Reliability and comparison of gain values with occurrence of saccades in the EyeSeeCam video head impulse test (vHIT).

The vHIT (video head impulse test) investigates the vestibular function in two ways: a VOR (vestibulo-ocular reflex) gain value and a head impulse diagram. From the diagram covert and overt saccades can be detected. Evaluation of the vestibular function based on vHIT depends on both parameters. There is a lack of knowledge regarding the reliability of the two parameters. The objective was to investigate the reliability of vHIT by comparing gain values between examiners on the same subjects, and to see how differences affected the occurrence of saccades. SUBJECTS: 25 subjects who had undergone cochlear implant (CI) surgery. Subjects were tested using the vHIT by two of four different examiners. Two judges interpreted the occurrence of saccades in the diagram. MAIN OUTCOME MEASURES: VOR gain values and the occurrence of saccades in the diagram. Differences in gain values between examiners varied from 0.2 to 0.58 with an average of 0.14 (95 % CI 0.12-0.16) on the right ear and 0.17 (95 % CI 0.15-0.19) on the left ear. Occurrences of saccades in the same patient were reproduced in 93 % of the cases by all examiners. Kappa's coefficient on the occurrence of saccades was 0.83. Interclass correlation coefficient (ICC) of the gain values between examiners ranged from 0.62 to 0.70. Differences in gain values amongst examiners did not seem to affect the occurrence of saccades in the same patient. The occurrence of saccades, therefore, seems to be more reliable than the gain value in the evaluation of the vestibular function. Interpretation of vHIT results should, therefore, first depend on the occurrence of saccades and second on the gain value.

The Otitis Media-6 questionnaire: psychometric properties with emphasis on factor structure and interpretability.

BACKGROUND: The Otitis Media-6 questionnaire (OM-6) is the most frequently used instrument to measure health related quality of life in children with otitis media. The main objectives of this study are 1) to translate and cross-culturally adapt the OM-6 into Danish, and 2) to assess important psychometric properties including structural validity and interpretability of the OM-6 in a Danish population of children suffering from otitis media. METHODS: The OM-6 was translated and cross-culturally adapted according to international guidelines. A longitudinal validation study enrolled 491 children and their families, and the measurement properties of the OM-6 were evaluated using the Cosmin taxonomy. The properties assessed were construct and structural validity (confirmatory factor analysis) including internal consistency, reproducibility (test-retest reliability and smallest detectable change), responsiveness and interpretability. RESULTS: A total of 435 children were eligible to participate in the study. Analyses of structural validity and internal consistency indicated that parent appraisal of hearing and speech problems may be problematic. Both scales showed similarly good test-retest reliability and construct validity, were able to discriminate between diagnostic subgroups and responsive to change. Cut-off values of 16.7 and 30.0 were found to represent minimal important change for the patients. CONCLUSIONS: The Danish version of the OM-6 is a reliable, valid, responsive and interpretable questionnaire to measure quality of life in children with otitis media. This study sheds light on possible weaknesses of the instrument that needs to be acknowledged in the utilization of the instrument. However, despite these issues our results support the continuing use of OM-6 as a 1-factor functional health scale with a separate global health rating. Furthermore, indications of values representing minimal important change as perceived by the respondent are presented.

RNA contact prediction by data efficient deep learning.

On the path to full understanding of the structure-function relationship or even design of RNA, structure prediction would offer an intriguing complement to experimental efforts. Any deep learning on RNA structure, however, is hampered by the sparsity of labeled training data. Utilizing the limited data available, we here focus on predicting spatial adjacencies ("contact maps") as a proxy for 3D structure. Our model, BARNACLE, combines the utilization of unlabeled data through self-supervised pre-training and efficient use of the sparse labeled data through an XGBoost classifier. BARNACLE shows a considerable improvement over both the established classical baseline and a deep neural network. In order to demonstrate that our approach can be applied to tasks with similar data constraints, we show that our findings generalize to the related setting of accessible surface area prediction.

Validation of the cholesteatoma diagnosis in the Danish National Hospital Register.

INTRODUCTION: The aim was to evaluate the validity and the degree of completeness of the cholesteatoma diagnosis in the Danish National Hospital Register (DNHR). VALIDITY: A random sample of 286 patients with a cholesteatoma diagnosis who had been admitted to an ear-nose-throat department on Funen between 1977 and 2007 were selected from the DNHR for validation. The diagnosis was verified on the basis of surgical chart review. Completeness: The DNHR was compared with the local Ear-database at Odense University Hospital (EDOUH) covering the 1996-2007 period. VALIDITY: A total of 273 patients had 422 registrations of a cholesteatoma diagnosis combined with relevant surgery (CWRS). The remaining 13 of the initially 286 selected patients had a cholesteatoma diagnosis, but without relevant surgery. Surgical charts could be retrieved for 262 patients with 401 registrations. The positive predictive value (PPV) of the CWRS in the DNHR was 85.8%. When only the first-time patients with CWRS were recorded, the PPV was 89.3%. Completeness: A total of 329 cases of surgery were recorded in the DNHR, the EDOUH or both. Surgical charts could be retrieved for 322. The diagnosis was confirmed for 277. Based on the confirmed cases, the degree of completeness of the CWRS in the DNHR was estimated to 91.0%. When only the first-time patients were included, the degree of completeness was estimated to 89.3%. CONCLUSION: Misclassification of the first CWRS in the NHR was close to 10%, and the DNHR may be considered a useful tool for epidemiological research on cholesteatoma.

Decreasing incidence rate for surgically treated middle ear cholesteatoma in Denmark 1977-2007.

INTRODUCTION: The objective was to estimate the annual incidence rate of surgically treated middle ear cholesteatoma (STMEC) in Denmark from 1977 to 2007, taking age, gender and secular trends into consideration. MATERIAL AND METHODS: We used the Danish National Hospital Register to identify all registered cases of STMEC in Denmark between 1977 and 2007. Only the first registration of STEMC (STEMC1) was used for estimation of the annual incidence rate. RESULTS: A total of 13,606 cases of STMEC1 were identified. The highest incidence rates were seen in the beginning of the eighties with a maximum male incidence rate of 14.3 per 100,000 person-years in 1982 and a maximum female incidence rate of 9.1 per 100,000 person-years in 1981. In 2007 the incidence rate per 100,000 person-years was 8.5 for males and 5.4 for females. The age-specific incidence rate peaked at approx. nine years for both males and females with incidence rates of 21.4 and 13.6 per 100,000 person-years, respectively. The male:female incidence rate ratio was 1.51. CONCLUSION: The incidence rate of STMEC1 in Denmark showed a statistically significant decrease from 1977 to 2007. A male predominance was found. The age-specific incidence rate peaked at the age of approx. nine years. Further studies are required to perform a detailed analysis of factors that may influence the incidence rate of STMEC1, e.g. the incidence of grommet insertion and adenoidectomy, antibiotic treatment of middle ear infections and an expanding use of otomicroscopy in the early 1980s.

Surgical treatment of patulous Eustachian tube - a systematic review.

INTRODUCTION: Patulous Eustachian tube (PET) seems to be caused by a defect in the mucosal valve of the Eustachian tube. It causes troublesome autophony occasionally leading to an impaired quality of life. In the present study, we aimed to evaluate the effect of surgical treatment of PET through a systematic review of published studies. METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis statement. Medline, Embase and Cochrane were searched systematically for publications about PET. METHODS: Fourteen publications counting a total of 510 ears from 390 patients who had been treated surgically for PET were included. Complete relief of symptoms ranged from 7% to 77%, improvement from 7% to 86% and 0% to 41% had no response. No studies reported aggravation of symptoms. CONCLUSIONS: A number of suggested treatments appear to be promising for PET, but it is difficult to propose a specific surgical treatment due to low numbers of patients, lack of clinical trials and cohort studies without control groups.

Recurrence of Cholesteatoma - A Retrospective Study Including 1,006 Patients for More than 33 Years.

Introduction Cholesteatomas are benign tumors consisting of skin, and growing inside a retraction pocket in the tympanic membrane. Cholesteatomas can occupy the entirety of the middle ear, and are known for their osteolytic capabilities. Surgery is the only curative treatment for cholesteatomas. Objective To describe the risk of recurrence after first-time surgically-treated middle-ear cholesteatoma (STMEC1) on the island of Funen from 1983 to 2015. Methods Cases of STMEC1 were identified in the Danish National Hospital Register. The medical records were reviewed. Time-to-event analyses were applied. The ears were followed from STMEC1 to a secondary cholesteatoma, emigration, death, or end of follow-up. Results Records from 1,006 patients with STMEC1 were reviewed. A total of 54 patients were submitted to surgery on both ears. The total sample consisted of 1,060 ears with STMEC1; 300 were children's (< 16 years) ears, and 760 were adult's ears. The total observation time was of 12,049 years. The overall estimated proportion with recurrence 5 years after surgery was of 37% in children and of 15% in adults. The older the child was at the first surgery, the risk decreased by 7% per year. In children, canal wall up (CWU) mastoidectomy without obliteration was associated with a hazard ratio for recurrence of 1.9 (95% confidence interval [95%CI]: 1.2-3.0) compared with CWU with obliteration. Conclusion Compared with adults, children were had 2.6 times more risk of recurrence. Procedures performed without mastoidectomy had the lowest risk of recurrence. In children, obliteration was associated with a significantly lower risk of recurrence. However, patients were not randomized regarding the surgical approach; thus, the association between approach and risk of recurrence was likely influenced by confounding factors.

Postoperative infections following cochlear implant surgery.

INTRODUCTION: The aim of this study was to report the frequency and management of postoperative wound infections and to investigate bacteriology and biofilm formation following 653 consecutive cochlear implantations in adults. METHODS: A retrospective file review of 653 consecutive adult cochlear implantations between 1994 and 2015 at the Department of Otorhinolaryngology at Odense University Hospital. A reporting consensus was used to classify infections. RESULTS: The major and minor infection rates were 2% and 8%, respectively. The explantation rate due to infection was 1%. The most common pathogen found was Staphylococcus aureus and biofilm formation was found in 73% of the explantations. CONCLUSION: Postoperative infection occurred in 10% of the implantations. However, few of these were severe. Staphylococcus aureus was the most common pathogen and the presence of biofilm seemed to be associated with a higher risk of explantation.

Vestibular Outcome After Cochlear Implantation Is Not Related to Surgical Technique: A Double Blinded, Randomized Clinical Trial of Round Window Approach Versus Cochleostomy.

OBJECTIVE: To establish whether the round window approach (RWA) leads to less vestibular dysfunction and dizziness than the standard cochleostomy approach (SCA) during cochlear implant (CI) surgery, as assessed using the video head impulse test (vHIT).Additionally, objective findings were compared with the subjective dizziness perceived by the patient. STUDY DESIGN: Double blinded, clinical randomized trial. SETTING: University Hospital. PATIENTS: Fifty-two ears from 46 patients were included. Inclusion criterion was a gain value more than 0.50. INTERVENTION: Patients were randomized to the RWA or the SCA. Evaluation with the vHIT was performed before surgery, 1 day after surgery, and 1 month after surgery. Subjective dizziness was measured using a visual analogue scale (VAS) and the dizziness handicap inventory (DHI). MAIN OUTCOME MEASURES: Gain values and the incidence of catch-up saccades. RESULTS: Three out of 23 patients in the SCA group experienced catch-up saccades compared with no patients in the RWA group, indicating the occurrence of objective vestibular dysfunction after CI surgery; the difference was not statistically significant. The VAS increased in both groups the day after surgery. The difference between the groups was not statistically significant. No statistically significant changes in the gain value or the DHI score could were observed between the two groups. CONCLUSION: No statistically significant difference between the cochleostomy approach and the round window approach using the vHIT and subjective dizziness perceived by the patient was found.

[Temporary loss of vestibular function after cochlear implant surgery].

Loss of vestibular function is a common side effect to cochlear implant (CI) surgery. We present a patient who experienced balance problems and showed a reduced vestibulo-ocular reflex (VOR) gain (0.47 ± 0.10) combined with saccades in the horizontal semicircular canals demonstrated by the video head impulse test the day after CI surgery. One month after the operation VOR gain was normal (0.95 ± 0.05) and neither balance problems nor saccades occurred. Our findings indicate that vestibular dysfunction after CI surgery can be reversible, and VOR gain can return to normal.

Refixation Saccades with Normal Gain Values: A Diagnostic Problem in the Video Head Impulse Test: A Case Report.

Refixation saccades with normal gain value occur more frequently with increasing age. The phenomenon has also been observed in different vestibular disorders. In this case, we present a young male with normal gain value and refixation saccades tested with the video head impulse test (vHIT) the day after his cochlear implantation. One month after surgery, refixation saccades were no longer present. This suggests that refixation saccades can occur as a result of temporary pathology such as surgery. Refixation saccades with normal gain values might reflect a partial deficit in the vestibulo-ocular reflex. However, this partial deficit is in conflict with the current way of interpreting vHIT results in which the vestibular function is classified as either normal or pathological based only on the gain value. Refixation saccades, which are evident signs of vestibulopathy, are not considered in the evaluation. A new way of interpreting the vHIT based on the saccades must be considered.

Changes in salivary secretion and sense of taste following cochlear implantation: a prospective study.

CONCLUSION: A set of methods for evaluating changes in salivary secretion and sense of taste following cochlear implantation (CI) was applied and tested. No association between implantation and objectively assessed sense of taste was found. However, a statistically significant decrease in non-stimulated salivary flow on the day after surgery was found. OBJECTIVES: To develop and test a research method describing the course of changes in salivary secretion and sense of taste following CI. METHODS: This was a longitudinal study examining 13 patients undergoing CI at Odense University Hospital in 2012. Questionnaires, sialometry and gustatory testing were applied. RESULTS: A general postoperative decrease in salivary secretion could not be found. However, a 29.9% mean reduction in non-stimulated salivary flow was observed when looking specifically at the visit the day after surgery (p = 0.001). When adjusting for perioperative administration of glycopyrrolate (p < 0.001) and atropine (p = 0.178), the former was highly associated with a 69.7% mean decrease in non-stimulated salivary flow at the visit the day after surgery. The third examination was still, independent of glycopyrrolate administration, borderline significantly associated with a 14.5% mean decrease (p = 0.054). We did not find any significant decrease in sense of taste following implantation.

Cholesteatoma in Danish children - a national study of changes in the incidence rate over 34 years.

OBJECTIVE: To describe temporal trends in the incidence rate of surgically treated middle ear cholesteatoma in Danish children from 1977 to 2010. METHODS: Data on surgically treated middle ear cholesteatoma was drawn from the Danish National Patient Register. A change in incidence rate over time was examined using Poisson regression analysis, while the cumulative incidence proportion was estimated using life-tables. RESULTS: A total of 5850 cases of surgically treated middle ear cholesteatoma distributed among 3874 children aged 0-15 years were identified. From 1977 to 2002 the age-standardized incidence rates for first-time surgically treated middle ear cholesteatoma increased from 8 to 15 per 100,000 person-years with an estimated annual increase of 1.8% (95% confidence interval (CI) 1.3-2.2%). From 2002 to 2010 the rates decreased from 15 to 10 per 100,000 person-years with an annual decrease of 5.4% (95% CI 3.2-7.5%). Age-specific incidence rates were at maximum around the age of 9 years during the whole period. The estimated cumulative incidence proportion at age 16 years based on the 2010 age-specific incidence rates was 0.16% (95% CI 0.09-0.32%) compared with 0.20% (95% CI 0.11-0.37%) based on the 2000 age-specific incidence rates. CONCLUSION: From 2002 to 2010 there was a decrease in the incidence rate of first-time surgically treated middle ear cholesteatoma. The decrease was preceded by a significant increase in the incidence rate of middle ear ventilation tube insertion. However, further studies are needed to find possible explanations for the decrease.

Cholesteatoma risk in 8,593 orofacial cleft cases and 6,989 siblings: A nationwide study.

OBJECTIVES/HYPOTHESIS: To estimate the risk of surgically treated middle ear cholesteatoma in individuals with a nonsyndromic orofacial cleft and in their siblings compared with the general population. STUDY DESIGN: Historical cohort study. METHODS: Using the unique civil registration number for linkage, data from three national registers were used for the Danish 1936-2009 birth cohorts. Hazard ratios (HRs) were estimated with Cox regression analyses using age as the underlying time variable. Individuals were followed from January 1, 1977 until time of surgically treated cholesteatoma, and censored at emigration, death, or end of follow-up (December 31, 2010). RESULTS: A total of 8,593 individuals with nonsyndromic orofacial cleft and 6,989 siblings were identified, undergoing 201 and 21 first-time cholesteatoma surgeries, respectively. A 5% random sample of the Danish population comprising 249,708 persons without an orofacial cleft was created, and 175,724 siblings to these persons were identified. These controls underwent 485 and 332 first-time cholesteatoma surgeries, respectively. For individuals with cleft lip and palate the HR for cholesteatoma surgery was 14 (95% confidence interval [CI], 12-18) and for individuals with cleft palate the HR was 20 (95% CI, 16-24) when compared with the random sample. In siblings of individuals with cleft palate, the HR for cholesteatoma surgery was 2.1 (95% CI, 1.1-4.1) when compared with siblings of the random sample. CONCLUSIONS: A 20-fold increase in the risk of cholesteatoma was found in individuals with cleft palate, whereas cleft lip did not pose a risk of cholesteatoma. Furthermore, the study indicates an increased risk of cholesteatoma in unaffected siblings of individuals with cleft palate. LEVEL OF EVIDENCE: 2b Laryngoscope, 125:1225-1229, 2015.

The impact of ventilation tubes in otitis media on the risk of cholesteatoma on a national level.

OBJECTIVE: To estimate the impact of treatment with middle ear ventilation tube insertion (VTI) in children with otitis media (OM) on the risk of cholesteatoma on a national level. METHODS: Data were obtained from the Danish National Patient Register, the National Health Service Register and Statistics Denmark. Cumulative incidence proportions were estimated by the Kaplan-Meier method and hazard ratios with Cox regression analysis. The first surgically treated middle ear cholesteatoma in a child (STMEC1) was considered an event. RESULTS: A total of 217,206 children, born after December 31, 1996, who had VTI from January 1, 1997 to August 31, 2011 were identified. Of these, 374 subsequently had a STMEC1. A corresponding 36,981 children without any VTI were identified for comparison using a random 5% sample of the Danish population. Of these, 5 had a STMEC1. The cumulative incidence proportion with STMEC1 at 12 years of age for children with 0, 1, 2, 3, and ≥4 VTI's was 0.04% (95% confidence interval 0.02-0.12%), 0.21% (0.18-0.26%), 0.35% (0.28-0.43%), 0.40% (0.30-0.54%), and 0.55% (0.44-0.70%), respectively. In the regression model each additional year of age before the first VTI increased the risk of STMEC1 by 54% (47-63%), while each additional year between two successive tube insertions increased the risk by 28% (15-43%). CONCLUSION: We found that prolonged OM requiring multiple VTIs was associated with an increased risk of STMEC1. Early age at first VTI and short time between two VTIs was associated with a lower risk of STMEC1. This may be the result of reduced time with negative middle ear pressure and OM. However, these findings may be susceptible to selection bias, as age at first VTI and time between VTIs, as well as the outcome variable, STMEC1, may all depend on the underlying indication for VTI. In short the present study suggests that treatment with VTI in children with OM reduces the risk of STMEC1 on a population level. However, for the individual child the absolute risk reduction is very small, and the decision of treatment with VTI must always rely on the symptoms and clinical findings in the individual child.

Bone-anchored hearing aids are effective and associated with a high degree of satisfaction.

INTRODUCTION: The objective of this study was to evaluate patients' satisfaction with bone-anchored hearing aids (BAHA). METHODS: This study was retrospective and based on a postal questionnaire. The study sample consisted of patients undergoing surgery at Odense University Hospital in the 1992-2013-period. The questionnaire was a combination of Satisfaction with Amplification in Daily Life questions from the Hearing Aid Research Lab at the University of Memphis and questions used in a previous Danish study. We also used data from each patient's medical records. All information was collected in a database. RESULTS: The response rate was 80% and the user percentage 88. The majority of the patients used their BAHA seven days a week and most of the day. 88% reported that it was in their best interest that they had received a BAHA. 80% of the respondents were able to communicate better using their BAHA in one-on-one conversations. CONCLUSION: BAHA is helpful in one-on-one conversations in quiet surroundings. Sound quality in group situations seems to be the main problem associated with BAHA. However, this study showed that BAHA is an effective hearing aid that is associated with a high degree of satisfaction. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Recurrence of Cholesteatoma: A Retrospective Study Including 1006 Patients for More than 33 Years

Abstract Introduction Cholesteatomas are benign tumors consisting of skin, and growing inside a retraction pocket in the tympanic membrane. Cholesteatomas can occupy the entirety of the middle ear, and are known for their osteolytic capabilities. Surgery is the only curative treatment for cholesteatomas. Objective To describe the risk of recurrence after first-time surgically-treated middle- ear cholesteatoma (STMEC1) on the island of Funen from 1983 to 2015. Methods Cases of STMEC1 were identified in the Danish National Hospital Register. The medical records were reviewed. Time-to-event analyses were applied. The ears were followed from STMEC1 to a secondary cholesteatoma, emigration, death, or end of follow-up. Results Records from 1,006 patients with STMEC1 were reviewed. A total of 54 patients were submitted to surgery on both ears. The total sample consisted of 1,060 ears with STMEC1; 300 were children's (< 16 years) ears, and 760 were adult's ears. The total observation time was of 12,049 years. The overall estimated proportion with recurrence 5 years after surgery was of 37% in children and of 15% in adults. The older the child was at the first surgery, the risk decreased by 7% per year. In children, canal wall up (CWU) mastoidectomy without obliteration was associated with a hazard ratio for recurrence of 1.9 (95% confidence interval [95%CI]: 1.2-3.0) compared with CWU with obliteration. Conclusion Compared with adults, children were had 2.6 times more risk of recurrence. Procedures performed without mastoidectomy had the lowest risk of recurrence. In children, obliteration was associated with a significantly lower risk of recurrence. However, patients were not randomized regarding the surgical approach; thus, the association between approach and risk of recurrence was likely influenced by confounding factors.

Quality-of-Life Differences among Diagnostic Subgroups of Children Receiving Ventilating Tubes for Otitis Media.

OBJECTIVE: The pathological picture may differ considerably between diagnostic subgroups of children with otitis media receiving ventilating tubes. The aims of this study are to investigate differences in quality of life among diagnostic subgroups of children treated with ventilating tubes and to investigate possible predictors for clinical success. STUDY DESIGN: Longitudinal observational study. SETTING: Secondary care units. METHODS: Four hundred ninety-one families were enrolled in the study. The Otitis Media-6 questionnaire was applied in the assessment of child quality of life. Caregivers completed questionnaires at 7 time points from before treatment to 18-month follow-up. Logistic regression analysis was used to investigate possible predictors for clinical success. RESULTS: Response rates ranged from 96% to 81%; diagnostic distribution: 15% recurrent acute otitis media (rAOM), 47% otitis media with effusion (OME), and 38% mixed diagnosis of rAOM and OME (rAOM/OME). There were no significant differences between children diagnosed with rAOM and children diagnosed with rAOM/OME. However, these children had a significantly poorer quality of life at baseline compared with children diagnosed with only OME. Factors associated with clinical success included a diagnosis of rAOM, number of interrupted nights, physician visits, and canceled social activities due to OM. CONCLUSIONS: Results highlight the importance of distinguishing between diagnostic subgroups of children having ventilating tube treatment. A diagnosis of rAOM was found to predict baseline quality of life. Children with rAOM with or without OME were found to suffer significantly more than children with only OME before treatment. Factors associated with disease severity were found to predict clinical success.

Anterior mandibular positioning device for treatment of snoring and obstructive sleep apnoea.

The aim of this study was to determine the severity of side effects and the influence on snoring and the AHI (apnoea-hypopnoea index = number of apnoeas and hypopnoeas per hour recording) of an anterior mandibular positioning device (AMP device) for treatment of snoring and obstructive sleep apnoea. Questionnaires were mailed to a consecutive series of 30 patients who had started treatment with an AMP device. The mean follow-up interval from receiving an AMP device to answering the questionnaire was 22 months. The perceived degree of sore teeth increased statistically significantly (p < 0.01) as a result of the AMP device treatment, but there was no increase in the degree of facial pain, salivation, or temporomandibular joint pain. The AMP device treatment resulted in a statistically significant reduction (p < 0.01) of the mean AHI and of the mean percentage of the recording time with loud snoring (p < 0.05). Twenty-two patients out of 30 were still using the device at the time of follow-up. In conclusion, AMP device treatment was associated with only mild side effects and resulted in a statistically significant reduction of the AHI and of the percentage of the recording time with loud snoring.

Increasing rate of middle ear ventilation tube insertion in children in Denmark.

OBJECTIVE: To study the incidence rates of middle ear ventilation tube insertion in children aged 0 to 15 years in Denmark from 1997 to 2010. METHODS: Using two national registers, the Danish National Health Service Register and the Danish National Patient Register, practically all cases of middle ear ventilation tube insertion performed in Denmark in the period were identified. A possible change in incidence rate over time was examined using Poisson regression analysis, while the cumulative incidence proportion was estimated using life-tables. RESULTS: A total of 502,569 uni- or bilateral ventilation tube insertions distributed among 269,459 different children were identified. From 1997 to 2010 the age standardized incidence rate in 0-15-year-olds increased from 26 to 40 per 1000 person years with an estimated annual increase of 2.0% (95% confidence interval 1.9-2.1%). The largest increase in incidence rate was found in 1-year-olds with an annual increase of 4.5% (95% confidence interval 4.4-4.6%). Age-specific incidence rates remained at maximum around the age of 14 months throughout the period. The cumulative incidence proportion for the 2010 birth cohort by the time they reach the age of 5 years was estimated to 29% (95% confidence interval 28-29%). CONCLUSION: The rate for middle ear ventilation tube insertion in Denmark was high compared to other developed countries, and an estimated 3 in 10 children born in 2010 will undergo at least one ventilation tube insertion before their fifth birthday.