Indhold - DSOHHdsohh.dk/wp-content/uploads/2015/05/DSOHH2015.pdfCompleteness and validity in a national clinical thyroid cancer database: DATHYRCA 09.20-09.40 21 TT Kristensen Cellular

XII Årsmøde Dansk Selskab for Otolaryngologi, Hoved & Halskirurgi // 3

Indhold

Velkommen til DSOHH 2015 4

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

4 // XII Årsmøde Dansk Selskab for Otolaryngologi, Hoved & Halskirurgi

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 omgiv-elser 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 speciallæ-geuddannelsen i oto-rhino-laryngologi. Arbejdsgruppen vil meget gerne præsenterer den nye kit-tellommebog, 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 feed-back 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 præsen-teres. Vi håber på at phd-sessionen bliver den første i en lang række af DSOHH – phd-sessioner.

Med ønsker om et godt møde fra DSOHH bestyrelse

AnetteDrøhseKjeldsen MadsKlokker AndersSchermacher ThomasHjuler ClausGregersPetersen


DSOHH 2015 program oversigt

21.MAJ(TOR) 22.MAJ(FRE)

09.00 RegistreringAfhandlinger Thyroidea

10.00Velkomst

RhinologiKAFFE

11.00

Laryngologiogkræft

OtologiKAFFE

12.00 Kliniskeretningslinjer

13.00 FROKOST FROKOST

14.00 Professorrunde VejlederseminarSøvnapnø

oginfektionerAudiologi

15.00KAFFE

Professorrunde VejlederseminarAfslutningogprisoverrækkelse

16.00

17.00 DSOHHGeneralforsamling

18.00

19.00 Gallamiddagogdans


Program torsdag 21. maj

09.00-10.00 Registrering

AUDITORIUMRhinologi-Moderator:ChristianvonBuchwald

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 AlaninThe association between sinus and lung infections in patients with primary ciliary dyskinesia

11.30-12.00 KAFFE

AUDITORIUMKliniskeretningslinjer–Moderator:AnetteKjeldsen

12.00-12.10 A. Kjeldsen DSOHH og kliniske retningslinjer

12.10-12.20C. Heide-mann

Hvordan laves en NKR

12.20-12.35 18C. Heide-mann

Mellemørebetændelse og tubulation

12.35-12.50 19 P. Darling Høfeber og allergi

12.50-13.00 28 U. PedersenOrientering om den Europæiske øre-næse-halseksamen (EBEORL)

13.00-14.00 FROKOST


19.00-01.00 Gallamiddagogdans

AUDITORIUMProfessorrunde-Moderator:MadsKlokker

SALKVejlderseminar-Moderator:JacobMelchiors

14.00-14.20 T OvesenEn lærestolsprofessors glæder og byrder

14.00-15.00 C AhrensbachVejledning og feedback i den lægelige videreud-

dannelse

14.20-14.40 MS SørensenRH-professorat i otologi og otopatologi

14.40-15.00 A KjeldsenRhinologi og vaskulære mal-formationer

15.00-15.30 KAFFE

AUDITORIUMProfessorrunde-Moderator:MadsKlokker

SALKVejlederseminar-Moderator:JacobMelchiors

15.30-15.50 C BuchwaldHvad vil, skal, kan og gør en øre-, næse-halsprofessor på Rigshospitalet?

15.30-16.00J MelchiorsKB Petersen

Den nye målbeskrivelse. Gennemgang af kittellom-mebog og ny værktøjer til

kompetencevurderin

15.50-16.10 C GodballeORL-Forskningsenheden, OUH: Hvor er vi og hvor skal vi hen?

16.00-16.20 JJM Henriksen360 graders evaluering –

erfaringer fra Århus

16.10-16.30 P HomøeRosinen i pølseenden - om det nye professorat ved ØNH i Køge

16.20-17.00J MelchiorsKB Petersen

Implementering af kittel-lommebog- udfordringer

og praktiske løsninger

16.30-16.50 Panel diskussion

AUDITORIUM

17.00-18.30 DSOHHGeneralforsamling

Program torsdag 21. maj - fortsat


Program fredag 22. maj

AUDITORIUMAfhandlinger2014-Moderator:ChristianGodballe

SALKThyroidea-Moderator:VivequeEgsgaardNielsen

09.00-09.20 20 MS GaihedeInvestigations on tympanomet-ric determination of middle ear pressure

09.00-09.15 32 S. LonderoCompleteness 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 RubeckDiagnostik og Risiko-stratificer-ing af Knuder i Thyroidea

09.40-10.00 22 S LonderoPapillært Thyreoidea Carcinom: Klinisk Betydning og Meta-statisk Potentiale

09.30-09.45 34 PF Jensen

Complications after total thy-roidectomy in the management of benign thyroid disease at a single center in Denmark

10.00-10.20 23 B LangeChronic rhinosinusitis in the Danish population; A Ph.D. study

09.45-10.00 35 G Obel

Øges cure rate ved parathy-roidektomi under anvendelse af peroperativ parathyroideahor-mon måling?

10.20-10.30 30 S. GadeGlobal Online Fellowship in Head And Neck Cancer

10.00-10.15 36ER Rasmus-sen

Sialendoscopy has significantly decreased the number of excised salivary glands in Denmark

10.15-10.30 37ER Rasmus-sen

Real-life experiences with prophylactic C1-inhibitor con-centrate (Cinryze®) in HAE – a case series.

10.30-11.00 KAFFE

AUDITORIUMLaryngologiogkræft-Moderator:JesperTvedskov

SALKOtologi-Moderator:LarsVendelboJohansen

11.00-11.15 39 GN.BossenGenetic etiology of sulcus voca-lis: case reports of 6 families

11.00-11.15 47 MN MøllerIntracranial pressure regulation revisited The Petro-Sigmoid Reticulum

11.15-11.30 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 MehlumDANGLOT og DAHANCA 27 - National database for patienter med LIN og T1a-glottiscancer

11.30-11.45 49 B DjurhuusSchool performance in cho-lesteatoma-operated Danish children: A nationwide study

11.45-12.00 41 M Svahn

Risk of human papilloma asso-ciated head and neck cancer following a diagnosis of cervi-cal 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

12.00.12.15 42 A Christensen

New uPAR-targeted near-in-frared fluorescent tracer for image-guided real-time detection of squamous cell carcinoma and cervical lymph node metastases in oral cancer

12.00.12.15 51 M KaltoftLifetime recurrence rate after operation for acquired middle ear cholesteatoma


Program fredag 22. maj - fortsat

AUDITORIUMLaryngologiogkræft-Moderator:JesperTvedskov

SALKOtologiModerator:LarsVendelboJohansen

12.15-12.30 43 S Al-Hayder

Clinical outcome and survival following micro-vascular reconstruction in patients with oral and oropharyngeal cancer

12.15-12.30 52 SAW Andersen

Stabilitet af stapedotomi og behovet for efterfølgende rutine-kontrol: Er 1-års kontrollen obsolet? Et prospektivt database studie.

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 AndersenLæringskurver i virtuel mas-toidektomi: Hvor meget og hvordan skal man træne?

12.45-13.00 45 CS Danstrup

Rekonstruktion af øvre oesophagus/hypophar-ynx med frit tyndtarmsin-terponat – en update

12.45-13.00 54 E ArndalBehandling af otomykose i ØNH speciallægepraksis i Danmark; en spørgeskemaundersøgelse.

13.00-14.00 FROKOST

AUDITORIUMSøvnapnøoginfektioner-Moderator:JesperBille

SALKAudiologi-Moderator:JesperSchmidt

14.00-14.15 56 C PrætoriusDen 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 ThorupEn klinisk auditiv profil hos Høreap-paratskandidater

14.30-14.45 58 T Klug

Antibody development to Fusobacterium necro-phorum 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 JuulTonsillectomies in Denmark in the period of 1991-2012

14.45-15.00 65 DT SchanckSporadisk endolymfatisk sæk tumor - en meget sjælden årsag til høretab, tinnitus og svimmelhed

15.00-15.15 60 JF ThraneNecrotizing fasciitis in the head and neck: Still a challenge

15.00-15.15 66 JH WanscherBone-anchored hearing aid: Com-plications and patient satisfaction, a retrospective study

15.30-16.00 AFSLUTNINGOGPRISOVERRÆKKELSE


Praktisk information

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-HotspotInternet: nyborgstrandPassword: nyborgstrand

Hotel værelser

Værelserne er til disposition fra klokken 14.00 på ankomstdagen. Nøgleudlevering foregår i recep-tionen. Hotel Nyborg Strand er ansvarlig for værelsesfordelingen.

Organisationskomite

Formand Anette KjeldsenNæstformand Mads KlokkerKasserer Anders Schermacher LarsenRedaktør Claus Gregers PetersenSekretær Thomas Hjuler


Praktisk information

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 foredra-get. 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

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 mod-tager 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 erfar-ingsniveau.

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 pris-erne uddeles. Det er en forudsætning at vinderne er personligt tilstede ved pris overrækkelsen, alternativt går prisen videre til næste kandidat.


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

DANSTorsdag 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.


GULD udstillere

SØLV udstillere



UDSTILLER STANDNR

A-data 14

AbenaA/S 19

AbigoPharmaA/S 16

Alcon 9

AlereA/S 7

Bernafon FOYER

BKMedical 10

DanaflexA/S 17

EGClinea FOYER

GSK 6

Interacoustics FOYER

Johnson&Johnson 11

KarlStorzEndoskopiA/S 15

KEBOMED 12

MariboMedico 25

MaxManus 13

MediqDanmark 2

MED-EL,MöllerströmMedicalAB 26

MediplastKendanA/S 5

NovaxA/S 3

OlympusDanmark 27

Oticon FOYER

OticonMedical FOYER

POMedicaAB 22

POAPharmaScandinavia 20

SantaxMedico 23

SiemensHøreapparater 24

SimonsenogWeel 21

Smith&NephewA/S 8

SomnomedicsGmbh 1

Zeiss 4

Udstillere på DSOHH 2015


Udstillerplan DSOHH 2015

Sal A

Sal B

Sal C

40 meterVinduer ogglasdøre påhele denneside

Lofthøjde 5 meterGrønne stoleSorte/grå borde

Tegningen er ikke målfast

1,30 meter

6 meter

5,90 meter

1,20 meter

2

23

20

22

19

21

1

27

24

26

25

34

6

1613 1514

11

10

8

7

12

17

KAFFE

KAFFE

9

5

18

16 // XXXII Congress of the Nordic Association of Otolaryngology


Inviterede foredrag


Inviterede foredrag

Common cold. Integrative approaches for treatment and prevention ( at different healthcare levels)

Lars Eric Pontus stiErna, ProfEssor, mD PHDkaoLinska institutEt, stokHoLm.


Inviterede foredrag

Ph.d. afhandlingAn 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 Laboratory, gHEnt uniVErsity HosPitaL, bELgium anD karoLinska 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 lungefunktionsun-dersøgelse. Artikel 2) baserer sig på et klinisk studie af 40 CRSwNP patienter og 21 kontroller hen-vist til Rigshospitalet mhp FESS eller septumkirurgi; alle inkluderede blev udredt for lungesygdom på Bispebjerg Lungemedicinsk klinik efter internationale retningslinjer. Artikel 3) tager udgang-spunkt 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 luftvejssyg-dom ofte er sameksisterende med sygdom i de øvre luftveje.


Inviterede foredrag

National klinisk retningslinjeNye 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, aaLborg uniVErsitEt; cEntrE for rEsEarcH in EViDEncE-basED PracticE, bonD uniVErsity; forskningsEnHEDEn for aLmEn mEDicin, syDDansk uniVErsitEt; kLinisk mikrobioLogisk afDELing, sLagELsE sygEHus; mEDicinsk bibLiotEk, aaLborg uniVErsitEtsHosPitaL; sunDHEDsstyrELsEn; ØrELægErnE fiskEtorVEt, oDEnsE; ØrELægErnE sunDHEDsHusEt, aarHus; ØrE-næsE-HaLsafDELingEn, VEjLE sygEHus; ØrE-næsE-HaLskirurgisk afDELing, kØgE sygEHus; ØrE-næsE-HaLskirurgisk 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 litter-atur 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 retning-slinje vedrørende diagnostiske kriterier for akut mellemørebetændelse og kirurgisk behandling af rAOM og COME.

Materiale/metode: GRADE-systemet (The Grading of Recommendations Assessment, Develop-ment and Evaluation) blev anvendt i udarbejdelse og formulering af anbefalingerne i denne ret-ningslinje. Dette system giver en omfattende og gennemsigtig tilgang til udvikling af kliniske ret-ningslinier, 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 Diagnos-tic 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 behan-dling af rAOM og COME inklusiv adenoidektomi og behandling af øreflåd hos drænbehandlede børn.


Inviterede foredrag

National klinisk retningslinjeNational klinisk retningslinje for høfeber. 2 udvalgte spørgsmål

DarLing PoDEnsE 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 primærar-tiklerne(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.


Inviterede foredrag

Ph.d. afhandlingInvestigations on tympanometric determination of middle ear pressure

gaiHEDE mL


Inviterede foredrag

Ph.d. afhandlingCellular 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 mitochon-drial 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 mem-brane 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-re-lated gene expression was down-regulated compared to preoperative levels.


Inviterede foredrag

Ph.d. afhandlingPapillært 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 radio-jodbehandling 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 overbe-handling. 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 favora-ble 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 risikostratificer-ing.• En genprofil til påvisning af metastatisk potentiale blev udviklet men kunne ikke valideres. Yder-ligere 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 overens-stemmelse med gældende retningslinjer. Den fundne genprofil kunne ikke bidrage yderligere til risikostratificering og således er de kendte prognostiske scoringssystemer fortsat det bedste tilgængelige redskab.


Inviterede foredrag

Ph.d afhandlingChronic 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 aarHus, aarHus, 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 prev-alence 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 rhinom-etry 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 recom-mendation by an ENT doctor.

XXXII Congress of the Nordic Association of Otolaryngology // 25


Vejlederseminar


Vejlederseminar

14.00-15.00 Vejledning og feedback i den lægeligevidereuddannelse

camiLLa aHrEnsbacH

ProjEktLEDEr, konfLiktHånDtEring, PatiEntsikkErHED og DEfusing

canD.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 kittellommebog- udfordringer og praktiske løsninger

jacob mELcHiors og kristian bruun PEtErsEn


Abstracts - Torsdag 21. Maj

Frie foredragTorsdag



The association between sinus and lung infections in patients with primary ciliary dyskinesia

mc aLanin (1), kg niELsEn (2), m skoV (2), k aanæs (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 infec-tions 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 dur-ing 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.



Orientering om den Europæiske Øre-næse-halseksamen (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. Beståelsespro-centen har gennem årene været omkring 80. Dem der består kan kalde sig: “Fellow of the Euro-pean 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



Frie foredragFredag


Abstracts - Fredag 22. Maj

Global Online Fellowship in Head And Neck Cancer

s gaDE

ØrE-næsE-HaLsafDELing H På aarHus 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/observer-ship 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 comple-tion of the examination.

Resultater: Jeg er optaget vil fortælle om ansøgnings processen samt mine første erfaringer.



Frie foredragThyroidea



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, aarHus 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, aarHus uniVErsity HosPitaL, DEnmark

8. DEPartmEnt of Ent HEaD & nEck surgEry, aaLborg uniVErsity HosPitaL, DEnmark

9. DEPartmEnt of surgEry, aarHus 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 ascer-tainment 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 inter- and 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.



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, aarHus uniVErsitEtsHosPitaL (auH)2. EnDokrinoLogisk afDELing, oDEnsE uniVErsitEtsHosPitaL

3. PatoLogisk afDELing, auH4. 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 hyppi-gere 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 præopera-tive 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.



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 manage-ment of hypocalcaemia were investigated.

Materiale/metode: A retrospective study of 114 consecutive patients undergoing total thyroidec-tomy 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 tempo-rary and permanent postoperative hypocalcaemia were 22,8% and 17,4% respectively. Auto-transplantation 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.



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 multidsci-plinært, 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 operatør-baseret 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 perop-erativ 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.



The introduction of sialendoscopy has significantly decreased the number of excised salivary glands in Denmark

Er rasmussEn, 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. Unfortu-nately 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. sali-vary stones or stenosis), sialendoscopy has been developed and implemented in several coun-tries 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 chal-lenge 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.



Real-life experiences with prophylactic C1-inhibitor concentrate (Cinryze®) in HAE – a case series.

Er rasmussEn, a bygum

ØrE-næsE-HaLs-afDELingEn kØgE

HuDafDELing i og aLLErgicEntErEt ouH

Introduktion: Hereditary angioedema (HAE) is a genetic disorder which usually becomes symp-tomatic 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-threat-ening 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®¬ introduc-tion, 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® (Fig-ure 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.



Frie foredragLaryngologiog kræft



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 vibra-tory 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.



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 rasmussEn (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, aaLborg 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 regis-treret 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.



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 cancEr 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, Haz-ard 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 previ-ously diagnosed with CIN2/3.



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 aDEPartmEnt 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-Glu-Glu-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 imag-ing 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-back-ground ratio of 3.0 (range 2.2-4.0) in the tongue tumors was observed. Real-time fluores-cence-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 squa-mous cell carcinoma. Further study of this tumor-specific optical probe to aid radical surgical resection of carcinomas is warranted.



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



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 robot-kirurgiske 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 særde-leshed også i robottens anvendelse som diagnostisk redskab

Diskussion: De fremtidige muligheder for robottens anvendelse ved hoved- og halskræft i primær-behandling af dels oropharynxcancer og måske senere glottiske/supraglottiske cancere i de tidlige stadier er inden for rækkevidde. Strålebehandlingens rolle for disse sygdomme kan herved reduc-eres til fordel for et mere skånsomt behandlingstilbud



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, aarHus uniVErsitEtsHosPitaL, 2: PLastikkirurgisk afDELing Z, aarHus 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, onkol-oger, 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.



Frie foredragOtologi



Intracranial pressure regulation revisited. The Petro-Sigmoid 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.



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 ven-tilation tube inserted before August 31, 2011 were identified. Of these, 374 subsequently under-went 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 cholesteato-ma-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.



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 carE, 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 corre-sponding 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. How-ever, 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 disadvan-taged.Cholesteatoma-operated children who did attain compulsory schooling had average marks similar to those of the background population. Multiple cholesteatoma surgeries in childhood were, how-ever, associated with lower marks in foreign languages.



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 myringo-sclerosis) 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.



Lifetime recurrence rate after operation for acquired middle ear cholesteatoma

m kaLtoft, 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 oper-ated 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 mid-dle 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 recur-rence 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.



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 sta-pes-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 rutine-mæssigt planlægges. I stedet anbefales at patienterne kan genhenvende sig ved forværring af hørelsen inden for det første år.



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 mulig-gør 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 læringskur-verne 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 kursus-dage 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.



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 immunkompro-mitterede patienter mere intensivt.

Diskussion: Undersøgelsen demonstrerer en manglende konsensus i behandlingen af oto-mykose. Der er således behov for en fælles retningslinje. I denne bør følgende belyses: Diag-nostiske 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.



Frie foredragSøvnapnø &tonsiller



Den kirurgiske tilgang til obstruktiv søvnapnø

c Prætorius

ØrE-næsE-HaLskLinikkEn i HØrsHoLm

Introduktion: Traditionelt behandles obstruktiv søvnapnø med CPAP. Nogle patienter kan dog kur-eres 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.



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 spe-cialeplanen 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 kiru-rgi. 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 defini-tioner. 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.



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 conva-lescent 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 path-ogen in PTA. This finding has implications for the diagnostic work-up of PTA and may also have implications for the treatment of acute tonsillitis.



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-sig-nificantly 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 per-formed significantly more tonsillectomies than any other of the Regions. We do lack an explana-tion 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.



Necrotizing fasciitis in the head and neck: still a challenge

jf tHranE a PikELis, t oVEsEn

DEPartmEnt of otorHinoLaryngoLogy,HEaD anD nEck surgEry, aarHus uniVErsity HosPitaL, aarHus

Introduktion: Necrotizing fasciitis (NF) in the head and neck is still a challenging condition – devas-tating 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 complica-tions.

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 aggres-sive surgical debridement and treated according to our current guidelines: intravenous immuno-globulin 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 phar-ynx 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 oxy-gen. 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 pro-duction and bactericidal potention on anaerobes should be useful in treatment package.



Frie foredragAudiologi



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 res-thørelse 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 coch-lear implant behandling til patienter med ensidige høretab for alvor kommer på tale.



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 hand-icap. 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.



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 Hospi-tal. 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 child-hood 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.



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-næsE-HaLskirurgisk 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. Audi-ometri 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 cerebellopon-tine 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.



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 Universi-tyhospital. 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.



Posteroversigt



1 APetersen Effekt af behandling i TRV stol ved Benign Paroxysmal Positions Vertigo – preliminære resultater

2 SAndreasenRecurrent 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 JMHansen Effekt af vestibulær rehabilitering hos patienter med svimmelhed - en systematisk oversigt

4 CSDanstrup Managing traumatic subperiosteal haemorrhage in the orbita using functional endoscopic sinus surgery

5 JSMathiesenSpindle cell tumor with thymus-like differentiation i gl. thyroidea hos et 4-årig barn

6 MHøgsbroHearing preservation in cochlear implantation using standard elec-trodes and a soft surgery, round window approach

7 MSMowinckel Invert papillom i mellemøret - en sjælden tilstand

8 PJensen To yngre Øre-næse-halskirurger i Zimbabwe; klinisk ophold og opstart af nødtrakeotomi projekt

9 ERRasmussenRamsay Hunt syndrome revisited–emphasis on Ramsay Hunt syn-drome with multiple cranial nerve involvement

10 MPedersen Optical Coherence Tomography for studies of the larynx mucosa in the arytenoids regions.

11 KAabenhusHvor mange postoperative kontroller efter tympanoplastik er der egentlig behov for? - Et prospektivt databasestudie med evaluering af stabiliteten af postoperative høreresultater efter tympanoplastik

12 SRokkjær Noma (cancrum oris) in an adult Danish patient



Posterabstracts



Effekt af behandling i TRV stol ved Benign Paroxysmal Positions Vertigo – preliminære resultater

a PEtErsEn, D HougaarD

ØrE-, næsE-, HaLskirurgisk afDELing, aaLborg 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. Inklusionskrite-rie: 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 objek-tivt. Der findes til dato ingen sammenlignelige studier om emnet.



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 demon-stration 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 transforma-tion of the rare mPA. This case illustrates yet another complication in the management of salivary gland PA.



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 kom-promitteret 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 offent-liggjort 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 vesti-bulær rehabilitering hos voksne med svimmelhed. Resultaterne er baseret på randomiserede klinisk kontrollerede forsøg og understøtter brugen af måltrettede træningsøvelser til behan-dling af svimmelhed og balanceproblemer.



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.



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



Hearing preservation in cochlear implantation using standard electrodes and a soft surgery, round window approach

m HØgsbro

DEPt. of otoLaryngoLogy, HEaD anD nEck surgEry, aarHus uniVErsity HosPitaL.

Introduktion: The objective was to demonstrate the possibility of low frequency hearing preserva-tion 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 measure-ment) 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 monosylla-ble 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.



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, aaLborg 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. Postop-erativ strålebehandling anbefales ved malign transformation, hurtigt recidiv eller irradikalitet.



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 projek-ter.

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 suc-ces. Nødtrakeotomi projektet er igangsat, der er fulgt op på aktuelle projekter, og turen har affødt flere mulige projekter samt case reports.



Ramsay Hunt syndrome revisited–emphasis on Ramsay Hunt syndrome with multiple cranial nerve involvement

Er rasmussEn (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 data-base 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 cor-ticosteroids 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.



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-sec-tional 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 applica-tions for diagnostic and therapeutic laryngeal procedures.



Hvor mange postoperative kontroller efter tympanoplastik er der egentlig behov for?- Et prospektivt databasestudie med evaluering af stabiliteten af postoperative høreresultater efter tympanoplastik

k aabEnHus (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 anbefal-ing 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) mel-lem 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-årsre-sultater og kan bruges til rapportering af resultater efter tympanoplastik.



Noma (cancrum oris) in an adult Danish patient

ms rokkjaEr, tE kLug

DEPartmEnt of otorHinoLaryngoLogy, HEaD anD nEck surgEry, aarHus uniVErsity HosPitaL,noErrEbrogaDE 44, 8000 aarHus

Introduktion: We present a 37-year-old male admitted due to severe necrotizing gingivitis pro-gressing 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, exfo-liation 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 Scandina-via.


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