Indhold

Transcription

Indhold

Indhold
Velkommen til DSOHH 2015
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Program
Program oversigt
5
Program torsdag 21. maj
6
Program fredag 22. maj
8
Praktisk
Praktisk information
10
Socialt program
12
Udstillere
13
Abstracts
Inviterede foredrag
17
Vejleder seminar
26
Foredrag torsdag
28
Foredrag fredag 31
Poster præsentationer
69
Noter
83
XII Årsmøde Dansk Selskab for Otolaryngologi, Hoved & Halskirurgi
//
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Velkommen til DSOHH 2015
Kære DSOHH medlem
Vi er glade for at kunne præsenterer årets program for det 12 DSOHH årsmøde der efter en kort
afstikker til København i forbindelse med Nordisk kongres i 2014, atter afholdes i de vante omgivelser på Nyborg strand.
Vi ser frem til et godt møde med parallelle sessioner, og mulighed for faglige diskussioner på
kryds og tværs, mange engagerede kolleger har igen indsendt abstrakts der vedrører de mange
forskellige aspekter af vores speciale. Heldigvis har mange af vores kolleger også sagt ja til at
deltage som moderatorer af sessionerne og som bedømmere af de frie foredrag. Tak for det.
Vi har i år inviteret Professor Lars Eric Pontus Stierna fra Sverige til at opdatere vores viden om
det altid aktuelle emne forkølelse, det bliver spændende at høre om vi i fremtiden kan slippe for
irriterende forårsforkølelser.
Der er i det forgangne år blevet arbejdet intensivt med revision af målbeskrivelse for speciallægeuddannelsen i oto-rhino-laryngologi. Arbejdsgruppen vil meget gerne præsenterer den nye kittellommebog, samt de arbejdsredskaber der indføres til evaluering af uddannelsessøgende læger.
Til inspiration om vejledning afholder DSOHH’s uddannelsesudvalg et vejleder seminar. De har
inviteret cand.theol og konfliktmægler Camilla Ahrensback til at fortælle om vejledning og feedback i den lægelige videreuddannelse. Der vil desuden være en række oplæg for at sætte fokus
på supervision under uddannelse.
Indenfor de seneste år har vi set en stigning i antallet af ØNH professorer så der i skrivende
stund er ansat 7 professorer på de danske ØNH afdelinger. Vi inviterer derfor i år til et professor
seminar, hvor alle landets professorer får mulighed for at præsentere deres forskningsfelter.
Vi ser også flere og flere ØNH læger der er indskrevet som phd studerende og dermed afslutter
med et phd forsvar. For at alle medlemmer af DSOHH kan få kendskab til hvad phd afhandlingerne
omfatter har vi i år åbnet op for en ny session hvor afhandlinger forsvaret det seneste år præsenteres. Vi håber på at phd-sessionen bliver den første i en lang række af DSOHH – phd-sessioner.
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Med ønsker om et godt møde fra DSOHH bestyrelse
//
Anette Drøhse Kjeldsen
Mads Klokker
Anders Schermacher
Thomas Hjuler
Claus Gregers Petersen
DSOHH 2015 program oversigt
21. MAJ (TOR)
09.00
22. MAJ (FRE)
Registrering
Afhandlinger
Thyroidea
Velkomst
10.00
KAFFE
Rhinologi
11.00
KAFFE
12.00
Kliniske retningslinjer
13.00
FROKOST
14.00
Professor runde
Laryngologi
og kræft
Otologi
FROKOST
Vejlederseminar
KAFFE
Søvnapnø
og infektioner
Audiologi
15.00
Afslutning og prisoverrækkelse
Professor runde
Vejlederseminar
16.00
17.00
DSOHH Generalforsamling
18.00
19.00
Gallamiddag og dans
//
5
Program torsdag 21. maj
09.00-10.00
Registrering
AUDITORIUM
Rhinologi - Moderator: Christian von Buchwald
10.00-10.15
A. Kjeldsen
Velkomst
10.15-11.00
LEP. Stierna
The Common Cold. Integrative
approaches for treatment and
prevention
11.00-11.15
17
K Håkansson
An investigation of co-existing
upper and lower airway disease:
the united airways further
supported
11.15-11.30
27
M Alanin
The association between sinus
and lung infections in patients
with primary ciliary dyskinesia
11.30-12.00
KAFFE
AUDITORIUM
Kliniske retningslinjer – Moderator: Anette Kjeldsen 12.00-12.10
A. Kjeldsen
DSOHH og kliniske retningslinjer
12.10-12.20
C. Heidemann
Hvordan laves en NKR
12.20-12.35
18
C. Heidemann
Mellemørebetændelse og
tubulation
12.35-12.50
19
P. Darling
Høfeber og allergi
12.50-13.00
28
U. Pedersen
Orientering om den Europæiske
øre-næse-halseksamen
(EBEORL)
13.00-14.00
6
//
FROKOST
Program torsdag 21. maj - fortsat
AUDITORIUM
Professor runde - Moderator: Mads Klokker
SAL K
Vejlderseminar - Moderator: Jacob Melchiors
14.00-14.20
T Ovesen
En lærestolsprofessors glæder
og byrder
19.00-01.00
14.20-14.40
MS Sørensen
RH-professorat i otologi og
otopatologi
14.40-15.00
A Kjeldsen
Rhinologi og vaskulære malformationer
14.00-15.00
C Ahrensbach
Vejledning og feedback i
den lægelige videreuddannelse
Gallamiddag og dans
15.00-15.30
KAFFE
AUDITORIUM
Professor runde - Moderator: Mads Klokker
SAL K
Vejlederseminar - Moderator: Jacob Melchiors
15.30-15.50
C Buchwald
Hvad vil, skal, kan og gør en
øre-, næse-halsprofessor på
Rigshospitalet?
15.30-16.00
J Melchiors
KB Petersen
Den nye målbeskrivelse.
Gennemgang af kittellommebog og ny værktøjer til
kompetencevurderin
15.50-16.10
C Godballe
ORL-Forskningsenheden, OUH:
Hvor er vi og hvor skal vi hen?
16.00-16.20
JJM Henriksen
360 graders evaluering –
erfaringer fra Århus
16.10-16.30
P Homøe
Rosinen i pølseenden - om
det nye professorat ved ØNH
i Køge
16.20-17.00
J Melchiors
KB Petersen
Implementering af kittellommebogudfordringer
og praktiske løsninger
16.30-16.50
Panel diskussion
AUDITORIUM
17.00-18.30
DSOHH Generalforsamling
//
7
Program fredag 22. maj
AUDITORIUM
Afhandlinger 2014 - Moderator: Christian Godballe
SAL K
Thyroidea - Moderator: Viveque Egsgaard Nielsen
09.00-09.20
20
MS Gaihede
Investigations on tympanometric determination of middle ear
pressure
09.00-09.15
32
S. Londero
Completeness and validity in a
national clinical thyroid cancer
database: DATHYRCA
09.20-09.40
21
TT Kristensen
Cellular metabolic changes
after hemithyroidectomy
- Focus on mitochondrial
function and dysfunction
09.15-09.30
33
KZ Rubeck
Diagnostik og Risiko-stratificering af Knuder i Thyroidea
09.40-10.00
22
S Londero
Papillært Thyreoidea Carcinom:
Klinisk Betydning og Metastatisk Potentiale
09.30-09.45
34
PF Jensen
Complications after total thyroidectomy in the management
of benign thyroid disease at a
single center in Denmark
10.00-10.20
23
B Lange
Chronic rhinosinusitis in the
Danish population; A Ph.D.
study
09.45-10.00
35
G Obel
Øges cure rate ved parathyroidektomi under anvendelse af
peroperativ parathyroideahormon måling?
10.20-10.30
30
S. Gade
Global Online Fellowship in Head
And Neck Cancer
10.00-10.15
36
ER Rasmussen
Sialendoscopy has significantly
decreased the number of
excised salivary glands in
Denmark
10.15-10.30
37
ER Rasmussen
Real-life experiences with
prophylactic C1-inhibitor concentrate (Cinryze®) in HAE – a
case series.
10.30-11.00
KAFFE
AUDITORIUM
Laryngologi og kræft - Moderator: Jesper Tvedskov
11.00-11.15
39
11.15-11.30
GN.Bossen
Genetic etiology of sulcus vocalis: case reports of 6 families
11.00-11.15
47
MN Møller
Intracranial pressure regulation
revisited The Petro-Sigmoid
Reticulum
GN. Bossen
Spatisk dystoni og Botox
11.15-11.30
48
B Djurhuss
The impact of ventilation tubes
in otitis media on the risk of
cholesteatoma on a national
level
11.30-11.45
40
CS Mehlum
DANGLOT og DAHANCA 27 National database for patienter
med LIN og T1a-glottiscancer
11.30-11.45
49
B Djurhuus
School performance in cholesteatoma-operated Danish
children: A nationwide study
11.45-12.00
41
M Svahn
Risk of human papilloma associated head and neck cancer
following a diagnosis of cervical intraepithelial neoplasia
11.45-12.00
50
MB Avnstorp
Chronic suppurative otitis
media, middle ear pathology
and hearing loss in a cohort of
Greenlandic children
42
New uPAR-targeted near-infrared fluorescent tracer
for image-guided real-time
A Christensen
detection of squamous cell
carcinoma and cervical lymph
node metastases in oral cancer
12.00.12.15
51
M Kaltoft
Lifetime recurrence rate after
operation for acquired middle
ear cholesteatoma
12.00.12.15
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SAL K
Otologi - Moderator: Lars Vendelbo Johansen
//
Program fredag 22. maj - fortsat
AUDITORIUM
Laryngologi og kræft - Moderator: Jesper Tvedskov
SAL K
Otologi Moderator: Lars Vendelbo Johansen
12.15-12.30
43
S Al-Hayder
Clinical outcome and
survival following microvascular reconstruction
in patients with oral and
oropharyngeal cancer
12.30-12.45
44
N Rubeck
Trans Oral Robot kirurgi
af oropharynx cancer
og diagnosticering af
ukendt primær tumor på
Rigshospitalet
12.30-12.45
53
SAW Andersen
12.45-13.00
45
CS Danstrup
Rekonstruktion af øvre
oesophagus/hypopharynx med frit tyndtarmsinterponat – en update
12.45-13.00
54
E Arndal
13.00-14.00
12.15-12.30
52
SAW Andersen
Stabilitet af stapedotomi og
behovet for efterfølgende rutinekontrol: Er 1-års kontrollen obsolet?
Et prospektivt database studie.
Læringskurver i virtuel mastoidektomi: Hvor meget og hvordan
skal man træne?
Behandling af otomykose i ØNH
speciallægepraksis i Danmark; en
spørgeskemaundersøgelse.
FROKOST
AUDITORIUM
Søvnapnø og infektioner - Moderator: Jesper Bille
SAL K
Audiologi - Moderator: Jesper Schmidt
14.00-14.15
56
C Prætorius
Den kirurgiske tilgang til
obstruktiv søvnapnø
14.00-14.15
62
J Schmidt
Casestudie: Cochlear implant til
patienter med asymmetrisk hørelse
og resthørelse på det opererede
øre.
14.15-14.30
57
K Larsen
Cardio respiratorisk
måling for søvnapnø før
og efter bariatrisk kirurgi.
Prospektivt arbejde.
14.15-14.30
63
N Thorup
En klinisk auditiv profil hos Høreapparatskandidater
14.30-14.45
58
T Klug
Antibody development
to Fusobacterium necrophorum in patients with
peritonsillar abscess
14.30-14.45
64
K Mey
The natural history of hearing
loss in Pendred Syndrome and
Non-syndromic Enlarged Vestibular
Aqueduct.
14.45-15.00
59
M Juul
Tonsillectomies in
Denmark in the period of
1991-2012
14.45-15.00
65
DT Schanck
Sporadisk endolymfatisk sæk
tumor - en meget sjælden årsag til
høretab, tinnitus og svimmelhed
15.00-15.15
60
JF Thrane
Necrotizing fasciitis in
the head and neck: Still a
challenge
15.00-15.15
66
JH Wanscher
Bone-anchored hearing aid: Complications and patient satisfaction, a
retrospective study
15.30-16.00
AFSLUTNING OG PRISOVERRÆKKELSE
//
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Kongres center
Årsmødet bliver afholdt på Hotel Nyborg Strand, hvor mødet har været afholdt i en længere
årrække. Hotellet er centralt og smukt beliggende. Der er 650 gratis P-pladser.
DSOHH har booket auditoriet og Salon K der ligger i underetagen. Desuden afholdes udstillling i
foyeren og i sal B+C.
WIFI
TDC-Hotspot
Internet: nyborgstrand
Password: nyborgstrand
Hotel værelser
Værelserne er til disposition fra klokken 14.00 på ankomstdagen. Nøgleudlevering foregår i receptionen. Hotel Nyborg Strand er ansvarlig for værelsesfordelingen.
Organisationskomite
Formand
Næstformand
Kasserer
Redaktør
Sekretær
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//
Anette Kjeldsen
Mads Klokker
Anders Schermacher Larsen
Claus Gregers Petersen
Thomas Hjuler
Foredrag
Foredrag under DSOHH2015 er opdelt i tre kategorier.
1. Key-note forelæsning (30 min. tale og 15 min. til spørgsmål)
2. Inviterede forelæsere (15 min tale og 5 min til spørgsmål)
3. Frie foredrag (8 min tale og 5 min til spørgsmål)
Foredragsholdere bedes være opmærksomme på følgende:
•
•
•
Taletid skal overholdes. Hvis taletiden overskrides forbeholder vi os ret til at afbryde foredraget. Der vil være tidtagere der hjælper med at holde tiden.
Præsentationer indlæses på computer i god tid, og senest i pausen inden foredraget skal
afholdes. Der vil være både PC og Mac til rådighed.
Hvis præsentationen indeholder videosekvenser, er det vigtigt, at du indlæser foredraget i
god tid og sikrer dig, at videoer kan afspilles.
Poster præsentationer vil under hele mødet være placeret i foyeren. Hver poster er nummereret
og der er en oversigt over postere i mødebogen.
Det er forfatterne, som er ansvarlige for ophængning og nedtagning af posters.
Priser til bedste foredrag og poster
DSOHH uddeler priser til de tre bedste foredrag. Foredragsholderen til det bedste foredrag modtager 5000,- kroner og de to næstbedste modtager 2500,- kroner. Der er desuden en pris til den
bedste poster på 1000,- kroner.
Alle ikke-inviterede foredragsholdere deltager i konkurrencen om priser, uanset alder og erfaringsniveau.
DSOHH bestyrelsen har udpeget en vurderingskomite, som vil vurdere alle foredrag og postere.
Vinderne bliver annonceret ved årsmødets afslutning, fredag den 22. maj klokken 15.30, hvor priserne uddeles. Det er en forudsætning at vinderne er personligt tilstede ved pris overrækkelsen,
alternativt går prisen videre til næste kandidat.
//
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Abstracts – Torsdag 21. maj
Socialt program
GALLAMIDDAG
Torsdag 21. maj kl. 19.00-22.00
MENU
Forret: Rødtunge Walewska
Hovedret: Pestostegt dansk kalvehøjreb med lys Madagaskar peberflødesauce.
Serveret med dagens garniture/friske grønsager og kartoffel
Dessert: Hindbærmousse med citron/mandel biskuit og hindbærsorbet
DANS
Torsdag 21. maj kl. 22.00-01.00
POPFEVER - ET AF DANMARKS BEDSTE PARTYBANDS!
POP FEVER er et partykoncept på den danske live scene. Pop Fever består
af de musikere (samt kapelmester), som spiller i DR’s X-Factor program.
POPFEVER viderefører arven fra de etablerede jam- og showbands, men
med et væsentligt bredere repertoire.
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//
GULD udstillere
SØLV udstillere
//
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Abstracts –på
Udstillere
Torsdag
DSOHH21.
2015
maj
UDSTILLER
A-data
19
Abigo Pharma A/S
16
Alcon
9
Alere A/S
7
Bernafon
FOYER
BK Medical
10
Danaflex A/S
17
GSK
Interacoustics
FOYER
6
FOYER
Johnson & Johnson
11
Karl Storz Endoskopi A/S
15
KEBOMED
12
Maribo Medico
25
Max Manus
13
Mediq Danmark
2
MED-EL, Möllerström Medical AB
26
Mediplast Kendan A/S
5
Novax A/S
3
Olympus Danmark
//
14
Abena A/S
EG Clinea
14
STAND NR
27
Oticon
FOYER
Oticon Medical
FOYER
PO Medica AB
22
POA Pharma Scandinavia
20
Santax Medico
23
Siemens Høreapparater
24
Simonsen og Weel
21
Smith & Nephew A/S
8
Somnomedics Gmbh
1
Zeiss
4
Udstillerplan DSOHH 2015
Sal A
5
4
3
2
1
Sal B
6
meter
740
Vinduer og
glasdøre på
hele denne
side
8
1,30 meter
23
KAFFE
22
25
24
6 meter
10
26
27
20
11
Lofthøjde 5 meter
Grønne stole
Sorte/grå borde
9
Sal C
KAFFE
Tegningen er ikke målfast
12
21
19
5,90 meter
18
13
14
15
16 17 1,20 meter
//
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Inviterede
foredrag
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//
XXXII Congress of the Nordic Association of Otolaryngology
Inviterede foredrag
Common cold. Integrative approaches for treatment
and prevention ( at different healthcare levels)
Lars Eric Pontus Stierna, Professor, MD PHD
K aolinska Institutet, Stokholm.
//
17
Inviterede foredrag
Ph.d. afhandling
An investigation of co-existing upper and lower
airway disease: the united airways further
supported
Håkansson K (1), Backer V (2), Konge L (3), Thomsen SF (4), Backert C (5), Buchwald C (1)
1. Øre-, næse-, halskirurgisk og audiologisk klinik, Rigshospitalet, 2. Lungemedicinsk afdeling L, Bispebjerg
Hospital, 3. Center for klinisk uddannelse, Københavns Universitet, 4. Dermatologisk afdeling, Gentofte
Hospital, 5. Upper Respiratory Research L aboratory, Ghent University Hospital, Belgium and K arolinska
University
Indledning: Afhandlingen tog udgangspunkt i konceptet ”den forenede luftvej” (united airway) og
omfatter i alt 4 artikler, herunder ét review. De tre original artikler beskæftiger sig med: 1) rhinitis
og rygning samt KOL; 2) asthma hos patienter med kronisk rhinosinuitis med nasal polypose
(CRSwNP); og endelig 3) en analyse af luftvejsinflammationen i næse og lunger hos patienter med
CRSwNP samt i en kontrolgruppe.
Metode: Artikel 1) bygger på et epidemiologisk studie udført på Glostrup hospital (n=3471);
studiet omfattede en general spørgeskemaundersøgelse samt en allergitest og lungefunktionsundersøgelse. Artikel 2) baserer sig på et klinisk studie af 40 CRSwNP patienter og 21 kontroller henvist til Rigshospitalet mhp FESS eller septumkirurgi; alle inkluderede blev udredt for lungesygdom
på Bispebjerg Lungemedicinsk klinik efter internationale retningslinjer. Artikel 3) tager udgangspunkt i en analyse af 14 inflammatoriske markøre (Th1/Th2) i biopsier fra polypper, choncha
inferior og bronkier hos CRSwNP patienter samt kontroller.
Resultater: I artikel 1) fandt vi at nonallergisk rhinitis (NAR) var signifikant associeret med rygning,
asthma, kronisk bronkitis og nedsat lungefunktion men ikke kronisk obstruktiv lungesygdom (KOL).
I artikel 2) viste vi en høj frekvens af asthma hos CRSwNP patienter (65%). I artikel 3) påviste vi,
at inflammationsprofilen i polypper og bronkier korrelerede signifikant i den enkelte patient, samt
at koncentrationen af inflammatoriske Th2 markører var signifikant højere i polypperne i forhold til
den resterende luftvej.
Diskussion: Således udgør cigaretrøg formentligt et patogen i både de nedre og de øvre luftveje.
Vores arbejde tyder desuden på, at associationen mellem CRSwNP og asthma er stærkere end
hidtil antaget. Endelig peger vi på at polypperne kan være en drivende kraft for inflammationen i
luftvejen fremfor at være et sekundært fænomen. Alle tre artikler bekræfter, at nedre luftvejssygdom ofte er sameksisterende med sygdom i de øvre luftveje.
18
//
Inviterede foredrag
National klinisk retningslinje
Nye danske retningslinjer for diagnosticering
af akut otitis media og kirurgisk behandling af
recidiverende akut otitis media og kronisk otitis
media med effusion.
Heidemann C, Berg J, Christensen JJ, Homøe P, Johansen LJ, Lous J, Nielsen LH, Plejdrup M,
Poulsen A, Schousboe P, Vind AB, Håkonsen SJ, Jakobsen M, Skrubbeltrang C
BørneUngeKlinikken, Rigshospitalet; Center for Kliniske Retningslinjer, A alborg Universitet; Centre
for Research in Evidence-Based Practice, Bond University; Forskningsenheden for almen medicin,
Syddansk Universitet; Klinisk mikrobiologisk afdeling, Slagelse Sygehus; Medicinsk Bibliotek, A alborg
Universitetshospital; Sundhedsstyrelsen; Ørelægerne Fisketorvet, Odense; Ørelægerne Sundhedshuset, A arhus;
Øre-Næse-Halsafdelingen, Vejle Sygehus; Øre-Næse-Halskirurgisk Afdeling, Køge Sygehus; Øre-NæseHalskirurgisk Afdeling, Odense Universitetshospital; Øre-næse-halskirurgisk klinik, Rigshospitalet.
Introduktion: Otitis media er en af de mest almindelige tilstande hos småbørn i førskolealderen
hvilket understreger vigtigheden af stadig optimering af diagnostik og behandling. Nyere litteratur peger mod en strengere tilgang til diagnostik af akut otitis media (AOM). Drænbehandling
af recidiverende AOM (rAOM) og kronisk mellemørebetændelse med effusion (COME) blevet det
hyppigst udførte kirurgiske indgreb hos førskolebørn. Der er behov for en opdateret dansk retningslinje vedrørende diagnostiske kriterier for akut mellemørebetændelse og kirurgisk behandling af
rAOM og COME.
Materiale/metode: GRADE-systemet (The Grading of Recommendations Assessment, Development and Evaluation) blev anvendt i udarbejdelse og formulering af anbefalingerne i denne retningslinje. Dette system giver en omfattende og gennemsigtig tilgang til udvikling af kliniske retningslinier, hvor både evidensens kvalitet og styrken af anbefalingerne vurderes. En omfattende
litteratursøgning blev gennemført i efteråret 2013. Kvaliteten af den eksisterende litteratur blev
vurderet ved anvendelse AGREE II (Appraisal of Guidelines for Research & Evaluation), AMSTAR
(assessing the Methodological Quality of Systematic Reviews), QUADAS-2 (Quality of Diagnostic Accuracy Studies), Cochrane Risk of Bias Tool til randomiserede studier og ACROBAT-NRSI (A
Cochrane Risk of Bias Assessment Tool til non-randomiserede studier). Arbejdsgruppen bestod af
øre-næse-halslæger, praktiserende læger, børnelæger, mikrobiologer og epidemiologer.
Diskussion: Anbefalinger udarbejdes vedrørende diagnostiske kriterier for AOM, kirurgisk behandling af rAOM og COME inklusiv adenoidektomi og behandling af øreflåd hos drænbehandlede
børn.
//
19
Inviterede foredrag
National klinisk retningslinje
National klinisk retningslinje for høfeber. 2 udvalgte
spørgsmål
Darling P
Odense Universitetshospital, Sundhedsstyrelsen
Introduktion: Næsespray med glukokortikoid og perorale antihistaminer er to af de hyppigst
brugte behandlinger til høfeber, og det er derfor vigtigt for den kliniske beslutningstagning,
hvilken af de to behandlinger, der har størst virkning.
Materiale/metode: Evidensgrundlaget for det fokuserede spørgsmål er en guideline(1) suppleret
med 3 randomiserede kontrollerede studier fra den opdaterende søgning (fra Arias søgning i
2007 og til 2014)(2-4). Guidelinen bygger på 11 studier, men da den ikke rapporterer alle de
kritiske outcomes, er de relevante data fra disse studier fundet i en gennemgang af primærartiklerne(5-15).
Resultater: Vil gerne præsentere sammen med Christian Heidemann efter aftale. Således kan vi
suplere hinanden i NKR processen. Fremlæægelse af de sparsomme resultater i høfeber gruppen
som har relevans for ENT tager få minutter.
Diskussion: Arbejdsgruppen lagde vægt på, at næsesymptomer lindres bedre af nasalsteroid end
antihistamin både for de enkelte næsesymptomer og for en samlet symptomscore. Desuden blev
der lagt vægt på, at der ikke er fundet evidens for langtidsbivirkninger ved nasalsteroid.
20
//
Inviterede foredrag
Ph.d. afhandling
Investigations on tympanometric determination of
middle ear pressure
Gaihede ML
//
21
Inviterede foredrag
Ph.d. afhandling
Cellular metabolic changes after
hemithyroidectomy- Focus on mitochondrial
function and dysfunction
TT Kristensen (1), PL Pedersen (2), J Larsen (3), S Jelstrup (1), J Kvetny (4)
(1) Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, Region
Zealand, Denmark
(2) Department of ClinicalBiochemistry, Naestved Hospital, Region Zealand, Denmark
(3) Department of ClinicalPathology, Naestved Hospital, Region Zealand, Denmark
(4) Department of InternalMedicine, Naestved Hospital, Region Zealand, Denmark, University of Southern
Denmark
Introduction: Hemithyroidectomy is associated with a recognized risk of overt hypothyroidism.
Regarding the majority of patients who do not develop hypothyroidism after hemithyroidectomy,
thyroid function is persistently decreased within the laboratory reference range. Although low
normal thyroid function is associated with several adverse metabolic markers, the significance of
this consequence of hemithyroidectomy has not previously been addressed. Thyroid hormones
regulate a number of cellular functions, of which one major function is regulation of mitochondrial energy production and biogenesis. The purpose of the PhD project has been to examine
if hemithyroidectomy for benign euthyroid goiter affects metabolism in apparent euthyroid
patients. Instead of focusing solely on post-hemithyroidectomy perturbations of peripheral thyroid
hormones and TSH, the thesis examines thyroid hormone-induced alterations in mitochondrial
function.
Method: The thesis includes three studies. Study 1 retrospectively examined TSH changes and
weight gain of 28 patients two years after hemithyroidectomy compared with matched controls.
Two subsequent prospective studies of 28 patients examined the thyroid hormone-induced
alterations in the mitochondrial membrane potential (MMP) of peripheral blood mononuclear cells
(study 2) and the expression of mitochondrial-related genes before and during the first year after
hemithyroidectomy for benign euthyroid goiter (study 3). An additional purpose was to examine
weight changes after hemithyroidectomy in relation to changes in mitochondrial function.
Results: Study 1 demonstrated TSH increase and weight gain two years after hemithyroidectomy,
suggesting the presence of a metabolic post-hemithyroidectomy impairment. In study 2, patients
not on L-T4 replacement therapy had sustained increased serum TSH and decreased serum T4
within the laboratory reference range with a concomitant increase in the mitochondrial membrane consumption and basal oxygen consumption. Study 3 demonstrated negative correlations
between relative changes in mitochondrial-related gene expressions and the relative change in
serum T4. In selected patients with post-hemithyroidectomy weight gain, the mitochondrial-related gene expression was down-regulated compared to preoperative levels.
22
//
Inviterede foredrag
Ph.d. afhandling
Papillært Thyreoidea Carcinom: Klinisk Betydning
og Metastatisk Potentiale
S Londero, A Krogdahl, L Bastholt, J Overgaard, C Godballe
Øre- Næse- Halskirurgisk afd. F, Odense Universitetshospital
Introduktion: Den hyppigste kræftform i thyreoidea er den papillære subtype. Denne er i stigning
på verdensplan. Man mener at stigningen skyldes øget påvisning af klinisk insignifikante tilfælde
grundet øget brug af ultralyd og finnålsaspiration. Total thyreoidektomi med efterfølgende radiojodbehandling er den definitive behandling. Alle patienter har dog ikke behov for dette grundet en
generelt favorabel prognose og individualiseret behandling er påkrævet for at minimere overbehandling.
Formålene med ph.d.-studiet var:
• At foretage en demografisk beskrivelse af papillære thyreoidea karcinomer i Danmark
• At beskrive risikofaktorer og overlevelse for papillære thyreoidea karcinomer i Danmark
• At identificere gener eller en genprofil som kan forudsige spredning fra papillære thyreoidea
karcinomer
• At identificere patienter som efter initial kirurgisk behandling er uden eller med minimal risiko
for recidiv af papillært thyreoidea karcinom.
Materiale/metode: Prospektiv kohorte studie
Resultater: En stigning i incidensen af papillære thyreoidea karcinomer i Danmark fra 1996 til 2008
blev påvist, men denne var ikke kun til stede for de små karcinomer. Yderligere kunne der ikke
påvises en øget brug af diagnostiske modaliteter i de diagnosticerede tilfælde.
• Stigningen for karcinomer ≤ 10 mm var udelukkende forekommende i tilfældigt påviste
tilfælde. For patienter der fik påvist et karcinom tilfældigt ved hemithyreoidektomi kunne ikke
påvises en forbedret overlevelse ved efterfølgende komplimenterende thyreoidektomi.
• Overlevelsen for papillære thyreoidea karcinomer påvist i Danmark fra 1996 til 2008 var favorable med en 10 års sygdomsspecifik overlevelse på 93,8 % og en recidiv fri overlevelse på 90,2 %.
• De evaluerede prognostiske scoringssystemer kunne alle påvise en signifikant risikostratificering.
• En genprofil til påvisning af metastatisk potentiale blev udviklet men kunne ikke valideres. Yderligere kunne profilen ikke identificere patienter uden risiko for recidiv.
Diskussion: Resultaterne underbygger at små unifokale karcinomer uden tegn til metastasering
eller ekstrathyreoidal vækst kan behandles med hemithyreoidektomi, hvilket er i overensstemmelse med gældende retningslinjer. Den fundne genprofil kunne ikke bidrage yderligere
til risikostratificering og således er de kendte prognostiske scoringssystemer fortsat det bedste
tilgængelige redskab.
//
23
Inviterede foredrag
Ph.d afhandling
Chronic rhinosinusitis in the Danish population; A
Ph.D. study
B Lange 1), T Thilsing 2), J Baelum 2), OF Pedersen 3), R Holst. 4), AD Kjeldsen 1)
1) Department of Otorhinolaryngology, Odense University Hospital, University of Southern Denmark,
Odense, Denmark
2) Research Unit for Occupational and Environmental Medicine, Institute of Clinical Research and Research
Unit of General Practice, Department of Public Health, University of Southern, Denmark
3) Institute of Public Health, University of A arhus, A arhus, Denmark
4) Department of biostatistics, University of Southern Denmark, Odense, Denmark
Introduction: The aim of this Ph.D. study was to assess the prevalence of clinical diagnosed chronic
rhinosinusitis (CRS) in a Danish population; to compare epidemiological and clinical diagnostic
tools; to assess quality of life, subjective symptoms, and objective findings in individuals with CRS;
to follow the fluctuation over time while optimizing information and treatment.
Method: As part of Ga2len (Global Asthma and Allergy European Network) persons representing
the general population was examined. Participants completed a main questionnaire and were
interviewed. QoL was registered using EQ-5D and the Sino Nasal Outcome Test 22 (SNOT-22).
Objective evaluation was performed using rhinoscopy, acoustic rhinometry, peak nasal inspiratory
flow, smell test, and prick test. CRS was diagnosed according to the EPOS guidelines. Reliability
of questionnaire-based CRS was tested, and QoL and objective findings were compared between
those with and without CRS. Participants with CRS were followed for 2 years.
Results: A total of 362 persons were examined of which 91 had CRS, with an estimated prevalence at 8.5%. Persons with CRS had reduced QoL with a SNOT-22 score at 28.1. Persons with
CRS had reduced olfactory function and PNIF score. There was no difference in acoustic rhinometry between individuals with and without CRS. Over time individuals with CRS experienced an
increase in disease-specific QoL and in objective measures.
Conclusion: The diagnostic instruments for epidemiological use should be revised. The prevalence
of clinical diagnosed CRS in the general population was 8.5%. CRS had a negative impact on QoL
and objective measurements which could be improved through information and treatment recommendation by an ENT doctor.
24
//
Vejleder
seminar
//
25
Vejlederseminar
14.00-15.00
Vejledning og feedback i den
lægeligevidereuddannelse
Camilla Ahrensbach
Projektleder, Konflikthåndtering, patientsikkerhed og defusing
C and.Theol. og konfliktmægler
15.00-15.30
PAUSE
15.30-16.00
Den nye målbeskrivelse. Gennemgang
af kittellommebog og nye værktøjer til
kompetencevurdering.
Jacob Melchiors og Kristian Bruun Petersen
16.00-16.20
360 graders evaluering – erfaringer
fra Århus
Jens-Jacob Mølby Henriksen
16.20-17.00
Implementering af kittellommebogudfordringer og praktiske løsninger
Jacob Melchiors og Kristian Bruun Petersen
26
//
Abstracts - Torsdag 21. Maj
Frie foredrag
Torsdag
//
27
The association between sinus and lung infections in
patients with primary ciliary dyskinesia
MC Alanin (1), KG Nielsen (2), M Skov (2), K A anæs (1), N Høiby (3), HK Johansen (3,4), C
von Buchwald (1)
1. Department of Otolaryngology - Head and Neck Surgery and Audiology, Copenhagen University Hospital,
Rigshospitalet, Denmark
2. Danish PCD Centre, Pediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine,
Copenhagen University Hospital, Rigshospitalet, Denmark
3. Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Denmark
4. Novo Nordisk Foundation Center for Biosustainability, The Technical University of Denmark, Hørsholm,
Denmark.
Introduktion: In patients with primary ciliary dyskinesia (PCD) the impaired mucociliary clearance
leads to accumulation of secretions in the airways and susceptibility to repeated bacterial infections in both the upper and lower airways. Sinusitis is ubiquitous.
Materiale/metode: We investigated the association between the bacteriology of the sinuses and
the bacteriology of acute and chronic infections from the lower airways in patients with PCD during an 11-year period. Further, we genotyped 35 longitudinally stored Pseudomonas aeruginosa
isolates from 12 patients with chronic infection using pulsed-field gel electrophoresis.
Resultater: Chronic lung infection with P. aeruginosa was found in 39/108 patients (39%). Patients
had intermediate periods without chronic infection. Inter-patient relatedness of longitudinally
stored P. aeruginosa lung isolates was found in ten out of 12 chronically infected patients (83%).
No sharing of clone types or patient-to-patient transmission was observed. Bacterial sinusitis with
concordant bacteriology in the lungs was common.
Diskussion: We present a longitudinal overview of the lower respiratory tract infections in patients
with PCD. H. influenza and P. aeruginosa are frequent pathogens in both upper and lower airways.
The sinuses should be considered as a bacterial reservoir and a target for surgery and antibiotic
treatment in patients with PCD.
28
//
Orientering om den Europæiske Øre-næsehalseksamen (EBEORL)
U Pedersen
Præsident UEMS ORL Section
Introduktion: Den Europæiske ØNH eksamen (EBEORL) blev oprettet af UEMS ORL Section og har
eksisteret siden 2009. Den består af en skriftlig del med 100 multiple choice spørgsmål. Dem der
der består kan indstille sig til den mundtige del som foregår i Wien.
Materiale/metode: Fra starten har examen været populær især for kandidater uden for EU. Ved
den sidste mundtlige eksamen i Wien eksamineredes 117 kandidater på en dag. Beståelsesprocenten har gennem årene været omkring 80. Dem der består kan kalde sig: “Fellow of the European Board of ORL-HNS”
Resultater: Adskillige lande i EU har en obligatorisk national eksamen. I Danmark har vi valgt at
evaluere speciallægeuddannelsen på andre måder. Den stigende interesse for at få dele af sin
uddannelse i udlandet betyder imidlertid at eksamenspapirer og Europæisk logbog efterlyses på
mange Europæiske ØNH afdelinger
Diskussion: Imødeser diskussion af muligheden for fremtidige tanker om en national dansk
eksamen og for dansk deltagelse i den Europæiske eksamen. Endelig vil jeg foreslå at DSOHH
opretter et legat til dækning af deltagelsen for en eller 2 danske kandidater
//
29
Frie foredrag
Fredag
30
//
Abstracts - Fredag 22. Maj
Global Online Fellowship in Head And Neck Cancer
S Gade
Øre-Næse-Halsafdeling H på A arhus Universitetshospital
Introduktion: Efteruddannelse i hoved-hals cancer via IFHNOS - International Federation of Head
And Neck Oncologic Societies
Materiale/metode: Beskrivelse fra hjemmesiden:
There are no current global standards of training, practice and level of care for patients with
neoplasms of the Head and Neck. There are significant variations in the quality and levels of care
in various geographic locations in the world. The goal of developing a global online fellowship
is to create a program to teach and train young surgeons and test their knowledge and thought
processes, through which relative uniformity of knowledge base and judgment are measured
and certified for specialists, through an online education process, with continuous updating and
monitoring of the knowledge base.
The fellowship will involve a commitment of 2 years of self learning through a structured course
curriculum, with periodic online examinations as the program progresses, until completion. At the
completion of the course curriculum, the candidates will embark upon a 2 month fellow/observership and then appear for an oral examination before an international panel of examiners.
Upon successful completion of the oral examination a certificate will be issued recognizing the
satisfactory completion of the course curriculum, and passing the examination.
Such certification will ensure that the candidate has acquired an established global standard of
core knowledge, and matured a judgment process through self education and successful completion of the examination.
Resultater: Jeg er optaget vil fortælle om ansøgnings processen samt mine første erfaringer.
//
31
Frie foredrag
Thyroidea
32
//
Completeness and validity in a national clinical
thyroid cancer database: DATHYRCA
S Londero (1), J Mathiesen (1), A Krogdahl (2), L Bastholt, J Overgaard (4), J Bentsen (5), C
Hahn (6), S Schytte (7), H Pedersen (8), P Christiansen (9), C Godballe (1)
1. Department of ENT Head & Neck Surgery, Odense University Hospital, Denmark
2. Department of Pathology, Odense University Hospital, Denmark
3. Department of Oncology, Odense University Hospital, Denmark
4. Department of Experimental Clinical Oncology, A arhus University Hospital, Denmark
5. Department of Oncology, Herlev Hospital, Denmark
6. Department of ENT Head & Neck Surgery, Copenhagen University Hospital, Denmark
7. Department of ENT Head & Neck Surgery, A arhus University Hospital, Denmark
8. Department of ENT Head & Neck Surgery, A alborg University Hospital, Denmark
9. Department of Surgery, A arhus University Hospital, Denmark
Introduktion: Although a prospective national clinical thyroid cancer database (DATHYRCA) has
been active in Denmark since January 1, 1996, no assessment of data quality has been performed.
The purpose of the study was to evaluate completeness and data validity in the Danish national
clinical thyroid cancer database: DATHYRCA
Materiale/metode: Completeness of case ascertainment was estimated by the independent case
ascertainment method using three governmental registries as a reference. The reabstracted record
method was used to appraise the validity. For validity assessment 100 cases were randomly
selected from the DATHYRCA database; medical records were used as a reference.
Resultater: The database held 1,934 cases of thyroid carcinoma and completeness of case ascertainment was estimated to 90.9%. Completeness of registration was around or above 90% in
most instances. Perfect agreement on the diagnosis of thyroid carcinoma was found, both interand intra-observer, and κ values of selected variables showed overall good to excellent
agreement.
Diskussion: In a setup with public health insurance, personal identity numbers and extended
governmental databases, it is possible to establish national clinical cancer databases with a
satisfactory completeness and validity. The DATHYRCA database is considered reliable in terms of
describing thyroid carcinoma at a national level.
//
33
Diagnostik og Risiko-stratificering af Knuder i
Thyroidea
KZ Rubeck (1), SJ Bonnema (2), ML Jespersen (3), P Christiansen (4), VE Nielsen (1)
1. Øre-næse-halskirurgisk Afdeling H, A arhus Universitetshospital (AUH)
2. Endokrinologisk Afdeling, Odense Universitetshospital
3. Patologisk Afdeling, AUH
4. Kirurgisk Afdeling P, Sektion for Mamma og Endokrin Kirurgi, AUH
Introduktion: Forekomsten af cancer i thyroidea er stigende over hele verden. Udredningen er
udfordrende da man i nogle tilfælde må operere patienter for at skelne cancer fra de langt hyppigere benigne knuder. Egne tal fra et tertiært center viser, at andelen af diagnostiske operationer
nærmer sig 50 %, og en stor del af disse er opereret i accelereret udredningsforløb.
Ultralydsskanning (US) og finnålsaspirationsbiopsi (FNAB) er bredt tilgængelige diagnostiske
værktøjer, der bruges til stratificering af knuder i thyroidea afhængig af risikoen for malignitet.
Risiko-stratificeringen danner grundlag for det videre forløb, hvor patienten tilbydes operation eller
klinisk opfølgning. Den diagnostiske værdi af US og FNAB er dog begrænset af falsk positive såvel
som falsk negative resultater, og kun den histologisk undersøgelse efter operation anses for en
sikker diagnose.
Studiet sammenligner US-karakteristika og FNAB med histologisvar efter operation, for at evaluere
forekomsten af risikomarkører for thyroideacarcinom på en dansk kohorte.
Materiale/metode: Patienterne rekrutteres prospektivt i perioden januar 2014 - april 2015 på
Øre-næse-halskirurgisk Afdeling H, AUH. Der udføres præ-operativ US, og resultatet af præoperative FNAB og histologi efter operation registreres.
Resultater: US og FNAB data fra ca. 200 patienter præsenteres til DSOHH årsmødet 2015.
Diskussion: Den præ-operative udredning af knuder i thyroidea er udfordrende og får megen
opmærksomhed i international forskning. Da der på nuværende tidspunkt ikke findes en enkelt
præ-operativ test der med sikkerhed kan udelukke malignintet i thyroidea, er det nødvendigt
at optimere brugen af de tilgængelige diagnostiske værktøjer, og dermed selektere de rigtige
patienter til FNAB og operation.
34
//
Complications and long-term calcium problems
after total thyroidectomy in the management
of benign thyroid disease at a single center in
Denmark: a review of 114 cases
P Jensen, S Jelstrup, P Homøe
Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, Denmark
Introduktion: The aim of this study was to assess the complication rates of total thyroidectomy in
a regional hospital setting in Denmark regarding permanent hypocalcaemia, recurrent laryngeal
nerve palsy and postoperative bleeding. Furthermore, the long term outcomes in the management of hypocalcaemia were investigated.
Materiale/metode: A retrospective study of 114 consecutive patients undergoing total thyroidectomy due to benign thyroid disease was conducted.
Resultater: 0,9% suffered from permanent recurrent laryngeal nerve palsy, whereas temporary
nerve palsy was seen in 1,8%. Postoperative bleeding occured in 5,4%. The frequencies of temporary and permanent postoperative hypocalcaemia were 22,8% and 17,4% respectively. Autotransplantation of parathyroid tissue was performed in 23,7%. Unintentional parathyroidectomy
occurrred in 8,7%. Serum ionized calcium was significantly lower preoperatively in the group who
developed hypocalcemia (p = 0,03).
Diskussion: The incidence of recurrent laryngeal nerve palsy was similar to other published
studies. Postoperative bleeding was more common than in other studies. The high frequency of
permanent postoperative hypocalcemia is a cause of concern. We need to consider implementing
a guideline to facilitate outfacing of calcium and vitamin D supplements as some patients were
not attempted outfaced.
//
35
Øges cure rate ved parathyroidektomi under
anvendelse af peroperativ parathyroideahormon
måling?
G Obel, A Rørbæk Madsen.
Øre-, næse-, halskirurgisk afdeling F, Odense Universitetshospital.
Introduktion: Primær hyperparathyroidisme (pHPT) er en tilstand med forhøjet calcium i blodet
forårsaget af én eller flere syge biskjoldbruskkirtler. Udredningen af pHPT foregår multidsciplinært, men behandlingen er kirurgisk med fjernelse af den/de syge kirtler. Parathyroidektomi
ved pHPT er kendetegnet ved høj cure rate og få komplikationer. I en nylig dansk opgørelse
(2004-2009) så man en øgning i antallet af fokuserede indgreb, dette dog på bekostning af et
fald i cure rate fra 94,3% til 88,7 %.
I 2011 indførte man brugen af blandt andet peroperativ Parathyroideahormon(PTH) måling på
OUH. Dette som supplement til de vanlige undersøgelser (Parathyroideascintigrafi og operatørbaseret ultralyd) med henblik at øge cure rate til internationale værdier.
Materiale/metode: Prospektiv, konsekutiv analyse af 364 patienter opereret for pHPT på Øre-,
næse-, halskirurgisk afdeling F, Odense Universitetshospital i perioden 2011-2014. Dataene er
trukket fra PARATHYRKIR databasen. Inklusion: pHPT, parathyroidektomi, peroperativ PTH-måling
og postoperativ histologisk bekræftelse af adenom/hyperplasi.
Helbredelse defineres som ioniseret calcium i normalområdet efter 6 måneder.
Resultater: Analyserne er igangværende, data følger. Der vil udover cure rate, blive præsenteret
data vedrørende prognostiske faktorer såsom histologi, præoperativ calcium niveau samt peroperativ PTH fald.
Vi har sammenlignet resultaterne med data fra perioden 2004-2009 (artikel under review), hvor
peroperativ PTH måling ikke var rutine. Dette for at verificere berettigelsen af peroperativ PTH
måling.
Diskussion: Præliminære data viser, at cure rate øges ved anvendelsen af peroperativ PTH måling
ved parathyroidektomi hos patienter med primær hyperparathyroidisme.
36
//
The introduction of sialendoscopy has significantly
decreased the number of excised salivary glands
in Denmark
ER R asmussen, E Lykke, N Wagner, T Nielsen, S Wærsted, H Arndal
Øre-næse-halsafdlingerne Køge, Hillerød, Rigshospitalet
Privarhospitalet Valdemar
Introduktion: Excision has been the first choice in the treatment of benign obstructive disorders
of major salivary glands, when symptoms persisted in spite of conservative measures. Unfortunately surgical resection has been associated with a relatively high rate of adverse effects. To
meet the need of a less invasive treatment modality for benign obstructive disorders (i.e. salivary stones or stenosis), sialendoscopy has been developed and implemented in several countries including Denmark over the past 20 years. The method has been refined and improved;
the results have been encouraging, as the rate of adverse effects are very low and patients
satisfaction high. In Denmark the procedure was introduced in 2004 and in order to assess the
impact on the number of excised salivary glands a large registry based study was carried out.
Materiale/metode: This was a 13-year retrospective registry based study using The Danish
National Patient Register (‘Landspatientregisteret’). The ICD-10 codes used for obstructive
disease of the salivary glands were identified and used to extract patients potentially eligible
for sialendoscopy in order to compare sialendoscopic surgery and extirpations of salivary glands
(table 2). Patients suffering from malignant disease were excluded.
Resultater: In 2004 sialendoscopy was introduced in Denmark and from 2004 to 2012 the total
number of endoscopic interventions of the major salivary glands increased from 0 to 143 per
year. In 2012 sialendoscopy accounted for almost 20% of all surgical interventions on the major
salivary glands due to benign non-tumor disease. Nationally the total number of resected major
salivary glands due to benign obstructive disease also decreased significantly over the study
period from a mean of 158 resected glands per year in 2000-2004 to a mean of 117 glands
per year in 2005-2012 (p = 0.0004, CI 22.915-59.884). This extrapolates to a total of 329 major
salivary glands being spared nationally since sialendoscopy was introduced in Denmark. It
was mainly the submandibular gland resections that contributed to the over-all decrease both
regionally and nationally. The most significant decrease was observed from 2004 to 2006: From
161 to 109 resected submandibular glands, a decline of 32.3%
Diskussion: Obstructive diseases of the major salivary glands have long been known as a challenge to the otolaryngologist and his patients. In this study the main objective was to assess
whether the introduction of sialendoscopy has saved any major salivary glands from excision.
This was indeed the case; nationally the number of resected submandibular glands due to
non-tumor obstructive disease suddenly decreased with 32.3% from 2004-2006 due to the
introduction of sialendoscopy in Denmark late in 2004. In 2011 and 2012 the lowest number of
submandibular glands was excised since 2000, and hopefully this development will continue.
//
37
Real-life experiences with prophylactic C1-inhibitor
concentrate (Cinryze®) in HAE – a case series.
ER R asmussen, A Bygum
Øre-næse-hals-afdelingen Køge
Hudafdeling I og Allergicenteret OUH
Introduktion: Hereditary angioedema (HAE) is a genetic disorder which usually becomes symptomatic early in life. The main symptom is recurrent swelling episodes (angioedema) of the skin
and/or mucosa. When the upper airways are involved, the angioedema can become life-threatening due to possible asphyxiation. The disease is caused by either a diminished level (HAE type
1) or dysfunction (HAE type 2) of complement C1-inhibitor (C1INH).
Materiale/metode: This was a prospective observational study on the efficacy of Cinryze® as LTP
in six adult HAE type-1 patients not sufficiently controlled (continuous breakthrough angioedema
attacks and/or rebound effect of medication) with other types of C1INH concentrate and/or
Firazyr®. The patients were included from the national HAE Centre, which oversees the regular
management of 91 HAE (type I and II) patients and 7 AAE patients. Prior to Cinryze®¬ introduction, all patients were instructed in self-administering C1INH intravenously at home. The patients
had a disease specific diary handed out prior to the first scheduled treatment, and the correct
way to fill it out was explained to them by a nurse or physician.
Resultater: The attack rate before initiation of LTP with Cinryze® ranged from four to eight per
month and the rate dropped to a mean of 2.1 attacks per month [range 0.1-3.7] after starting
Cinryze®. A total of 281 swellings were recorded during 61 months (4.6 attacks per month)
prior to initiation of Cinryze® and 86 swellings were recorded during 76 months (1.1 attacks per
month) after starting Cinryze®. The treatment delay was reduced from a mean of 3.9 hours to
2.2 hours before and after initiation of Cinryze® treatment. The main challenge encountered by
patients was to obtain the correct injection technique, as the Danish HAE patients are using small
butterfly needles and not indwelling catheters. However the attack frequency was still reduced
by more than 80%. A rather high economic burden is related to the new HAE pharmaceuticals.
Diskussion: In the present study the over-all attack frequency was decreased by two thirds after
initiation of LTP with Cinryze®. The mean duration of an attack and the number of hours lost
from school or work were reduced remarkably, as was the treatment delay. This supports prior
findings. The proportion of localization sites were not significantly changed by Cinryze® (Figure 1). However only four head and neck swellings were observed during 76 months (0.05 per
month) as opposed to 15 in a period of 61 months (0.25 per month) prior to Cinryze treatment,
a reduction of 80 %. This is important as those can be life-threatening due to asphyxiation. The
ecnoomic burden of LTP in HAE patients is justified by the decrease in disease severity.
38
//
Frie foredrag
Laryngologi
og kræft
//
39
Genetic etiology of sulcus vocalis: case reports of 6
families
G Nikoghosyan-Bossen, S Prytz
Foniatric clinique, department of Neurology, Bispebjerg Hospital, Denmark
Introduktion: Sulcus vocalis (SV) has been known since nineteenth century and is a rare lesion of
the true vocal folds referring to a linear groove on the mucosal lining, extending along its vibratory surface. Its etiology is a controversial matter. Theories concerning congenital and acquired
origins have been suggested. The objective of this study was to support the theory of a congenital
etiology of sulcus vocalis by presenting six families, where two or more members were diagnosed
with SV.
Materiale/metode: Videostroboscopy was performed on all the dysphonic family members. The
vast majority were operated by a single surgeon with extirpation of SV. Subjective and objective
evaluation was performed after surgery using videostroboscopy in all patients.
Resultater: Case 1 Mother and two daughters; all 3 operated for bilateral SV at ages 33, 10 and 13.
Case 2 Mother and son, both operated for unilateral SV at ages 44 and 12. Case 3 two brothers,
both operated for bilateral SV at ages 10 and 11. Case 4 three siblings operated for bilateral or
unilateral SV all at age 11. Case 5 two siblings diagnosed with SV at ages 10 and 13, one operated
for bilateral SV. Case 6 two sisters, both operated for bilateral SV at age 13.
Diskussion: All family members presented in this study have been dysphonic since childhood,
thus favoring the hypothesis of a congenital etiology. Sulcus vocalis being present in up to three
siblings and in mother-and-child cases reinforces the hypothesis of genetic etiology.
40
//
DANGLOT og DAHANCA 27 - National database
for patienter med laryngeal intraepitelial neoplasi
(LIN) og T1A-glottiscancer samt opstart af kirurgisk
behandling af T1A-glottiscancer (DAHANCA 27).
Status 2015.
C Slot Mehlum (1), C Godballe (1), Å Møller Grøntved (1), N Munk Lyhne (2), T Kjærgaard (2),
S Schytte (2), K Lambertsen (2), B Parm Ulhøj (3), J Overgaard (4), J Schultz (5), K Hald (6),
N R asmussen (7), B Charabi (7), W Trolle (2), J Tvedskov (7)
(1) ØNH afd, Odense Universitets Hospital, (2) ØNH afd, Århus Universitets Hospital, (3) Patologisk afd,
Århus Universitets Hospital, (4) Onkologisk afd, Århus Universitets Hospital, (5) ØNH afd, Vejle sygehus,
(6) ØNH afd, A alborg Universitets Hospital, (7) ØNH afd, Rigshospitalet
Introduktion: I 2012 indførte vi i Danmark nationale retningslinjer for håndtering af LIN og
T1A-glottiscancer, som det fremgår af http://www.dahanca.dk/get_media_file.php?mediaid=317.
Ændringen indebar en helt ny strategi for både udredning og behandling af patienter med
læsioner på stemmelæberne, hvor der rejses mistanke om neoplasi. Den kirurgiske behandling
af LIN og T1a glottiscancer foregår nu efter samme princip. Patienter med T1a glottiscancer, som
vurderes radikalt opereret, kan indgå i protokolleret kontrolforløb i henhold til DAHANCA 27.
Man vedtog at oprette en national database (”DANGLOT”) for at kunne dokumentere effekten af
de nye retningslinjer.
Erfaringer fra de første 2 ½ år siden opstart af DANGLOT og DAHANCA 27 vil blive belyst.
Materiale/metode: Vi præsenterer status for DANGLOT og DAHANCA 27 ud fra oplysninger registreret i de deltagende centre.
Resultater: Foreløbige tal vedrørende patienter inkluderet i DANGLOT og DAHANCA 27 vil blive
gennemgået.
Diskussion: Erfaringerne i forbindelse med opstart vil blive diskuteret, herunder udfordringer i
forbindelse med stramning af regler vedrørende databaser.
//
41
Risk of human papillomavirus associated head
and neck cancer following a diagnosis of cervical
intraepithelial neoplasia
M Svahn (1), C Munk C (1), SM Jensen (1), K Frederiksen (1), C Buchwald (2), SK Kjaer (1)
(1) Danish C ancer Society Research Center, (2) Department of ORL, H&N surgery and audiology,
Rigshospitalet, Copenhagen University Hospital, Denmark
Introduktion: Human papillomavirus (HPV) represents a necessary cause for the development
of cervical cancer and its severe precursors (CIN2/3). Furthermore, HPV is associated with the
development of a subset of head and neck cancers (HNCs). The aim was to investigate whether
women previously diagnosed with CIN2/3 had an increased risk of developing HPV-associated
HNC. Degree of HPV association was based on the current literature.
Materiale/metode: This nationwide register-based cohort study included all women born in
Denmark between 1918 and 1990 (~2,800,000). Of these, 135,349 women were registered with a
diagnosis of CIN2/3 in The Danish Cancer Registry or The Danish Pathology Data Bank. All women
were followed from the age of 18 until date of HNC diagnosis, date of migration, date of death or
December 31, 2012. Using Cox regression analysis with age as the underlying time scale, Hazard Ratios (HR) for the risk of HNC in women with previously diagnosed CIN2/3 were estimated
(adjusted for birth year).
Resultater: A significantly increased risk of any HNC of 95% (HR 1.95, 95% CI 1.69–2.25) was found
for women with a previous diagnosis of CIN2/3. Restricting the analysis to include only highly
HPV-associated HNCs (oropharynx) increased the risk (HR 2.22, 95% CI 1.78–2.77). The risk of
medium HPV-associated HNC was (HR 1.35, 95% CI 0.95–1.90).
Diskussion: Our study shows a highly significant risk of HPV-associated HNC among women previously diagnosed with CIN2/3.
42
//
New uPAR-targeted near-infrared fluorescent
tracer for image-guided real-time detection of
squamous cell carcinoma and cervical lymph
node metastases in oral cancer
Christensen A, Juhl K, Persson M, Charabi B, Mortensen J, Kiss K, von Buchwald C, Kjær A
Department of Otolaryngology , Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen
University Hospital, Denmark
Department of Clinical physiology, Nuclear Medicine & PET and Cluster for Molular Imaging,
Rigshospitalet and University of Copenhagen, Denmark
Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Denmark
Introduktion: Fluorescence-guided surgery is a novel modality that enables intraoperative
detection of tumor and assessment of resection margins. The urokinase-type plasminogen
activator receptor (uPAR) is associated with tumor invasion and metastatic spread in oral
cancer. The aim of this study was to investigate the feasibility of the optical probe ICG-GluGlu-AE105 targeting uPAR for detection of tumor and metastases by fluorescence-guided
imaging in an orthotopic animal model of tongue cancer.
Materiale/metode: The human SCC cell line OSC-19-luc was injected into the tongue of nude
mice. Tumor growth was monitored over time by bioluminescence imaging. On day 14 or day
19 10 nmol of ICG-Glu-Glu-AE105 was injected systemically and 15 hour post injection imaging in vivo and ex vivo was performed with a small-animal fluorescence scanner and with a
clinically approved fluorescence camera. Injection of saline served as control. In adjacent tissue
sections prepared from either fresh frozen or paraffin embedded tissue the microanatomical
distribution of the fluorescent signal from ICG-Glu-Glu-AE105 was compared with H&E staining
and immunohistochemical staining for uPAR and cytokeratin.
Resultater: Following the injection of ICG-Glu-Glu-AE105, fluorescence could successfully be
detected in the primary tumor and cervical lymph node metastases. A mean tumor-to-background ratio of 3.0 (range 2.2-4.0) in the tongue tumors was observed. Real-time fluorescence-guided tumor resection was possible. Histological analysis showed microanatomical
colocalization of the fluorescent signal, uPAR expression and tumor cell deposits demonstration
the tumor-specific binding of ICG-Glu-Glu-AE105.
Diskussion: Specific real-time optical imaging of the primary tumor and cervical lymph node
metastases with ICG-AE105 targeting uPAR proved feasible in a mouse model of tongue squamous cell carcinoma. Further study of this tumor-specific optical probe to aid radical surgical
resection of carcinomas is warranted.
//
43
Clinical outcome and survival following
microvascular reconstruction in patients with oral
and oropharyngeal cancer
S Al-Hayder (1), JJ Elberg (2), B Charabi (1)
1. Department of otorhinolaryngology, Head and Neck Surgery, and Audiology, University Hospital of
Copenhagen, Rigshospitalet
2. Department of Plastic Surgery, Breast Surgery, and Burns Treatment, University Hospital of Copenhagen,
Rigshospitalet
Introduktion: The purpose of the study was to examine the clinical outcomes and survival in
patients with oral or oropharyngeal cancer following primary microvascular reconstruction
Materiale/metode: The study was conducted as a retrospective review of medicals records. All
patients diagnosed with oral or oropharyngeal cancer, who underwent tumour surgery followed by
primary reconstruction by radial forearm free flap or fibula free flap at Rigshospitalet, Copenhagen
University Hospital, in the period September 2001 to July 2012 were included.
Resultater: The final results will be presented at the annual meeting.
Diskussion: The final conclusion will be presented at the annual meeting
44
//
Trans Oral Robot kirurgi af oropharynx cancer
og diagnosticering af ukendt primær tumor på
Rigshospitalet
N Rubek
Øre-næse-halskirurgisk og audiologisk klinik, Rigshospitalet
Introduktion: Gennem de sidste 2 år har Rigshospitalet gennemført omkring 100 transorale robotkirurgiske indgreb. Robotten er hovedsageligt blevet anvendt til salvage kirurgi, primær kirurgi af
oropharynx cancer og til diagnosticering af ukendt primærtumor ved metastase på halsen.
Materiale/metode: Vi præsenterer hermed to af vores aktuelle studier, dels et prospektivt
pilotstudie med primær behandling af oropharynxcancer, hvor primary endpoint er behovet for
postoperativ stråleterapi samt et retrospektivt studie robottens anvendelse ved diagnosticering af
primærtumor i tungeroden.
Resultater: De initiale resultater er lovende, både i primær behandling af oropharynx og i særdeleshed også i robottens anvendelse som diagnostisk redskab
Diskussion: De fremtidige muligheder for robottens anvendelse ved hoved- og halskræft i primærbehandling af dels oropharynxcancer og måske senere glottiske/supraglottiske cancere i de tidlige
stadier er inden for rækkevidde. Strålebehandlingens rolle for disse sygdomme kan herved reduceres til fordel for et mere skånsomt behandlingstilbud
//
45
Rekonstruktion af øvre oesophagus/hypopharynx
med frit tyndtarmsinterponat – en update
CS Danstrup (1), S Schytte (1), B Kiil (2)
1: Øre-næse-halskirurgisk afdeling H, A arhus Universitetshospital, 2: Plastikkirurgisk afdeling Z, A arhus
Universitetshospital
Introduktion: Rekonstruktion med et frit tyndtarmsinterponat blev først beskrevet af Seidenberg
i 1957. Anvendes i dag i forbindelse med kurativt intenderet behandling af cancer i proximale
oesophagus. Behandlingen er et multidisciplinært samarbejde mellem øre-næse-halslæger, onkologer, thorax-, abdominal-, og plastikkirurger. Aarhus Universitetshospital har landsdelsfunktion for
behandling af patienter med høj oesophaguscancer
Materiale/metode: Retrospektiv gennemgang af patienter opereret på Aarhus Universitets hospital
i perioden 2000-2013.
Resultater: I alt 29 patienter blev opereret i perioden. 20 mænd og 9 kvinder. Medianalder 61
år. 82% med svær dysphagi preoperativt. 13 patienter modtog preoperativ strålebehandling. 11
patienter havde tidligere modtaget strålebehandling i det kirurgiske felt.
Ingen 30 dages mortalitet. 1 patient med tab af interponatet. 27% med strikturdannelse. 10%
med svær dysphagi 3 måneder postoperativt
Diskussion: Prognosen for høj oesophaguscancer er i fremskredne stadier generel dårlig. Det
primære symptom er dysphagi. Behandling med resektion og rekonstruktion med eller uden
neoadjuverende radiokemoterapi tåles generelt godt på en selekteret gruppe af patienter med lav
morbiditet og perioperativ mortalitet.
46
//
Frie foredrag
Otologi
//
47
Intracranial pressure regulation revisited. The PetroSigmoid Reticulum: A new intravascular receptor
for intracranial pressure
MN Møller, S Kirkeby, K Qvortrup, J Vikesaa, FC Nielsen, PC-Thomasen
Øre-næse-halskirurgisk klinik, Rigshospitalet
Introduktion: The Monro-Kellie hypothesis dictates that in an incompressible cranium, the blood,
CSF, and brain tissue exist in a state of volume equilibrium. In order to maintain a constant blood
perfusion, the brain utilizes “cerebral autoregulation”. The molecular regulation of blood pressure
is poorly understood and specific receptors for homeostasis equal to the carotid glomus and
sinus have not yet been identified. However, indications of an unspecific receptor function in
the cerebellopontine angle do exist. Although the receptor has remained unidentified, surgical
stimulation in this area elicits a “cerebral natriuretic response”. The proper stimulus however may
be increased intracranial sodium. In conjunction with the new discovery of the regional situated
human endolymphatic sac as a novel intracranial natriuretic gland, we set out to explore and
examine the tissue surrounding the human ES and sigmoid sinus in order to identify a possible
anatomical well defined receptor for intracranial homeostasis.
Materiale/metode: Using fresh human endolymphatic sacs, a coordinate design of both standard and ultrastructural morphology as well
as molecular biology was utilized. Standard light microscopy and transmission electron microscopy for morphological analysis and both
DNA micro-arrays and immuno-histochemistry for molecular biology. A total of 30 tissue samples from the human endolymphatic sac were
obtained during translabyrinthine surgery for vestibular schwannoma. 18 were prepared for light microscopy using standard methods and for
TEM using an oxygenated fluorocarbon fixative before standard preparations for TEM. Microarray technology was used to investigate tissue
sample gene expression, using adjacent dura mater as control. The expression of genes specific for neurotransmission was determined and
results for selected key molecules verified by immuno-histochemistry.
Resultater: Both light microscopy and in particular the TEM revealed a morphological picture
consistent with the occurrence of intravascular situated cells, who’s cell-bodies penetrated the
endothelial wall. Two cells types are described, and both have the morphological appearance
of neuroendocrine cells or indeed nerve terminals. This was strongly supported by the DNA
analysis, which was additionally confirmed by the immuno-histochemistry. From the molecular
biology analysis we confirmed the intravascular occurrence of cell bodies which expressed the
dopamine receptor DRD2 and DRD5, as well as all enzymes responsible the rate limiting steps in
the dopamine synthesis, release and re-uptake: Tyrosine hydroxylase (TH), DOPA decarboxylase
(DDC), Vesicular Monoamine Transporter 2 (VMAT2), Plasma membrane monoamine transporter
(PMAT) and Dopamine Transporter (DAT).
Diskussion: From the combined morphological and molecular biology analysis we hypothesize
that the capillary network interposed between the human endolymphatic sac and sigmoid sinus
likely hosts a dopamine dependent intravascular receptor, which we suspect reacts to changes
in intracranial pressure and/or plasma sodium concentration. The receptor is tentatively named
The Petro-Sigmoid Reticulum due to its anatomical location. Further analysis are currently being
conducted to verify this hypothesis and to determine the nature of the natriuretic capability.
48
//
The impact of ventilation tubes in otitis media on
the risk of cholesteatoma on a national level
B Djurhuus (1), K Christensen (2), A Skytthe (2), C Faber (1)
1. Department of ENT Head & Neck Surgery, Odense University Hospital, Odense, Denmark
2. Epidemiology, Biostatistics and Biodemography, Institute of Public Health, University of Southern
Denmark, Odense, Denmark
Introduktion: The objective was to estimate the impact of middle ear ventilation tube insertion in
children with otitis media on the risk of cholesteatoma on a national level.
Materiale/metode: Survival analyses were applied on data obtained from the Danish National
Patient Register, the National Health Service Register and Statistics Denmark.
Resultater: A total of 217,206 children, born after December 31, 1996, who had at least one ventilation tube inserted before August 31, 2011 were identified. Of these, 374 subsequently underwent cholesteatoma-surgery.
A corresponding 36,981 children without any ventilation tube insertion were identified for
comparison using a random sample of the Danish population. Of these, 5 underwent cholesteatoma-surgery.
An increasing number of ventilation tube insertions was associated with an increasing risk of
cholesteatoma-surgery.
In the regression model each additional year of age before the first ventilation tube insertion
increased the risk of cholesteatoma-surgery by 54% (47%-63%), while each additional year
between two successive tube insertions increased the risk by 28% (15-43%).
Diskussion: Prolonged otitis media requiring multiple ventilation tube insertions was associated
with an increased risk of cholesteatoma-surgery. Early age at first tube insertion and short time
between two tube insertions was associated with a lower risk of cholesteatoma-surgery. This may
be the result of reduced time with negative middle ear pressure and otitis media. However, these
findings may be susceptible to selection bias, as age at first tube insertion and time between
tube insertions, as well as the outcome variable, cholesteatoma-surgery, may all depend on the
underlying indication for ventilation tube insertion.
//
49
School performance in cholesteatoma-operated
Danish children: A nationwide study
B Djurhuus (1), T Hansen (2), J Pedersen (3), C Faber (1), K Christensen (2)
1. Department of ENT Head & Neck Surgery, Odense University Hospital, Odense, Denmark
2. Department of Anesthesia and Intensive C are, Odense University Hospital, Odense, Denmark
3. Epidemiology, Biostatistics and Biodemography, Institute of Public Health, University of Southern
Denmark, Odense, Denmark
Introduktion: The objective was to investigate a possible influence of surgically treated middle ear
cholesteatoma in childhood on school performance in adolescence.
Materiale/metode: Final marks given to children with cholesteatoma surgery performed before
the age of 15 years (cholesteatoma group) upon completion of compulsory schooling (9th grade)
were compared with the corresponding marks from a random sample of Danish children (control
group) taking potential confounders into account. Data from 5 national registers were combined
for the Danish 1986-1991 birth cohorts by use of the unique civil registration number.
Resultater: The cholesteatoma group consisted of 702 children. After excluding those who died or
emigrated before the age of 17 and those with congenital anomalies, 549 remained. The corresponding numbers for the control group were 17,757 and 15,106.
In the cholesteatoma group, 86.0% of the children attained normal compulsory schooling, which
was 4.2% less than in the control group (95% confidence interval 1.3-7.2%).
The average marks in the cholesteatoma group were similar to those in the control group. However, children with ≥2 cholesteatoma surgeries scored 0.26 marks lower in English (1st
foreign language) when compared to the control group (95% confidence interval 0.03-0.48).
Diskussion: A higher proportion of children with cholesteatoma surgery did not attain compulsory
schooling. This could suggest that a subgroup of these individuals was developmentally disadvantaged.
Cholesteatoma-operated children who did attain compulsory schooling had average marks similar
to those of the background population. Multiple cholesteatoma surgeries in childhood were, however, associated with lower marks in foreign languages.
50
//
Chronic suppurative otitis media, middle ear
pathology and hearing loss in a cohort of
Greenlandic children
MB Avnstorp (1,2), RG Jensen (1), P Bjerregaard (3), P Homøe (1)
1 Dept. of Otorhinolaryngology and Maxillofacial Surgery, Køge Hospital, University of Copenhagen, 2
Dept. of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, 3
National Institute of Public Health, Division of Greenland, University of Southern Denmark
Introduktion: Severe middle ear pathology such as chronic suppurative otitis media (CSOM) has
been observed at high prevalence rates in Greenlandic children. Middle ear pathology leads to
hearing loss (HL) which may compromise social development and educational achievements.
Objective: We investigated CSOM, otitis media with effusion (OME) and tympanic membrane
pathology, and the association with hearing loss in Greenlandic children.
Materiale/metode: In 2010 we examined a cohort of 223 children aged 4-10 years and born in
Greenland. We performed video otoscopy, tympanometry and tested the hearing thresholds by
pure tone average for the frequencies 500, 1000, 2000, 4000 and 6000 Hz. The children were
categorized into the groups: CSOM, OME, sequelae of OM (circular atrophy, fibrosis and myringosclerosis) and normal. Ears occluded by unremovable earwax were excluded from the study.
Resultater: In 207 children the prevalence rate of CSOM was 5.8% and sequelae of OM was 60.9%.
Investigating the children’s 399 unique ears, we found CSOM in 3.8%, OME in 7%, and tympanic
sequelae of OM in 44.6%. The severity of HL correlated significantly (P<0.05) with the severity of
middle ear pathology in the following order: CSOM: 32.5 dB (23.3-41.7), OME: 22.2 dB (18.6-25.7),
sequelae of OM 14.4 dB (13.1-15.7) and normal: 12.0 dB (10.9-13.1). Children with HL of any kind
above 15 dB were found in 56.5%.
Diskussion: The burden of CSOM and middle ear pathology is still high in Greenlandic children and
correlates significantly to the severity of HL.
//
51
Lifetime recurrence rate after operation for
acquired middle ear cholesteatoma
M K altoft, P Cayé-Thomasen and SE Stangerup
Dept. oto-rhino-laryngology, Rigshospitalet
Introduktion: To assess a lifetime recurrence rate after middle ear cholesteatoma surgery, we
looked at a group of deceased patients previously operated for cholesteatoma.
Materiale/metode: Retrospective study. 181 patients (121 men and 60 women), 199 ears operated for middle ear cholesteatoma between 1962 and 1992. Existing data was combined with
data for outpatient clinic visits, admissions and operations. Median patient age was 51 years at
operation (range 5 to 73).
Resultater: The median observation period was 20.6 years (range 0 to 46 years) and the median
censored period was 4.8 years. 78% of patients had an observation period longer than 10 years
and 52% longer than 20 years. 19% of the patients had a censored period less than one year, and
51% had a censored period less than 5 years. 19 patients were operated for a recurrence of middle ear cholesteatoma. The median period from the primary operation to operation for recurrence
was 5.6 years (range 0.6 to 17), the longest period was 17 years. The Kaplan-Meier recurrence
rate was 11.6%. Recurrence rates were equal among men and women, and among intact wall
technique and wall down technique. There was no age difference between patients with recurrence and no recurrence.
Diskussion: With longer observation follows higher recurrence rates. The median period until
recurrence was 5.6 years and recurrences were seen in the first 11 postoperative years, and one
as late as after 17 years. This advocates for long follow up periods.
52
//
Stabilitet af stapedotomi og behovet for
efterfølgende rutinekontrol: Er 1-års kontrollen
obsolet? Et prospektivt database studie.
SAW Andersen, MC Öhman, MS Sørensen
Øre-, næse- og halskirurgisk og Audiologisk Klinik, Rigshospitalet/Gentofte Hospital.
Introduktion: Stapeskirurgi er en effektiv behandling af det konduktive høretab ved otosklerose.
De amerikanske guidelines rekommanderer at kun 1-års resultaterne efter kirurgi for konduktivt
høretab rapporteres. Denne anbefaling er imidlertid baseret på ekspertkonsensus fremfor evidens
og vores hypotese er at den postoperative hørelse efter stapedotomi er stabil allerede ved
3-måneders kontrollen.
Materiale/metode: 371 stapedotomier for otosklerose var registreret i vores prospektive stapes-database i 2004-2013. Der blev inkluderet 166 primære og 37 revisionsoperationer med
komplet audiometri fra både 3-måneders kontrollen (2-6 måneder) og 12-måneders kontrollen
(>12 måneder).
Resultater: Den gennemsnitlige ændring i høretærsklen fra 3 til 12-måneders kontrollen var
minimal og uden klinisk betydning for både pure-tune average af air conduction, air-bone gap
og speech reception threshold og for primære og revisions operationer. Kun 3-5 % af primært
opererede og 14-16 % af revisionerne havde en forværring mellem rutinekontrollerne på 10 dB
eller mere.
Diskussion: Hørelsen var stabil for størstedelen af patienterne og 3-måneders resultaterne kan
derfor bruges uden tab af vital information. 3-måneders resultater bør derfor kunne rapporteres
og bruges til komparative studier med sidegevinst i form af at tabet til follow-up reduceres hvilket
mindsker bias. 1-års kontrollen er unødvendig for en stor del af patienterne og bør ikke rutinemæssigt planlægges. I stedet anbefales at patienterne kan genhenvende sig ved forværring af
hørelsen inden for det første år.
//
53
Læringskurver i virtuel mastoidektomi: Hvor meget
og hvordan skal man træne?
SAW Andersen (1), L Konge (2), P Cayé-Thomasen (1), MS Sørensen (1)
1. Øre-, næse- og halskirurgisk og Audiologisk Klinik, Rigshospitalet/Gentofte Hospital.
2. Center for Klinisk Uddannelse, Center for HR, Rigshospitalet.
Introduktion: Virtual reality (VR) simulationstræning kan bruges som et supplement til traditionelle
træningsmodaliteter i erhvervelsen af basale kirurgiske tekniske færdigheder. VR simulation muliggør gentagen træning i et beskyttet miljø og er i flere specialer implementeret i den lægelige
videreuddannelse. Evidensbaseret tilrettelæggelse af den virtuelle træning kræver imidlertid
detaljeret viden om læringskurverne ved proceduren. I dette studie undersøgte vi læringskurverne for virtuel mastoidektomi i to forskellige træningsregimer med og uden simulator-integreret
tutoring.
Materiale/metode: 40 lægestuderende gennemførte 12 virtuelle mastoidektomier i Visible Ear
Simulatoren i et massed (12 gentagne simulationer i træk) eller distribueret træningsprogram
(2 simulationer pr. gang over 4-6 uger) randomiseret til simulator-integreret tutoring i de første
5 procedurer. Procedurerne blev efterfølgende vurderet ved brug af slut-produkt analyse af to
otokirurgiske eksperter.
Resultater: Distribueret træning var mere effektivt end massed træning. Der blev observeret et
fald i performance over tid ved massed træning. Tutor-funktionen accelererede den initiale del af
læringskurven og øgede performance, men da tutor-funktionen blev taget af skete der et fald i
performance, hvilket især var udtalt ved massed træningsregimet.
Diskussion: Ofte er post-graduat lægelig træning tilrettelagt som massed træning i form af kursusdage og intensive forløb. Konsolidering spiller imidlertid en stor rolle for indlæringen af tekniske
færdigheder og udtrætning ved gentagen og massed træning er ødelæggende for performance
og indlæring. Simulator-integreret tutoring har en vis effekt på performance men skal undersøges
yderligere. VR simulationstræning af kirurgiske tekniske færdigheder bør derfor tilrettelægges på
baggrund af denne viden.
54
//
Behandling af otomykose i ØNH speciallægepraksis
i Danmark; en spørgeskemaundersøgelse.
E Arndal(1), H Glad(1,2), P Homøe(1,2) og SAFSOD(2).
(1) Øre-næse-hals- og kæbekirurgisk afdeling Køge Universitetssygehus
(2) Sammenslutningen af Forskningsinteresserede Speciallæger i Otorhinolaryngologien i Danmark.
Introduktion: Otomykoser ses som primær infektion i øregangen men også sekundært efter
længere behandling af otitis externa og kronisk otitis media med antibiotika- og steroidholdige
øredråber. Behandlingen foregår typisk i ØNH speciallægepraksis og kan være både langvarig
og genstridig. Formålet med undersøgelsen er at undersøge, hvorledes privatpraktiserende
ØNH læger diagnosticerer og behandler otomykose og endvidere, om immunkompromitterede
patienter behandles anderledes?
Materiale/metode: Et spørgeskema blev udsendt elektronisk og ved manglende besvarelse
tilsendt per brev til 147 privatpraktiserende ØNH læger i Danmark.
Resultater: Svarprocent 71% (104/147). Diagnosen otomykose stilles generelt på det kliniske
billede, og kun 20 % af otologerne kræver samtidig tilstedeværelse af synlige svampehyfer.
40 % poder initialt, hvorimod 90 % poder ved behandlingssvigt. 95% foretager oprensning af
den afficerede øregang under otomikroskop. Et stort antal forskellige behandlinger anvendes,
og der er stor diversitet i valget af antimykotika med eller uden kombinationspræparater såsom
binyrebarkhormon eller antibakterielle midler. 84 % vælger lokalbehandling som første valg,
mens 3 % behandler med både lokal og systemisk behandling. 13 % behandler immunkompromitterede patienter mere intensivt.
Diskussion: Undersøgelsen demonstrerer en manglende konsensus i behandlingen af otomykose. Der er således behov for en fælles retningslinje. I denne bør følgende belyses: Diagnostiske kriterier, betydning af dyrkning og resistens for svampe, oprensningsfrekvens, valg
af antimykotika, behandlingsvarighed samt reaktion på behandlingssvigt og endvidere, om
patientens immunologiske status bør påvirke behandlingsstrategien.
//
55
Frie foredrag
Søvnapnø &
tonsiller
56
//
Den kirurgiske tilgang til obstruktiv søvnapnø
C Prætorius
Øre-næse-halsklinikken i Hørsholm
Introduktion: Traditionelt behandles obstruktiv søvnapnø med CPAP. Nogle patienter kan dog kureres kirurgisk, men det er omdiskuteret hvem, der har gavn af operation og hvem, der ikke har.
Materiale/metode: Med udgangspunkt i litteraturgennemgang foretaget i forbindelse med
udarbejdelse af en MTV i 2013 om behandlingen af obstruktiv søvnapnø gennemgås virkning og
eller mangel på samme af de kirurgiske modaliteter, der findes på området. Dertil gennemgås et
mindre materiale af stærkt selekterede patienter opereret for obstruktiv søvnapnø.
Diskussion: Der ser ud til at være en gruppe af patienter med obstruktiv søvnapnø, som kan have
gavn af eller kureres for sygdommen ved operation. Effekten ser ud til at være størst hos patienter
med kombinationen af små tunger og store tonsiller, hvorfor udvælgelsen af patienter er meget
vigtig.
//
57
Cardio respiratorisk måling (CRM) for søvnapnø
før og efter bariatrisk kirurgi. Prospektivt arbejde.
K Larsen (1), PR Lage-Hansen (2), J Gram (2)
Øre-Næse-Hals Esbjerg, Endokrinologisk afd. Esbjerg
Introduktion: Undersøgelse og behandling for søvnapnø er på vej til at blive skrevet ind i specialeplanen for ØNH. Det er vigtigt at vi kan dokumentere videnskabelig aktivitet på området.
Vi har i samarbejde med endokrinologerne foretaget en prospektiv undersøgelse over godt 2
år af effekten af bariatrisk kirurgi på søvn-apnø hos patienter med morbid overvægt.
Materiale/metode: Der blev i alt inkluderet 56 patienter der blev accepteret til bariatrisk kirurgi. Subgrupper i den inkluderede population blev nærmere evalueret mhp på ændringer i en
række forskellige parametre fra CRM før og 1 år efter kirurgi.
Resultater: Hele materialet giver et estimat af frekvens af søvnapnø ud fra aktuelle definitioner. Subpopulation viser ikke overraskende stor effekt af vægttab for visse parametre mens
der ikke observeredes forventelige forskydninger i andre parametre. Dette redegøres der for.
Diskussion: Der var formidabel effekt på søvnapnø efter kirurgisk behandling for vægttab målt
med CRM. Undersøgelsens resultater iøvrigt må give anledning til overvejelser over hvor vi
som ØNH læger vil stå i diagnostisk, terapeutisk og forskningsmæssig sammenhæng indenfor
dette felt. Hvis vi ønsker at være med i dette hurtigt ekspanderende faglige område skal vi
gøre os disse ting klart.
58
//
Antibody development to Fusobacterium
necrophorum in patients with peritonsillar abscess
TE Klug, JJ Henriksen, M Rusan, K. Fuursted, KA Krogfelt, T Ovesen, C Struve
Statens Serum Institut
Introduktion: Abstract A polymicrobial mixture of aerobic and anaerobic bacteria is commonly
recovered from peritonsillar abscess (PTA) aspirates. Previous studies have suggested a role for
Fusobacterium necrophorum (FN) in the development of PTA. The purpose of the current study
was to explore whether anti-FN antibodies were produced in patients with PTA. We developed a
novel immunofluorescence-based method to measure anti-FN antibody levels in acute and convalescent sera from 15 patients with PTA and 47 patients with chronic tonsillar conditions (controls)
undergoing acute or elective tonsillectomy, respectively. Bacterial cultures were performed on
tonsillar cores and surfaces, pus aspirates, and blood. An increase in anti-FN antibody levels (of at
least doubling of the previous level) was observed in 8 of 11 (73 %) PTA patients with FN-positive
pus aspirate cultures (FN-positive patients).
In contrast, the four FN-negative PTA patients did not have an increase in anti-FN antibody levels
(p=0.026). The change in anti-FN antibody levels in FN-positive PTA patients was also significantly
greater than that for FN-positive electively tonsillectomized patients (p=0.0014) and all electively
tonsillectomized patients (p<0.001). Our results validate FN as a significant and prevalent pathogen in PTA. This finding has implications for the diagnostic work-up of PTA and may also have
implications for the treatment of acute tonsillitis.
//
59
Tonsillectomies and postsurgical hemorrhages in
Denmark in the period of 1991-2012
ML Juul (1), MF Howitz (2)
(1) Dep. of otolaryngology Rigshospitalet, (2) Dep. of otolaryngology Hillerød
Introduktion: The objective was in a retrospective national register-based epidemiological cohort
study to present descriptive epidemiology on tonsillectomies and postsurgical hemorrhage in
Denmark in the period 1991-2012.
Materiale/metode: Patients coded with a tonsillectomy or adenotonsillectomy were identified
from the National Patient Registry (NPR) and the National Health Insurance Service Registry.
These were paired with the postsurgical hemorrhage code within 3 weeks after the surgery. Data
obtained included cpr number, date of surgery and place of surgery (hospital/private clinic and
county/region).
Resultater: In the 22-year period 179.133 tonsillectomies were conducted; 88,6 % at public
hospitals and 11,4 % in private clinics. The overall incidence of tonsillectomies decreased non-significantly in the period; this covers a significant increase in the incidence of tonsillectomies
performed in private clinics while a significant decrease was observed in public hospitals. The
region Syddanmark had a significant higher incidence of tonsillectomies than any other region in
both public hospitals and private clinics. Also, the age group 3-4-year-old had significant higher
incidence of tonsillectomies in both public hospitals and private clinics. A secondary incidence
peak was present for females age group 15-19-year-old.
Diskussion: The incidence rate of tonsillectomies in Denmark decreased non-significantly in the
study period, and a shift from public to private clinics was observed. Region Syddanmark performed significantly more tonsillectomies than any other of the Regions. We do lack an explanation for this. The age-specific incidence rate peaks observed for the agegroups 3-4-year-old and
15-19-years old is comparable to other studies.
Data on postsurgical hemorrhage after tonsillectomy will in addition be presented.
60
//
Necrotizing fasciitis in the head and neck: still a
challenge
JF Thrane A Pikelis, T Ovesen
Department of Otorhinolaryngology,Head and Neck Surgery, A arhus University Hospital, A arhus
Introduktion: Necrotizing fasciitis (NF) in the head and neck is still a challenging condition – devastating or even life threatening. Due to the related morbidity and mortality NF requires immediate
diagnostics and urgent aggressive surgical debridement including broad spectrum antibiotical
treatment.Our purpose was to analize patient characteristics, origin of infection, microbiology,
comorbidity, as well as surgical,medical and hyperbar oxygen treatment, and eventually complications.
Materiale/metode: 43 consequetive and eligible patients with confirmed NF were enrolled in our
study from 2002 to 2014,which was conducted at our Department.All patients underwent aggressive surgical debridement and treated according to our current guidelines: intravenous immunoglobulin and broad-spectrum antibiotics.Hyperbaric oxygen was given in concern of the general
condition of the patient.
Resultater: There were 25 males and 18 females.Primary infection foci were located to the pharynx and the skin followed by odontogenic infections. The main pathogen was group A Streptococci
followed by non-hemolytic Streptococci.Preoperative CT revealed poorly defined fat tissue and
exudation in all cases; air was found in 25 cases. 31 patients were treated with hyperbaric oxygen. 19 patients developed serious complications (pleural exudation, pneumonia, ARDS, renal or
cardiac failure, diabetes, delirium).34 patients presented sequelae (scar tissue-21,nerve lesions-13)
Diskussion: Early diagnosis, aggressive urgent surgery, broad spectrum antibiotics help to survive
for patients from a rapid progressing and life-threatening condition such as necrotizing fasciitis in
head and neck. Immunoglobulin potention to burst the immune response and hyperbaric oxygen
therapy ,that increase polymorphonuclear cell function, fibroblast proliferation and collagen production and bactericidal potention on anaerobes should be useful in treatment package.
//
61
Frie foredrag
Audiologi
62
//
Casestudie: Cochlear implant til patienter med
asymmetrisk hørelse og resthørelse på det
opererede øre.
Schmidt JH (1,2,3), Petersen RS (1), Wetke R (1,3)
1 Audiologisk afd. Odense Universitetshospital, DK-5000 Odense C, Danmark
2 Øre-Næse-Halskirurgisk afd. F, Odense Universitetshospital, DK-5000 Odense C, Danmark
3Klinisk Institut, Syddansk Universitet, DK-5230 Odense M, Danmark
Introduktion: Cochlear implant har hidtil oftest været brugt til patienter med de sværeste
høretab, hvor høreapparatbehandling kun har begrænset effekt. I de senere år har der været
tiltagende fokus på at behandle med cochlear implant selv til patienter med betydelig resthørelse på det pererede øre men også til patienter, hvor der er asymmetrisk hørelse, og hvor
hørenedsættelsen på de bedst hørende øre kun er moderat påvirket.
Materiale/metode: Patienter med betydelig resthørelse og/eller asymmetrisk hørelse, der har
fået cochlear implant, er udvalgt som cases til denne multicase gennemgang. Det høremæssige
udbytte og sprogforståelsen vurderes i forhold til patientens præoperative situation.
Resultater: Cochlear implants forbedrer sprogforståelsen, selv om der var betydelig resthørelse
før cochlear implant. Resthørelse på det ikke opererede øre giver nogle udfordringer i forhold til
den træning, som patienterne skal have i forbindelse med, at de har fået cochlear implant.
Diskussion: Cochlear implant skal overvejes selvom der er resthørelse, hvis specielt skelneevnen
er nedsat. Desuden kan der være en høremæssig forbedring efter cochlear implant for patienter,
der har betydelig asymmetrisk hørelse, og også selvom hørelsen kun er moderat nedsat på det
bedst hørende øre. Mere forskning i disse specielle høresituationer er dog indiceret, hvis cochlear implant behandling til patienter med ensidige høretab for alvor kommer på tale.
//
63
En klinisk auditiv profil hos Høreapparatskandidater
N Thorup (1), S Santurette(2), S Jørgensen (3), E Kjærsbøll (4) and M Friis (5)
1. Rigshospitalet, Øre-nære-halskirurgisk og Audiologisk Klinik
2. Danmarks Tekniske Universitet, Institut for Elektroteknologi
3. Danmarks Tekniske Universitet, Institut for Elektroteknologi
4. Rigshospitalet, Øre-nære-halskirurgisk og Audiologisk Klinik
5. Københavns Universitet, Sundhedsvidenskabelige Fakultet
Introduktion: Formålet med studiet var at opstille og undersøge en klinisk relevant auditiv profil
for høreapparats-kandidater. Den auditive profil blev sammenholdt med audiogrammet, og det
oplevede udbytte af høreapparatsbehandlingen. Hypotesen var, at den auditive profil kunne
supplere audiogrammet, og at den auditive profil kunne skelne, mellem personer som fik stort
udbytte, og personer som kun fik begrænset udbytte af deres høreapparater.
Materiale/metode: 29 personer med aldersbetinget høretab (gennemsnitsalder alder 68,4 år) og
26 normalt hørende personer (gennemsnitsalder 55,8 år) deltog i studiet. Testbatteriet bestod af
fem forskellige høretest, en kognitiv test og et spørgeskema som omhandlede høreevne og handicap. Seks uger efter høreapparatstilpasningen modtog personerne med høretab et spørgeskema
(the International Outcome Iventory – Hearing Aid) med henblik på evaluering af høreapparaterne.
Resultater: Høretærsklen fra audiogrammet blev sammenholdt med alle tests ved at beregne
korrelationskoefficienter og opstille punktdiagrammer. Desuden blev korrelationskoefficienten
beregnet mellem testresultaterne og udfaldet af evalueringsskemaet (the International Outcome
Iventory – Hearing Aid).
Diskussion: Med udgangspunkt i de enkelte personers audiogram var gruppen af personer med
høretab homogen. Trods dette blev der fundet stor inter-individuel variation i de andre høretest,
som undersøgte andre høreegenskaber. Den information om høretabet, som kunne udledes af
den auditive profil, kunne supplere den information, som var opnået ved audiometri.
64
//
The natural history of hearing loss in Pendred
Syndrome and Non-syndromic Enlarged Vestibular
Aqueduct.
Mey K, Bille M, Cayé-Thomasen P,
East Danish Center for Cochlear Implantations, Department of Otorhinolaryngology, Head&Neck Surgery,
Rigshospitalet/Gentofte
Introduktion: The aim was to asses the natural progress of hearing loss over time in a cohort of
Pendred Syndrome (PS) and Non-Syndromic Enlarged Vestibular Aqueduct (NSEVA) with one or
two confirmed SLC26A4 mutations.
Study design: Retrospective cohort study
Materiale/metode: A retrospective search of all patients carrying one or two SLC26A4 mutations
yielded 70 patients with records of hearing from 0-63 years. All patients had CT/MRI confirmed
Inner ear abnormalities concurrent with PS/NSEVA and a congenital or pre-lingual sensory neural
hearing loss, and was admitted to the Audiological departments at Gentofte or Bispebjerg Hospital. First recorded PTA (Pure Tone Average of 500, 1000, 2000 and 4000Hz) and last recorded PTA,
and the age at the time respectively, were noted for left and right ears.
Resultater: Patients with PS/NSEVA and confirmed SLC26A4 mutations show an average decrease
in hearing of approximately 10dB per year from age 0-10 years and stabilizing at an average of 1
dB per year from 10-63 years of age.
Diskussion: Patients with PS/NSEVA tend to have on average a 10-fold decrease per year in childhood compared to adolescence and adulthood, emphasizing the need for a close clinical follow-up
of these children in order to plan interventions such as cochlear implantation without delay.
//
65
Sporadisk endolymfatisk sæk tumor - en meget
sjælden årsag til høretab, tinnitus og svimmelhed
DT Schnack (1), K Kiss (2), S Hansen (3), H Miyazaki (3+4), B Bech (1), P Caye-Thomasen (3)
1.Audiologisk afsnit, Nordsjællands Hospital, 2. Patologiafdelingen, Rigshospitalet, 3. Øre-næsehalskirurgisk og audiologisk klinik, Rigshospitalet, 4. Jikei University, Tokyo
Introduktion: Sporadisk endolymfatisk sæk tumor er en sjælden tumor. Den er lokal aggressiv og
destruktivt voksende men ikke-metastaserende og lavmalign. Findes sjældent i sporadisk form
men mere hyppigt associeret med von Hippel-Lindau’s sygdom.
Materiale/metode: Kasuistik med beskrivelse af patientforløb.
Resultater: 65-årig mand henvist til audiologisk afsnit pga. venstresidig tinnitus og høretab. Audiometri med asymmetrisk sensorineuralt høretab på venstre side op til 60 dB. Høretærsklen på
venstre side 30 dB i basområdet faldende til 90 dB i diskanten. Skelneevnen 45% på venstre side
og 100% på højre og stapediusreflekser ophævede på venstre side. For 10 år siden indlagt med
”virus på balancenerven”. MR cerebrum viste patologisk udfyldning i mellemøre og cerebellopontine vinkel. Supplerende scanninger udelukkede glomus jugulare tumor og von Hippel-Lindau’s
sygdom. Vestibulærundersøgelse viste udslukt funktion venstre side. I GA blev tumor fjernet
translabyrintært. Peroperativ frysemikroskopisvar viste inflammation men endelig histologi var
endolymfatisk sæk tumor.
Diskussion: Endolymfatisk sæk tumor kan præsentere sig med asymmetrisk sensorineuralt høretab
±tinnitus, svimmelhed og påvirkning af nervus facialis. Ved sådanne symptomer bør patienten
MR scannes for at udelukke tumor i den cerebello-pontine vinkel. Diagnose stilles ved histologi,
inkluderende immunhistokemiske undersøgelser. Aktuelle tilfælde viser at svimmelhed kan være
første tegn på en tumor i dette område.
66
//
Bone-anchored hearing aid: Complications and
patient satisfaction, a retrospective study
IS Gardell, K Andresen, CE Faber, JH Wanscher
ØNH-kirurgisk afdeling, Odense Universitetshospital
Introduktion: To evaluate patient satisfaction and complication rate with Bone-anchored hearing
aids (BAHA).
Materiale/metode: This study was retrospective and executed as a postal questionnaire. The study
sample consisted of patients operated at Odense University Hospital 1992-2013. The questionnaire
was a combination of SADL (Satisfaction with Amplification in Daily Life) questions from the HARL
(Hearing Aid Research Lab) at the University of Memphis, and questions used in a previous Danish
study. We also used data from the medical records of each patient.
Resultater: The response rate was 80%. There was a user percentage of 88%. The majority of the
patients used their BAHA seven days a week and most of the day. 88% reported it was in their
best interest they had received a BAHA. 80% of the respondents could communicate better using
their BAHA in one-on-one conversation.
The most frequent complication was infection (31 %) requiring a consultation at Odense Universityhospital. Only two had their implant removed due to infection.
Diskussion: BAHA is helpful in one-on-one conversations in quiet surroundings; however, sound
quality in group situations seems to be a main problem of BAHA. However, this study showed that
BAHA is an effective hearing aid with a high rate of satisfaction. The frequency of complications
where quit high however mostly mild complications occured.
//
67
Poster
oversigt
68
//
1
A Petersen
Effekt af behandling i TRV stol ved Benign Paroxysmal Positions
Vertigo – preliminære resultater
2
S Andreasen
Recurrent Pleomorphic Adenoma of the Parotid with Metastasis to the
Kidney and Liver with on-site malignant transformation to Salivary
Duct Carcinoma. A Case Report.
3
JM Hansen
Effekt af vestibulær rehabilitering hos patienter med svimmelhed - en
systematisk oversigt
4
CS Danstrup
Managing traumatic subperiosteal haemorrhage in the orbita using
functional endoscopic sinus surgery
5
JS Mathiesen
Spindle cell tumor with thymus-like differentiation i gl. thyroidea hos
et 4-årig barn
6
M Høgsbro
Hearing preservation in cochlear implantation using standard electrodes and a soft surgery, round window approach
7
MS Mowinckel
Invert papillom i mellemøret - en sjælden tilstand
8
P Jensen
To yngre Øre-næse-halskirurger i Zimbabwe; klinisk ophold og opstart
af nødtrakeotomi projekt
9
ER Rasmussen
Ramsay Hunt syndrome revisited–emphasis on Ramsay Hunt syndrome with multiple cranial nerve involvement
10
M Pedersen
Optical Coherence Tomography for studies of the larynx mucosa in
the arytenoids regions.
11
K Aabenhus
Hvor mange postoperative kontroller efter tympanoplastik er der
egentlig behov for? - Et prospektivt databasestudie med evaluering af
stabiliteten af postoperative høreresultater efter tympanoplastik
12
S Rokkjær
Noma (cancrum oris) in an adult Danish patient
//
69
Poster
abstracts
70
//
Effekt af behandling i TRV stol ved Benign
Paroxysmal Positions Vertigo – preliminære
resultater
A Petersen, D Hougaard
Øre-, Næse-, Halskirurgisk Afdeling, A alborg Universitetshospital
Introduktion: Manuel reposition af Benign Paroxysmal Positins Vertigo (BPPV) er beskrevet med en
generel succesrate på op til 80%. Brug af TRV stol til både diagnostik og behandling formodes at
give bedre behandling af patienter med BPPV samt mindre grad af recidiv. Patienter som henvises
til denne behandling har oftest behandlingsresistent BPPV og ofte involvering af flere buegange.
TRV stol diagnostik samt -behandling er påbegyndt i Aalborg medio august 2014. Vi beskriver i
dette studie succesrate og recidivrate for patenter behandlet i TRV stolen i perioden august 2014
til marts 2015.
Materiale/metode: Prospektivt follow up studie medio august 2014 – marts 2015. Inklusionskriterie: Patienter med behandlingsresistent unilateral BPPV. Eksklusionskriterier: Tidligere behandling i
TRV stol samt fund af bilateral BPPV.
Remission af BPPV defineres som negativ Dix Hallpike (DH) og Lateral Buegangs (LB) test i TRV
stol. Recidiv defineres som positiv DH eller LB test efter tidligere negativ test i TRV stolen.
Resultater: Data indsamles fortsat. Pr. 1. marts 2015 er der inkluderet 54 patienter. Der vil blive
præsenteret preliminære resultater, da der fortsat foregår inklusion af patienter. Populationens
karakteristika med bl.a. køn, alder, lokalisation af BPPV samt behandlingseffekt beskrives. Der vil
desuden fremgå hvilken type reponering, der er foretaget.
Diskussion: Patienter henvist med behandlingsresistent BPPV fra egen otolog formodes at kunne
diagnosticeres og behandles præcist i TRV stolen. Vi beskriver, inden for denne selekterede
patientgruppe, hvor mange patienter der opnår fuld remission af BPPV såvel subjektivt som objektivt. Der findes til dato ingen sammenlignelige studier om emnet.
//
71
Recurrent Pleomorphic Adenoma of the Parotid
with Metastasis to the Kidney and Liver with
on-site malignant transformation to Salivary Duct
Carcinoma. A Case Report.
S. Andreasen (1,2,3), P Homøe (1,3), K Kiss (4)
1 Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital
2 Department of Otorhinolaryngology Head and Neck Surgery, Rigshospitalet
3 University of Copenhagen
4 Department of Pathology, Rigshospitalet
Introduktion: Pleomorphic Adenoma (PA) is the most common tumor of the salivary glands, and
is known for its ability to transform to Carcinoma ex Pleomorphic Adenoma (Ca-ex-PA). A peculiar
variant of PA is the benign metastasizing PA (mPA), of which only few reports exist. We report the
case of an mPA which subsequently transformed to Ca-ex-PA.
Materiale/metode: The pathology reports and slides from the primary tumor, local recurrences
and liver and kidney biopsies from patient were reviewed. The patients’ file served as source for
follow-up information.
Resultater: The patient was diagnosed with a PA in the right parotid in 1986 aged 23 years, and 4
subsequent recurrences were surgically resected after 6, 7, 13 and 18 years, respectively. 26 years
after the initial surgery, tumors in the liver and kidney were identified. Histology showed benign
areas with epithelial, stromal and myxoid components, characteristic of PA, along with malignant
areas. The latter was consistent with Salivary Duct Carcinoma, which was confirmed by demonstration of Her2 and Androgen receptor overexpression. The patient died of disease at 51 years of
age.
Diskussion: To our knowledge, we present the first case ever published of malignant transformation of the rare mPA. This case illustrates yet another complication in the management of salivary
gland PA.
72
//
Effekt af vestibulær rehabilitering hos patienter
med svimmelhed - en systematisk oversigt
JM Hansen (1), M Friis (1,2)
1. Copenhagen Ear Research Center, Københavns Universitet
2. Øre-næse-halskirurgisk og Audiologisk Klinik, Rigshospitalet
Introduktion: Normal livsførelse forudsætter en fungerende balancefunktion. Denne er kompromitteret ved svimmelhed og risikoen for fald er dermed væsentligt øget. Svimmelhed er et
udbredt symptom og op mod hver tredje over 65 oplever svimmelhedstilfælde. Målet for dette
studie var at undersøge effekten af vestibulær rehabilitering, målrettet balance træning, hos
patienter med både perifer og central betinget svimmelhed.
Materiale/metode: En systematisk litteratursøgning blev foretaget i databaserne PubMed/
Medline, EMBASE og Cochrane Center Register for Controlled Trials (CENRAL). Der blev søgt efter
klinisk evidens ved hjælp af søgeordet “vestibular rehabilitation”. Artikler var begrænset til
kliniske randomiseret studier, metaanalyser og oversigtsartikler, udgivet på engelsk og offentliggjort i de seneste 25 år, 1990-2015. De to forfattere vurderede uafhængigt søgeresultaterne
og udvalgte de fremkomne relevante studier.
Resultater: Af 186 identificerede studier opfyldte 59 studier inklusionskriterierne og blev
inkluderet i undersøgelsen. Alle undersøgelser brugte en form for vestibulær rehabilitering og
involverede voksne med symptomatisk svimmelhed på baggrund af enten perifer eller central
patologi. Primære resultat var effekten på svimmelhed.
Data viste en statistisk signifikant effekt til fordel for vestibulær rehabilitering i forhold til kontrol
eller ingen intervention.
Diskussion: Undersøgelsen giver dokumentation, moderat-stærk evidens, for effekten af vestibulær rehabilitering hos voksne med svimmelhed. Resultaterne er baseret på randomiserede
klinisk kontrollerede forsøg og understøtter brugen af måltrettede træningsøvelser til behandling af svimmelhed og balanceproblemer.
//
73
Managing traumatic subperiosteal haemorrhage in
the orbita using functional endoscopic sinus surgery
CS Danstrup (1), K Clemmensen (2), CG Petersen (1)
Afdeling/praksis: 1: Øre-næse-halskirurgisk afdeling H, Århus Universitetshospital
2: Øjenafdelingen Århus Universitetshospital
Introduktion: Subperiosteal haemorrhage in the orbita can occur spontaneously or following
trauma. Ophthalmologists usually manage the condition by external surgery or conservatively.
Functional endoscopic sinus surgery is a well validated surgical technique used on a routine basis
by oto-rhino-laryngologist.
Resultater: This case report presents the management of a traumatic subperiosteal haemorrhage
in the orbita of a 15-year-old boy. Computed tomography- and magnetic resonance scans revealed
a superior-medial haemorrhage which was evacuated using functional endoscopic sinus surgery.
The boy recovered completely.
Diskussion: In a multidisciplinary setting, functional endoscopic sinus surgery should be considered
an option in the management of subperiosteal haemorrhage.
74
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Spindle cell tumor with thymus-like differentiation i
gl. thyroidea hos et 4-årig barn
JS Mathiesen (1), H Døssing (1), SR Larsen (2), K Kiss (3), C Godballe (1)
1) Øre-næse-halskirurgisk Afdeling F, Odense Universitetshospital, 2) Patologisk Afdeling, Odense
Universitetshospital, 3) Patologiafdelingen, Rigshospitalet
Introduktion: Spindle cell tumor with thymus-like differentiation (SETTLE) is a rare malignant
thyroid neoplasm, occurring predominantly in children or young adolescents. It is believed to be
derived from ectopic thymus or remnants of branchial pouches. Diagnosis of SETTLE is usually a
diagnostic dilemma because of limited experience but is important because of the tumors ability
to metastasize very late. We present the first case of SETTLE in Denmark.
Materiale/metode: Kasuistik
//
75
Hearing preservation in cochlear implantation
using standard electrodes and a soft surgery, round
window approach
M Høgsbro
Dept. of Otolaryngology, Head and Neck surgery, A arhus University Hospital.
Introduktion: The objective was to demonstrate the possibility of low frequency hearing preservation in cochlear implantation with careful surgery and a round window approach using standard
CI-electrodes.
Materiale/metode: Retrospective study at an academic cochlear implant centre in western
Denmark. Fourty-seven patients implanted in 2009 and 2010 with measurable residual hearing
preoperatively were enrolled in the study. 45 patients were tested at one-month follow-up. 26
patients were tested at long-term follow-up. Intervention was cochlear implantation with either
the Cochlear Nucleus 24 or the Advanced Bionics HiRes 90K cochlear electrode using a round
window approach. Pure tone audiometry was obtained preoperatively and approximately one
month postoperatively and at long-term follow-up. Preoperative and postoperative low-frequency
pure-tone average (PTA) and PTA shifts were calculated.
Resultater: One month follow-up PTA shifts were: <10dB: 25.5% (12/47); 10-30dB: 42.6% (20/47);
30dB+: 27.7% (13/47); missing: 2. Long-term follow-up PTA shifts (from pre-operative measurement) were: <10dB: 8.5% (4/47); 10-30dB: 19.1% (9/47); 30dB+: 27.7% (13/47); missing:21. No
significant changes were observed for the non-implanted ears. Only one patient had a monosyllable testing discrimination score >0 at long-term follow-up on the implanted ear.
Diskussion: We have shown that for cochlear implantation with standard electrodes and a round
window approach, residual low-frequency hearing can be well preserved for 25.5% at one month
post-implantation and for at least 8.5% at long-term follow-up. However in our cohort it was not
possible to estimate whether this residual hearing could be of any benefit for the patient.
76
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Invert papillom i mellemøret - en sjælden tilstand
MS Mowinckel (1), S Hansen (1), K Tveterås (2)
1)Øre-, næse- og halskirurgisk og Audiologisk klinik, Rigshospitalet, 2) Øre-, næse-, og halskirurgisk
Afdeling, A alborg Universitetshospital
Introduktion: Invert papillom (IP) i mellemøret er en meget sjælden tilstand. Det er en benign,
aggressivt voksende tumor med høj risiko for recidiv og malign transformation. Her præsenteres
det første publicerede tilfælde i Danmark.
Materiale/metode: Studiet presentæres som en kasuistik med fokus på tidligere publicerede
tilfælde, ætiologi, symptomer og behandling.
Resultater: Det er 27 tilfælde publiceret i litteraturen af IP i mellemøret. Det ser ud til at IP har en
højere malign transformationsrate og højere recidivrate en IP lokaliseret til næsehulen. Ætiologien
er ikke klarlagt, men der eksisterer flere dominerende hypoteser.
Behandlingen er kirurgi med radikal tympanomasteidektomi, evt. subtotal petrosektomi. Postoperativ strålebehandling anbefales ved malign transformation, hurtigt recidiv eller irradikalitet.
//
77
To yngre Øre-næse-halskirurger i Zimbabwe; klinisk
ophold og opstart af nødtrakeotomi projekt
P Jensen (1), M Avnstorp (2) , J Melchiors (3), N Matinhira (4), T Dzongodza (5), C Chidziva
(6), C Buchwald (7)
1-3,7 Øre-næse-halskirurgisk og Audiologisk Klinik, Rigshospitalet, 4-6 Department of Otolaryngology,
Head and Neck Surgery, Harare, Zimbabwe
Introduktion: I 2011 startede Rigshospitalets ØNH-kirurgiske Afdeling et samarbejde med
ØNH-kirurgisk Afdeling i Harare, Zimbabwe, bestående af udveksling, uddannelse, forskning og
etablering af en journal club. To yngre ØNH-læger fra Rigshospitalet tog i marts 2015 på et fire
ugers ophold i Harare. Formålet med denne tur var forskning, herunder opstart af et fælles projekt
i simulationsbaseret læring af nødtrakeotomi, opfølgning på igangværende projekter, initiering af
nye projekter samt klinisk arbejde.
Materiale/metode: Til nødtrakeotomi projektet ønskes indrulleret 20 Zimbabweanske læger. Disse
oplæres i rapid 4-step cricothyrotomy technique ved video- og simulationsbaseret træning på en
dummie. Lægens køn, alder, postgraduat erfaring i antal år, speciale, samlet oplæringstid og antal
træningsforsøg på dummie registreres og sidste forsøg videofilmes. Efter mindst 1 uge gøres test
på et kadaver i lighuset hvilket ligeledes videofilmes.
Herudover indhentedes data, billeddiagnostik og samtykke til igangværende- og initierede projekter.
Resultater: Under vort ophold er 14 læger indrulleret i nødtrakeotomi projektet. Fem af disse har
afsluttet med test på kadaver i lighuset.
Diskussion: Vort etablerede samarbejde baseret på udveksling, uddannelse og forskning er en succes. Nødtrakeotomi projektet er igangsat, der er fulgt op på aktuelle projekter, og turen har affødt
flere mulige projekter samt case reports.
78
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Ramsay Hunt syndrome revisited–emphasis on
Ramsay Hunt syndrome with multiple cranial nerve
involvement
ER R asmussen (1), Lykke E (2), Toft JG (3), Mey K (2)
1. Department of Otolaryngology-head and neck surgery, Koege.
2. Department of Otolaryngology-head and neck surgery, Rigshospitalet.
3. Private practice Ear, nose and throat diseases, Nykoebing Falster.
Introduktion: The Ramsay Hunt syndrome is characterized by herpetic lesions combined with
peripheral facial nerve palsy. The disease is caused by a reactivation of the varicella zoster virus
and can be deceiving since the herpetic lesions are not always present (zoster sine herpete) and
might mimic other severe neurological illnesses. This article reviews the various forms of Ramsay
Hunt syndrome and how they can give rise to diagnostic and therapeutic challenges.
Materiale/metode: Studies on the assessment and treatment of Ramsay Hunt syndrome were
found by conducting a thorough literature search in PubMed, Medline, The Cochrane Library database and Google Scholar using the search words «varicella»,«zoster», «ramsay hunt», «oticus»,
«cranial nerve», «facial nerve» and combinations thereof. The bibliographies of substantial articles
were subsequently assessed.
Resultater: About 12 % of all peripheral facial nerve palsies are caused by varicella zoster virus.
In more than 50 % pain is the initial symptom making the diagnosis difficult. Female gender, and
in general age above 50 years, renders patients more susceptible to Ramsay Hunt syndrome. The
main prognostic factor is the severity of the initial symptoms. The occurrence rate of associated
cranial polyneuropathy has been reported to be 1.8-3.2 % and cranial nerves VII, VIII, IX are the
ones most commonly affected. The full recovery rate is reported to be as low as 27.3% when
multiple cranial nerves are involved. Combination therapy comprising of antiviral drugs and corticosteroids is recommened and should be initiated within 72 hours. Vaccination against varicella
zoster virus is an interesting new development that might reduce the incidence of varicella zoster
virus associated disease altogether.
Diskussion: Ramsay Hunt syndrome is a difficult and severe diagnosis with a low full recovery rate.
Extensive randomized trials are urgently needed to verify the optimal treatment and the efficacy
of varicella zoster virus vaccine in both naïve and herpes zoster patients.
//
79
Optical Coherence Tomography for studies of the
larynx mucosa in the arytenoids regions.
M. Pedersen, ABA Agersted
Østergade 18, DK-1100 København
Abstract: Optical coherence tomography (OCT) is an imaging technology that provides cross-sectional images of subsurface tissue structure at approximately 10 µm resolution to a depth of 1,5
mm using backscattered light. OCT has shown promise in imaging normal vocal folds as well as
various laryngeal disorders. The use of OCT to image the larynx during diagnosis and treatment of
a vast array of laryngeal disorders continues to develop along with innovative surgical techniques.
An augmented form of OCT polarization-sensitive OCT (PS-OCT) is creating useful clinical applications for diagnostic and therapeutic laryngeal procedures.
80
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Hvor mange postoperative kontroller efter
tympanoplastik er der egentlig behov for?
- Et prospektivt databasestudie med evaluering af
stabiliteten af postoperative høreresultater efter
tympanoplastik
K A abenhus (1), MS Sørensen (2), SAW Andersen (2)
1) Øre-, Næse- & Halsafdelingen, Nordsjællands Hospital, Hillerød.
2) Øre-næse-halskirurgisk og Audiologisk Klinik, Rigshospitalet.
Introduktion: Traditionelt rapporteres primært 1-årsresultater efter mellemørekirurgi, efter anbefaling fra AAO-HNS. Formålet dette studie var at evaluere stabiliteten af tympanoplastik i løbet af det
første postoperative år, ved at undersøge den postoperative ændring i hørelse fra opfølgning ved
2-6 måneder til opfølgning efter mindst 12 måneder.
Metode: 1367 type I-V tympanoplastikker var registreret i Otokir Databasen. Der blev foretaget
analyse af ændring i rentonetærskelgennemsnittet (Pure-Tone Average, PTA) for luftledning (Air
Conduction, AC) og Air Bone Gap (ABG) samt ændring i Speech Recognition Threshold (SRT) mellem de to nævnte postoperative kontroller.
Resultater: 553 cases havde været til begge postoperative kontroller og kunne indgå i studiet. Den
gennemsnitlige ændring mellem kontrollerne var 0,7 dB; 0,5 dB og 0,3 dB for hhv PTA for AC; PTA
for ABG og SRT. Størstedelen af alle cases (87,7 %) havde en ændring i PTA for AC på 10 dB eller
mindre, og kun 7,6 % af type I tympanoplastikkerne havde en forværring i PTA for AC på over 10
dB. 59,5 % af alle cases havde inkomplet opfølgning.
Diskussion: Studiet viser at høreresultaterne er stabile i det første år efter en tympanoplastik da
der kun findes minimal og klinisk insignifikant ændring i hørelsen fra kontrol ved 2-6 måneder til
kontrol efter mindst 12 måneder. Tidlige korttidsresultater er derfor sammenlignelige med 1-årsresultater og kan bruges til rapportering af resultater efter tympanoplastik.
//
81
Noma (cancrum oris) in an adult Danish patient
MS Rokkjaer, TE Klug
Department of Otorhinolaryngology, Head and Neck Surgery, A arhus University Hospital,
Noerrebrogade 44, 8000 A arhus
Introduktion: We present a 37-year-old male admitted due to severe necrotizing gingivitis progressing to fulminant noma within few days.
Materiale/metode: Case report
Resultater: Physical examination revealed necrotic tissue in most of the oral cavity including the
floor of the mouth and the tongue. The infection rapidly progressed with exposure of bone, exfoliation of teeth and full-thickness skin destructions. Blood tests revealed electrolyte derangement,
signs of acute pancreatitis and sepsis.
The patient was treated with intravenous antibiotics and daily surgical debridement. Initially half
of the tongue, most of the intraoral mucosa and the inferior lip were removed. Two days later
parts of the mandible and maxilla became necrotic and were cut out.
Subsequently, the infection subsided, but the patient suffered from severe sequelae including
facial disfigurement and functional impairment. Seven months after the onset of symptoms, the
patient underwent reconstructive surgery. The long-term results of this procedure are currently
unknown.
Diskussion: Noma is a devastating orofacial gangrenous infection, which is predominantly seen in
malnourished children in developing countries. The pathogenesis is multifactorial and thought to
result from a complex interaction between opportunistic, bacterial pathogens, poor oral hygiene,
and malnutrition in patients debilitated by severe illness or immunosuppression. The disease is
associated with high morbidity and mortality.Only few cases of noma have been described in the
Western world and to our knowledge noma has not previously been reported in a Scandinavian
patient. The case report illustrates that noma should be considered as a differential diagnosis in
debilitated, malnourished patients presenting with severe orofacial infections, even in Scandinavia.
82
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Noter
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83
Noter
84
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Indhold

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