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Introduction: Recent studies implicate the presence of Fusobacterium necrophorum (FN) in recurrent tonsillitis (RT), acute tonsillitis and peritonsillar abscess. The objective of the present study was to determine whether FN plays a role in RT by comparing bacteriologic results from patients suffering from RT, tonsillar hypertrophy and halitosis or persistent sore throat syndrome (PSTS). We analyzed both tonsils to determine the degree of concordance., Material and Methods: A prospective study was conducted in 80 patients aged 8-30 years who were undergoing elective tonsillectomy. The patients were divided into four groups according to indication for surgery. Aerobic and anaerobic cultures from the tonsillar surface and core were analyzed., Results: FN was detected less frequently in the tonsillar cores of RT patients (22%) than in those of patients without RT (30%) (p=0.44). FN detection frequencies ranged between 20% and 35% across the four groups. Betahaemolytic streptococci groups A/C/G (BHS) were detected significantly (p=0.007) more often in the RT group than in the halitosis/PSTS group., Conclusion: A possible role of FN in RT was not substantiated. Our results indicate that FN is likely to be part of the normal flora. The tonsillar surface and core flora carry considerable interpersonal diversity, but is very similar bilaterally in each individual. Other factors seem to play a major role in the development of the represented tonsillar diseases., Funding: Not relevant., Trial Registration: The study was approved by The Research Ethics Committee of Aarhus County (no. 20050034).

In Danish healthcare there are increasing demands in the field of hospital care on performance and outcome measurement and quality improvement in relation to a number of diseases. Hitherto, corresponding measurements of quality have not been carried out among private specialized practitioners. The present project describes the development and selection of evidence-based national indicators, standards, and case mix factors in terms of prognostic factors with the purpose of measuring quality of out-patient tonsillectomy in Danish ear, nose & throat practices.

Introduction: Mild to moderate blunt laryngeal injuries are frequent. Under the present management regimens patients are hospitalized for 24h observation due to the potential risk of developing endolaryngeal oedema. This group of patients is poorly described in the literature, and the aim of this study was to estimate the incidence of acute and especially tardive endolaryngeal oedema as well as the association between type of injury, symptoms and findings to improve existing evaluation criteria and treatment regimens., Materials and Methods: A retrospective analysis of 130 cases exposed to mild to moderate laryngeal injury was performed. The mechanism of injury, symptoms, findings and treatment were registered., Results: Strangulation was the most common type of injury which was seen in 43% of cases, while stranglehold, fall and blow were observed in 29, 14 and 14%, respectively. Dysphagia was reported by 55%, while hoarseness was observed in 17% and stridor in 5%. Fibreoptically, 33% had endolaryngeal pathology. Twenty cases received treatment, 110 were observed. Immediate intubation was performed in 2.3% of the cases. In the observation-group, more patients were exposed to self-inflicted strangulation (p = 0.01). Fall and blow accidents were more frequent in the treatment than in the non-treatment group (p = 0.03). More patients in the treatment group had dyspnoea (p < 0.001), stridor (p = 0.001), hoarseness (p = 0.007) and endolaryngeal pathology (p < 0.001) than in the non-treatment group., Conclusions: In general, mild to moderate blunt external laryngeal injuries seem rather harmless and should need no further treatment. Nevertheless, any injury against the paediatric larynx and injuries related to fall-accidents or genuine hangings are associated with an increased risk of a respiratory threat. No patients in this study developed tardive laryngeal oedema.

Background: Group A streptococci are commonly regarded as the most prevalent cause of acute bacterial tonsillitis and peritonsillar abscess (PTA). However, the majority of PTA aspirates also contain strains of anaerobes, and accumulating evidence indicates that Fusobacterium necrophorum (FN) could be involved in acute tonsillitis. The purpose of the present study was to describe the epidemiology and bacteriology of PTA in Denmark, with particular emphasis on correlations between microbiological, clinical, and laboratory data., Methods: A retrospective study on all patients with PTA admitted to the ear, nose, and throat department at Aarhus University Hospitals from January 2001 through December 2006 was conducted., Results: In total, 847 patients were included in the study. The mean annual incidence of PTA was 41 cases/100,000 population. FN was the most frequently detected bacteria (in 23% of cultures), followed by group A streptococci (in 17%) and groups C and G streptococci (counted together, in 5%). Of the 191 FN isolates detected, 155 (81%) grew as pure culture. Patients infected with FN were significantly younger than patients infected with other strains of bacteria (P < .001). Patients with FN exhibited significantly higher neutrophil counts (P < .001) and C-reactive protein values (P = .01) than did patients infected with other bacteria., Conclusions: To our knowledge, this study is the first report of FN being the most prevalent pathogen in PTA patients. The significantly higher neutrophil counts and C-reactive protein values strongly indicate the pathogenic importance of FN in PTA. The widespread reliance on rapid streptococcal antigen test in general practice to appoint patients for antibiotics and the highest PTA incidence ever reported raise concern that highly virulent bacteria may be left initially untreated.

Introduction: The aim was to evaluate prognostic factors and outcome parameters related to otogenic pneumococcal meningitis (OPM)., Materials and Methods: Retrospective analysis of patients with OPM in Aarhus County from 1994 to 2003., Results: Seventy patients were included, corresponding to an annual incidence of 11.7/mill. The mean age was 36.6 years (range: four days - 80 years) and the mean duration from debut of acute otitis media (AOM) to admission was three days. Twenty three percent had received antibiotics prior to admission. The most common symptoms were fever and affected consciousness. The mortality was 11%, and 40% of the surviving population developed permanent sequelae, of which 88% suffered loss of hearing. Sixty one percent was not evaluated audiologically after hospitalization., Conclusion: Pre-admission antibiotics were associated with a decreased risk of death and sequelae. Affected consciousness was a significant prognostic factor. The mortality rate was four times higher among adults than among children. Mastoidectomy was performed in 56% of adults without any significant influence on the outcome. Based on the presented results it appears relevant to treat cases of AOM, especially in adults with early antimicrobials due to their higher relative risk of developing OPM and the related risk of a poor outcome. In addition, maintenance of the previously established treatment regimen in OPM followed by audiological control is recommended.

Introduction: Hearing loss affects 1.5 of newborns in Denmark. New research estimates that genetic factors account for 60% of hearing loss present at birth or in early childhood. The growing knowledge of the genetic causes of hearing loss provides new potential in the diagnostic process, either as prenatal diagnostics (PND) by means of placenta biopsy or amniocentesis or as a supplement to the existing audiologic screening. The purpose of this study was to shed light on the attitude towards PND among the parents of 22 children who received a cochlear implant in the cochlear implant centre of Western Denmark., Materials and Methods: The parents received a questionnaire with questions on demographics and general attitudes and personal views regarding PND., Results: In total, 42 persons received a questionnaire, 18 replied (41%). There was generally a positive attitude towards attaining early knowledge about the child's hearing status. The most significant reason for this attitude was that it would make it possible to prepare for having a deaf child. Only 6% thought that the obtained knowledge would lead to termination of pregnancy., Conclusion: In consistency with these parents' point of view, audiologic testing was implemented in Denmark in 2004. In future, screening for hearing loss would benefit from the addition of molecular genetic testing to detect late-onset hearing loss.

Objectives: To describe the clinical, microbiological, serological and radiological findings including the results of treatment in a Danish patient population with necrotizing fasciitis (NF) in the head and neck region., Materials and Methods: Data were retrieved from patient records with the ICD3 code DM725A from January 1, 2002-June 30 2007. Demographic data, clinical manifestations, microbiological and serological findings, treatment modalities, complications and sequelae were registered., Results: Twelve patients were identified during the 5-year period at the ENT department, Aarhus University Hospital (median age 54 years; 8 males). Minor head and neck surgery had been performed in 7 patients before development of NF. The classical clinical course included a rapidly-developing erythema associated with extreme tenderness and pain in the region. A diffuse edema in the soft tissues and vaguely differentiated and dilated fat compartments were found on the acute CT scans, including the presence of air within the tissues in many cases. Surgical débridement was performed in all patients within the first two days, including antibiotics and hemodynamic therapy. The majority of the patients were treated with hyperbaric oxygen and immunoglobulin. All the patients survived; half had sequelae such as excessive scar formation, nerve damage and psychological problems., Conclusion: With the actual treatment modalities a survival rate of 100% was achieved in patients with NF in the head and neck region. Early diagnosis is of utmost importance and especially the combination of growing erythema and extreme pain supports the diagnosis.

Introduction: The annual birth rate in Denmark is 65,000. Approximately 100 of these children have a congenital bilateral hearing loss which requires treatment. Furthermore, it is expected that yet another 150 newborns have a unilateral hearing loss. Treatment of the hearing loss within the first six months is fundamental in order to ensure optimal use of speech and language, as well as normal social adaptation. The purpose of this study is to compare the two screening methods for hearing loss in newborns as recommended in Denmark--ie. Transient-Evoked Oto-Acoustic Emission (TEOAE) and Automatic Auditory Brainstem Response (AABR)., Materials and Methods: During a period of six months, 1627 children were bilaterally screened with both AABR and TEOAE. The equipment used was Bio-logic's ABaer hearing screening system. Time usage and the number of refers was recorded., Results: Of the 1627 children, 67 (4% ) were referred on one or both ears when using AABR, compared to 177 (11% ) when using TEOAE, which is a statistically significant difference (p = 2.43 x 10-16). Re-screening and further examinations in the Department of Audiology identified five children as suffering from a hearing loss. The average time used to perform AABR was 6.6 min.s compared to 3.8 min.s for TEOAE., Conclusion: AABR is well chosen as primary screening method. The time usage and equipment costs related to AABR exceed those of TEOAE, but this seems acceptable considering the larger number of re-screenings and further examinations in the Department of Audiology when using TEOAE.

Introduction: The aim of this study was to quantify the incidence and evaluate the risk factors of post-tonsillectomy hemorrhage (PTH)., Materials and Methods: A retrospective study was performed of all patients with PTH at the three hospital departments in Aarhus County, Denmark (650,000 inhabitants), and a random sample of one-third of all tonsillectomised patients at Aarhus University Hospital (AS) in the period 1 December 2002 to 30 November 2003, during which period 918 patients were tonsillectomised., Results: Post-operative haemorrhage occured in a total of 48 patients (5.2%). Twenty-six patients (2.8%) needed re-operation: 12 (3.4%) at AS, 7 (3.7%) at Randers Centralsygehus (RCS) and 7 (1.8%) at Silkeborg Centralsygehus (SCS). The following factors correlated significantly with PTH: high age (p = 0.0093), greater perioperative blood loss (p = 0.026) and high perioperative blood pressure (p = 0.0007). In addition, we found a three times higher but insignificant (p = 0.26) risk during abscess tonsillectomy as compared to cold tonsillectomy., Conclusion: The three ENT departments of Aarhus County fulfil international standards, but the operation has a high complication rate, which emphasizes the importance of solid indications for operation. In light of the increased risk of PTH with higher age, the instructions at AS have been altered so that all patients over 20 years of age with peritonsillar abscess who can cooperate are treated with aspiration and incision.