Long-term follow-up evaluation of mastoidectomy in children with non-cholesteatomatous chronic suppurative otitis media.

OBJECTIVE: In spite of declining prevalence chronic suppurative otitis media without cholesteatoma (CSOM) still poses a significant health problem. Randomized clinical trials comparing medical and surgical intervention are not available. Hence, the treatment of CSOM is almost exclusively based on empirical experience. The purpose of the present study was to evaluate the long-term effects of mastoidectomy combined with myringotomy and exploration of the middle ear in children with CSOM. METHODS: 47 children with CSOM underwent surgery including mastoidectomy. Ear status was investigated peri-operatively and at a long-term follow-up (5-21 years post-operatively). MAIN OUTCOME MEASURES: Final success rate, FS (dry ears for several years) and the optimal final success rate, OFS (dry ears for several years without re-operations and without retractions/perforations) were estimated. RESULTS: No serious surgical complications occurred. Post-operatively re-mastoidectomy was performed in 13% and re-myringoplasty/tympanoplasty in 21%. At the long-term follow-up the FS rate was 94% and the OFS rate was 61%. CONCLUSIONS: Surgery alone did not entirely cure CSOM which may justify randomized studies comparing conservative treatment and myringoplasty with/without mastoidectomy. Finally, mastoidectomy in these patients must be considered as a last resort when intense conservative treatment fails.

[When cochlear implants came to Denmark and the deaf began to hear]. / Da cochlear implant kom til Danmark og de døve blev hørende.

For several hundreds years, deafness in humans and deaf-mute humans has been a challenge to doctors and other therapists. During the last 50 years, it has become possible to treat deaf people. The reasons for this success in treatment and the introduction of the treatment in Denmark are the topics of this text. To make deaf people hear, patients were treated with electricity for more than two hundred years,in Denmark as well as other countries. This development depended on many important factors for a positive result of the treatment. The first operation of a deaf patient in Denmark was performed in Odense. Some years later the treatment began at Gentofte Hospital and later at Aarhus City Hospital. The start was slow, to some extent because of financial circumstances but also because the necessary equipment was not fully developed. There were also difficulties with selection of the most suited patients, training of patients, resistance against treatment from organisations of the deaf and from conventional teachers of the deaf. The problems were solved over a period of some years, and the population could soon see and meet patients as celebrities, i.e., previously deaf persons who could now use a telephone. More than 600 deaf people have now been operated in Denmark. The term deafness has changed its meaning, and probably there will no new cases of the deaf-mute in the future.

[Postoperative hemorrhage after tonsillectomy in Denmark]. / Efterblødninger ved fjernelse af mandler i Danmark i 1900-tallet.

Removal of the tonsils, or tonsillectomy, is a very frequent surgical procedure in Denmark (5 million inhabitants). Nowadays, about 7-8,000 patients are operated on each year. The indications for surgery and the surgical principles have largely remained the same for a century, but different techniques have been employed. As in all surgical procedures, there are complications to tonsillectomy, first and foremost postoperative bleeding which occurs in 4-8% of all operated patients. In the last 100 years many studies have been undertaken to shed light on the frequency of postoperative bleeding following tonsillectomy. It is noteworthy that the studies have been carried out at times where there was a certain interest in the subject whereas in other periods of time, the subject has been of little interest to researchers. The definition of postoperative hemorrhage is not unambiguous. Despite the fact that various surgical techniques have been applied, no significant change in the incidence of postoperative hemorrhage after tonsillectomy has been shown over the past 100 years. The study calls for caution when evaluating new surgical techniques since the incidences of postoperative hemorrhage have been shown to change between high and low percentages through the entire 100 year period.