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Biomedical subjects

Gösta Granström

Publications and source records attributed to Gösta Granström.

11 recordsLinked to original sources
PubMed2006

BAHA in children and adolescents with unilateral or bilateral conductive hearing loss: a study of outcome.

OBJECTIVES: Bilateral BAHAs in adults with bilateral hearing loss (BHL) have proven to be superior to unilateral fitting, in both audiologically measurements and in overall patient satisfaction. There have been no similar studies in children. Furthermore, a recent meta-analysis of children with unilateral hearing loss (UHL) has shown numerous negative consequences. The objectives of the study were to investigate whether fitting of bilateral BAHAs in children with conductive BHL give additional hearing benefits, to investigate the effects of unilateral hearing aids in children with conductive UHL, and to identify different aspects of auditory problems in children with conductive UHL or BHL. STUDY DESIGN: This was a prospective study involving 22 children with either conductive UHL (unaided or with unilateral hearing aid) or conductive BHL (with unilateral or bilateral BAHAs) and 15 controls. METHODS: Baseline audiometry, tone thresholds in a sound field, speech recognition in noise and sound localization were tested without, and with unilateral and bilateral hearing aids. Two questionnaires, MAIS & MUSS and IOI-HA, were completed. RESULTS: Two problem areas were identified in the children with hearing impairment: in reactions to sounds and in intelligibility of speech. An additional BAHA in the children with BHL resulted in a tendency to have improved hearing in terms of better sound localization and speech recognition in noise. Fitting of unilateral hearing aids in the children with UHL gave some supplementary benefit in terms of better speech recognition in noise but no positive effect on ability to localize sound could be detected. Even so, all children fitted with hearing aids - either unilaterally or bilaterally - reported a positive outcome with their devices in the self-assessment questionnaire. CONCLUSIONS: Children with either UHL or BHL displayed several problems within the hearing domain. Fitting of bilateral BAHAs in children with BHL and of a single-sided hearing aid in children with UHL appears to have some supplementary audiological benefits and also renders high patient satisfaction. In order to investigate the possible supplementary effects of hearing aids, a 3-month trial of BAHA on Softband, either unilaterally or bilaterally, may be of value in children with conductive UHL or BHL, respectively.

Adolescent↗
PubMed2006

Retrieved implants from irradiated sites in humans: a histologic/histomorphometric investigation of oral and craniofacial implants.

PURPOSE: The aim of this report was to quantitatively and qualitatively evaluate the tissue response to bone-anchored implants retrieved from irradiated sites in patients. MATERIALS AND METHODS: The material consists of 23 consecutively received Brånemark implants (Nobel Biocare AB, Göteborg, Sweden) placed in pre- or postoperatively irradiated sites. Twenty-two of the 23 implants were suitable for histologic evaluation of undecalcified sections in the light microscope. RESULTS: The oral implants with shorter time in situ demonstrated sparse bone to implant contact with mainly dense connective tissue in the interface. However, for implants with longer time in situ, high amounts of bone-implant contact and bone fill of threads were noted. The mean values of bone-implant contact and bone area within the thread were calculated to 40% (16-94) and 70% (13-96), respectively. The craniofacial implants, with the exception of two implants lined with a capsular formation, demonstrated mature and newly formed bone at the bone-implant interface. The mean value for bone-metal contact was calculated to 45 and 53% for two specimens. The mean value for bone area within the thread ranged from 65 to 88% for three specimens. CONCLUSION; The possibility to achieve bone anchorage of implants in irradiated tissue was supported by the findings in this study. However, due to limited material, conclusions with regard to radiation dose and bone tissue response to implants cannot be stated.

Aged↗
PubMed2005

CHARGE association in Sweden: malformations and functional deficits.

CHARGE association (CA) consists of a non-random association of ocular coloboma (C), heart anomaly (H), atresia of choanae (A), retarded growth and/or development (R), genital hypoplasia (G), and ear anomalies and/or hearing impairment (E). A prospective multidisciplinary study of 31 Swedish patients with CA was undertaken in order to describe the associated malformations and functional deficits, find possible etiological factors and identify critical time periods for the maldevelopment. The clinical files were analyzed, the mothers answered a questionnaire on history of prenatal events, and a clinical evaluation of systemic findings, vision, hearing, balance, speech, oral and swallowing function, and neuro-psychiatric function, especially autism, was performed. The most frequent physical abnormalities affected ears (90%), eyes (90%), brain (61%), heart (52%), retarded growth (48%), genitals (38%), choanae (35%), and facial nerve (32%). Sixty-one percent of the patients were visually impaired or blind, and 74% had hearing loss or deafness. Problems in balance, speech, and eating were common. Forty percent of the patients had autism/atypical autism, and 82% had developmental delay. Three children were born following assisted fertilization and two mothers had diabetes. The mothers reported infections, bleedings, and drug use during pregnancy. Analysis of possible critical time periods suggested that most malformations were produced early in pregnancy, mainly during post conceptual weeks 4, 5, and 6. A multidisciplinary approach is essential in the assessment and management of CA.

Abnormalities, Multiple↗
PubMed2005

Hyperbaric oxygen and radiotherapy.

BACKGROUND: Hyperbaric oxygen (HBO) therapy is the inhalation of 100% oxygen at a pressure of at least 1.5 atmospheres absolute (150 kPa). It uses oxygen as a drug by dissolving it in the plasma and delivering it to the tissues independent of hemoglobin. For a variety of organ systems, HBO is known to promote new vessel growth into areas with reduced oxygen tension due to poor vascularity, and therewith promotes wound healing and recovery of radiation-injured tissue. Furthermore, tumors may be sensitized to irradiation by raising intratumoral oxygen tensions. METHOD: A network of hyperbaric facilities exists in Europe, and a number of clinical studies are ongoing. The intergovernmental framework COST B14 action "Hyperbaric Oxygen Therapy" started in 1999. The main goal of the Working Group Oncology is preparation and actual implementation of prospective study protocols in the field of HBO and radiation oncology in Europe. RESULTS: In this paper a short overview on HBO is given and the following randomized clinical studies are presented: a) reirradiation of recurrent squamous cell carcinoma of the head and neck after HBO sensitization; b) role of HBO in enhancing radiosensitivity on glioblastoma multiforme; c) osseointegration in irradiated patients; adjunctive HBO to prevent implant failures; d) the role of HBO in the treatment of late irradiation sequelae in the pelvic region. The two radiosensitization protocols (a, b) allow a time interval between HBO and subsequent irradiation of 10-20 min. CONCLUSION: Recruitment of centers and patients is being strongly encouraged, detailed information is given on www.oxynet.org.

Combined Modality Therapy↗
PubMed2005

Osseointegration in irradiated cancer patients: an analysis with respect to implant failures.

PURPOSE: This study retrospectively evaluated implant survival of 631 osseointegrated implants installed in irradiated cancer patients over a 25-year period. PATIENTS AND METHODS: The files of 107 patients followed since 1979 were evaluated. Factors influencing implant survival as oncologic treatment, radiotherapy protocols, patient and implant related elements were analyzed. RESULTS: Compared with a control group of non-irradiated patients, implant failures were higher after previous radiotherapy. High implant failures were seen after high dose radiotherapy and a long time after irradiation. All craniofacial regions were affected, but the highest implant failures were seen in frontal bone, zygoma, mandible, and nasal maxilla. Lowest implant failures were seen in oral maxilla. The use of long fixtures, fixed retention, and adjuvant hyperbaric oxygen therapy decreased implant failures. Noncontributing factors to implant survival were gender, age, smoking habits, tumor type and size, surgical oncologic treatment, and osseointegration (OI) surgery experience. CONCLUSION: Survival after cancer therapy is so high, and outcome from OI therapy so favorable that OI in the irradiated patient can be recommended. However, the OI clinician should be aware of the risks and pitfalls of treating such patients.

Adolescent↗
PubMed2005

The bone-anchored hearing aid in children: a surgical and questionnaire follow-up study.

OBJECTIVES: The main objectives were to evaluate the surgical techniques and problems seen in children with bone-anchored hearing aids (BAHA) as well as to determine the children's attitudes toward BAHA. STUDY DESIGN: A retrospective study of 41 children with unilateral BAHA was conducted. Surgical recordings were investigated and a questionnaire was distributed. RESULTS: Surgery was performed as a 2-stage procedure. Available bone thickness was measured in 29 patients and found to be on average 2.5 mm. Thin temporal bone necessitated bone augmentation in 8 patients. Of the implants, 70.5% were installed in contact with the dura or the sigmoid sinus. Implant failures were seen in 9.1% and adverse skin reactions appeared in 7.6% of the patients. Twenty-seven patients responded to the questionnaire, 19 were still BAHA users. Overall, these patients were very content with their BAHAs. CONCLUSION: BAHA is a good alternative in children despite limited thickness of the temporal bone.

Adolescent↗
PubMed2004

Bilateral bone-anchored hearing aids (BAHAs): an audiometric evaluation.

OBJECTIVES: Since the technique to implant bone-anchored hearing aids (BAHAs) with the use of osseointegrated implants was developed in 1977, more than 15,000 patients have been fitted with BAHAs worldwide. Although the majority have bilateral hearing loss, they are primarily fitted unilaterally. The main objective of this study was to reveal benefits and drawbacks of bilateral fitting of BAHAs in patients with symmetric or slight asymmetric bone-conduction thresholds. The possible effects were divided into three categories: hearing thresholds, directional hearing, and binaural hearing. STUDY DESIGN: Prospective study of 12 patients with bilateral BAHAs. METHODS: Baseline audiometry, directional hearing, speech reception thresholds in quiet and in noise, and binaural masking level difference were tested when BAHAs were fitted unilaterally and bilaterally. RESULTS: Eleven of the 12 patients used bilateral BAHAs on a daily basis. Tests performed in the study show a significant improvement in sound localization with bilateral BAHAs; the results with unilateral fitting were close to the chance level. Furthermore, with bilateral application, the improvement of the speech reception threshold in quiet was 5.4 dB. An improvement with bilateral fitting was also found for speech reception in noise. CONCLUSIONS: Overall, the results with bilateral fitted BAHAs were better than with unilaterally fitted BAHA; the benefit is not only caused simply by bilateral stimulation but also, to some extent, by binaural hearing. Bilateral BAHAs should be considered for patients with bilateral hearing loss otherwise suitable for BAHAs.

Adult↗
PubMed2003

A prospective study of orbital fracture sequelae after change of surgical routines.

PURPOSE: The present study was undertaken to investigate the circumstances surrounding the considerable increase in the number of orbital floor fracture repairs at the ORL Clinic at Sahlgrenska University Hospital at the end of the 1990s. PATIENTS AND METHODS: All the patients during a period of 1 year with a fracture involving the orbital floor were followed for 1 year using clinical assessments and questionnaires. Etiology, surgical methods, and the occurrence of long-term sequelae were investigated. RESULTS: Fifty-one patients were included. The main etiologies were assaults and falls. Surgery of the internal orbit was performed in 76%, often combined with a Gillies reduction. Porous polyethylene sheets (Medpor; Porex Surgical Inc, Newnan, GA) were used for the repair of large floor defects. Compared with previous results, the number of computed tomography investigations had considerably increased. The number of operations on the internal orbit due to fractures had doubled. The occurrence of diplopia was reduced compared with the situation when the floor was stabilized with an antral packing. Late enophthalmos developed in 11%. Despite fixation, the majority (67%) reported permanently affected sensibility. CONCLUSION: The frequency and severity of diplopia decreased parallel to the introduction of Medpor implants and the termination of the antral packing technique. Tetrapod zygomatic fractures, possibly unnecessarily submitted for surgery of the internal orbit, were in part responsible for the increase in the number of orbital explorations, in spite of preceding computed tomography scans. This indicates inadequate diagnostic techniques. Studies evaluating alternative complementary diagnostic methods are in progress.

Adolescent↗