Nose and Throat (ENT) Hospitals between September 2013 and January 2019. Fifty patients aged 18 and above presenting with AD in the emergency care were randomised into acute and delayed enDCR surgery groups, performed in 1 week or 4 months from the diagnosis of AD. The follow-up time was 18 months. Outcome measures were subjective epiphora, lacrimal symptoms and visual analogue scale (VAS) pain scores, the number of hospitalised and unhealthy days, use of medication and openness in lacrimal syringing and dye test. RESULTS: EnDCR was performed on 24 patients in the acute and 19 in the delayed group. There were no significant differences between the groups in follow-up lacrimal symptoms, syringing test, dye test or use of resources. At the 18 months' follow-up, 21/23 (91.3%) in the acute group and 12/13 (92.3%) in the delayed group had no disturbing lacrimal symptoms. When reoperations and dropouts are considered, beneficial outcome was 22/24 (91.7%) in the acute and 12/16 (75%) (p = 0.195) in the delayed group. The acute group had significantly fewer pain medication days than the delayed group, 3 versus 10.5 (p = 0.03). CONCLUSION: Acute enDCR is associated with fewer pain medication days and equal resolution of lacrimal symptoms and use of resources.

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

OBJECTIVES: The aim of this controlled follow-up study was to compare the need for revision surgery, long-term efficacy, and satisfaction in chronic rhinosinusitis patients who had undergone maxillary sinus operation with either balloon sinuplasty or traditional endoscopic sinus surgery (ESS) technique. METHODS: Thirty-nine ESS patients and 36 balloon patients of our previously described cohort, who had been primarily operated in 2008 to 2010, were contacted by phone. Symptoms, satisfaction, and need for revision surgery were asked. In addition, we collected data of patients who had undergone primary maxillary sinus balloon sinuplasty in the Helsinki University Hospital during the years 2005 to 2019. As a control group, we collected data of patients who had undergone primary maxillary sinus ESS at 3 Finnish University Hospitals, and 1 Central Hospital in years 2005, 2008, and 2011. RESULTS: Altogether, 77 balloon patients and 82 ESS patients were included. The mean follow-up time was 5.3 years in balloon group and 9.8 years in ESS group. Revision surgery was performed on 17 balloon patients and 6 ESS patients. In the survival analysis, the balloon sinuplasty associated significantly with a higher risk of revision surgery compared to ESS. According to the phone interviews, 82% of ESS patients and 75% of balloon patients were very satisfied with the primary operation. CONCLUSION: Although the patient groups expressed equal satisfaction and change in symptoms after the operations, the need for revision surgery was higher after balloon sinuplasty than after ESS. This should be emphasized when counselling patients regarding surgical options.

Who ends up having tonsillectomy after peritonsillar infection?

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

[Emergency rhinology]. / Päivystysrinologiaa.

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