Chronic otitis media sequelae in skeletal material from medieval Denmark.

OBJECTIVES: Chronic otitis media sequelae (COMS) have been identified in archaeological skeletal materials from various ages. COMS reflecting episodes of upper respiratory tract infection may be used as a paleopathological indicator of general health. Estimation of the frequency of COMS may be useful in the gross evaluation of general standard of living. MATERIALS AND METHODS: Temporal bones and auditory ossicles from 659 individuals from two Danish medieval rural parish cemeteries, dated to 1050-1200 and 1150-1350, respectively, were examined otomicroscopically. RESULTS: Osseous fistulae from mastoid abscesses, remodelling of the hypotympanon, and erosion of the incus were among the convincing indications of COMS. A minimum frequency of COMS of 1% to 7% was found. The youngest material displayed the highest frequency of pathological changes. CONCLUSION: Indications of a rising incidence of infectious middle ear disease in early medieval Denmark were found. This may reflect a deterioration of living conditions from the 11th through the 14th centuries.

Auditory ossicles in archaeological skeletal material from medieval Denmark.

Auditory ossicles were collected from two skeletal materials from early medieval Denmark. A total of 147 and 1,162 ossicles were obtained from the 2 materials, constituting 23% and 55% of the possible in vivo ossicles. The numbers and percentages found are among the highest reported from studies of archaeological skeletal material. Archaeological ossicles may be used in palaeopathological evaluation of chronic otitis media and otosclerosis, and morphometric studies of the ossicles might be valuable in analysis of population genetics and taxonomy.

Tympanoplasty with ionomeric cement.

Patients with isolated erosion of the long incus process suffer from severe hearing loss caused by lack of continuity of the ossicular chain. This study is a retrospective evaluation of the hearing results using two different surgical procedures. Since January 1993, 12 consecutive patients with isolated erosion of the long incus process have been treated with a new surgical technique in which the ossicular chain was rebuilt with ionomeric cement. The results in hearing performance (mean pure-tone average (PTA) 0.5, 1 and 2 kHz) were evaluated pre- and post-surgery, and compared to those in a group of 20 historical controls who underwent surgery in 1991 and 1992 using incus autograft interposition. Among the 12 index patients, 7 (58%) achieved improvement in PTA of > 10 dB, in 3 there was no difference and in 2 a slight decline. Among the 20 controls, 14 (70%) achieved improvement in PTA of > 10 dB, in 4 there was a slight improvement and in 2 a decline. The difference was not statistically significant. Hearing improvement using ionomeric cement in type II tympanoplasty was satisfactory. Reconstruction of the ossicular chain with ionomeric cement is recommended, as the procedure is easy to perform, presents less risk of damage to the stapes and cochlea, requires less extensive surgery and does not exclude other surgical methods in cases of reoperation.

Cochlear implantation and change in quality of life.

The aim of this study was to assess the benefits of cochlear implantation (CI) in adults and to evaluate the average implant usage per day. Ten profoundly deaf adults were implanted during the period April 1994 to September 1997. The patients answered questionnaires 1 year or more after receiving their cochlear implants. All of the patients used their implant daily. The average implant usage per day was 16 h. The patients stated that, given the choice, they would again opt for a cochlear implant and would recommend a cochlear implant for a deaf friend. A paired comparison showed that the implants led to significant improvements in a number of factors: self-perceived communication skills, frequency of conversation with others, telephone usage, self-confidence and the impact of hearing impairments on family life. CI dramatically changed the quality of life for all patients. No surgical complications were observed.

Complaints and satisfaction after uvulopalatopharyngoplasty.

A questionnaire administered 2 years after classical laser uvulopalatopharyngoplasty (UPPP) showed that 42% of 69 patients had complaints. Most of the complaints, however, were comparatively minor. The most frequent complaint was a tendency to nasal regurgitation (13%), although only two patients needed treatment. Other complaints were pharyngeal hypersecretion (10%), swallowing problems (9%) and speech disturbances (7%). Fourteen per cent of the 69 patients were not satisfied with the effect of the operation. In the group with complaints, 25% were dissatisfied with the result of the operation, whereas only 8% of those with no complaints were dissatisfied (p < 0.05). Continued snoring after UPPP was closely correlated to dissatisfaction with the general result (p < 0.01). It is very important to carry out follow-up after UPPP because complaints and dissatisfaction are common. Every effort should be made to reduce the tendency to nasal regurgitation. The results are relatively good and the procedure justified in cases of severe snoring and continuous positive airway pressure (CPAP)-resistant obstructive sleep apnoea (OSA). The severity and number of complaints were found to be acceptable in this difficult treatable entity.

pH monitoring in patients with benign voice disorders.

The aim of this study was to compare oesophageal pH-metry with laryngeal signs and symptoms in patients suspected of laryngeal reflux disease. A total of 60 patients with voice disorders, who were suspected of laryngeal reflux, were tested by single probe oesophageal pH monitoring. Thirty-two suffered from reflux laryngitis. A comparison of symptoms in patients with proven reflux to patients with no reflux was made. The symptoms were more frequent in the patients in the reflux group than in the non-reflux group. There was a significant difference between the groups with regard to dysphonia, sore throat, thick mucus and heartburn. Clinical signs appeared more frequently in the reflux group than in the non-reflux group. A significant difference was found between the groups regarding oedema of the vocal cords and hyperaemia and oedema of the posterior commisure, contact granuloma, posterior wall granulation and increased muscle tension. The patients in the reflux group were given medical treatment using omeprazole, and 76% logopedic voice training program. More than 50% of the laryngeal reflux patients were treated for more than 4 months before their voice problems had resolved. It is important to realize that signs of reflux laryngitis are not confined to the posterior commisure.

[Cochlear implantation in adults. Results and significance for communication and quality of life]. / Cochleaimplantationer hos voksne. Resultater og betydning for kommunikation og livskvalitet.

The aim of this study was to assess the benefits and complications from cochlear implantation and to evaluate the average implant usage per day. Ten profoundly deaf adults were implanted during the period April 1994 to September 1997. The patients answered questionnaires one year or more after receiving their cochlear implants. The average implant usage per day was 16 hours. The patients would again opt for a cochlear implant and would recommend a cochlear implant for a deaf friend. A paired comparison showed that the implants led to statistically significant improvement in a number of factors; self perceived communication skills, frequency of conversation with others, telephone usage, self-confidence, and the hearing impairment's impact on family life. No serious surgical complications were found.

[Subjective symptoms and sleep apnea among persons referred to a sleep center. A questionnaire survey]. / Subjektive gener og søvnapnø blandt personer henvist til et søvncenter. En spørgeskemaundersøgelse.

The aim of this study was to evaluate the relation between symptoms and clinical characteristics and the frequency of increased apnoea and hypopnoea activity. The study population consisted of 135 persons referred to a sleep centre. One hundred and fifteen patients (85%) completed a questionnaire and were subsequently monitored during one night's sleep. Fifty-two persons (45%) had an Apnoea Hypopnoea Index (AHI = the mean number of apnoea and hypopnoea episodes per hour of sleep) > or = 10. Forty-one (36%) had an Apnoea Index (AI = the mean number of apnoea per hour of sleep) > or = 10. Symptoms and clinical characteristics had no significant correlation to increased apnoea activity; however, there was a significant relationship between self-reported frequent breathing pauses during sleep and increased AHI and AI. Symptoms and clinical characteristics are not capable of identifying persons with increased apnoea activity.

[Mediastinoscopy in bronchogenic carcinoma]. / Mediastinoskopi ved bronkogent karcinom.

During recent years it has been discussed whether mediastinoscopy could be replaced or supplemented by other diagnostic procedures for detection of mediastinal lymph node metastases in patients with pulmonary cancer. The results of 289 mediastinoscopies were analyzed and correlated to thoracotomy in order to evaluate the procedure. Two hundred and six males and 83 females were included in the study. The mean age was 63 years for men and 58 years for women. Mediastinoscopy was positive (N2 disease) in 113 cases (39%) and negative in 176 cases. The 113 N2 patients were not operated upon. One hundred and seven patients (37%) had thoracotomy performed. 12% of these patients had metastases at the time of thoracotomy. Mediastinoscopy is still the most reliable method in selecting patients with bronchogenic carcinoma for thoracotomy. It is important to make a careful dissection during the mediastinoscopy at both tracheo-bronchial angles as well as at the subcarinal. Eleven percent of the metastatic lymph nodes were found only at the subcarinal or at the contralateral tracheo-bronchial angle. Sixteen (5.5%) of the 289 patients are still alive, with a follow up of more than six years. Only resected patients survived.