[The CPAP therapy in sleep apnea is a simple treatment tolerated by many].
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Evaluation Studies as Topic↗
Biomedical subjects
H Ejnell
Publications and source records attributed to H Ejnell.
Swallowing problems in rheumatoid arthritis.
Twenty-nine female patients with definite or classical rheumatoid arthritis (RA) and 30 controls were investigated in order to evaluate oral symptoms, particularly xerostomia, and swallowing difficulties in RA by means of a questionnaire, physical examination, stimulated saliva secretion, labial salivary gland biopsy, esophageal manometry and laboratory blood tests. Xerostomia was reported by 6 patients (21%), compared with no-one in the control group. Four of these 6 patients had decreased stimulated saliva secretion, compared with 2 of the remaining 23 patients. Dysphagia was experienced by 8 patients (28%), compared with one control subject. Dysphagia was associated with disease severity. Esophageal manometry revealed a decrease of the amplitude of the peristaltic pressure complex in the proximal part of esophagus in the RA group, indicating dysfunction of the striated muscles. No correlation was found between dysphagia and esophageal manometry results.
Arthritis, Rheumatoid↗
Laryngeal involvement in rheumatoid arthritis.
Twenty-nine female patients with definite or classical rheumatoid arthritis (RA) and 30 controls were studied in order to assess the prevalence of laryngeal involvement in patients with RA and the occurrence of extrathoracic airway obstruction. Laryngeal involvement was assessed by physical examination including direct fiberoptic laryngoscopy, respiratory function tests and low-voltage radiography. Physical examination revealed laryngeal involvement in 17 RA patients (59%), extrathoracic airway obstruction was indicated by spirometry in 4 (14%) and radiography revealed pathological findings in 3 patients (10%). One or more signs of laryngeal involvement were found in 20 patients (69%). Symptoms of breathing difficulties were common (75%) among patients with laryngeal involvement. The erythrocyte sedimentation rate and class-specific rheumatoid factors were not correlated to laryngeal involvement.
Adult↗
The ability of noninvasive methods to detect and quantify laryngeal obstruction.
The ability of the noninvasive methods forced oscillation technique (Rosc), spirometry and flow-volume curves to detect and quantify laryngeal obstruction, using assessment of orolaryngeal (upper) airway resistance (Rol) as reference, was compared in 55 patients with various laryngeal diseases. Statistical analysis was performed by means of sensitivity/specificity, simple regression, stepwise regression and stepwise logistic regression. The results showed that the ability to detect a laryngeal obstruction was acceptable and that Rosc-Insp, peak inspiratory flow (PIF) and forced inspiratory volume in one second (FIV1) seemed to be the best variables for detection of a laryngeal obstruction. None of the studied noninvasive methods appeared to be adequate for quantification of laryngeal obstruction.
Airway Obstruction↗
Left ventricular hypertrophy independent of hypertension in patients with obstructive sleep apnoea.
To evaluate cardiac structure and function as well as blood pressure in the obstructive sleep apnoea syndrome (OSAS), we investigated 61 male patients and 61 male controls with M-mode and two-dimensional echocardiography. All patients had a history of habitual snoring and a diagnosed light to severe OSAS by previous investigations of nocturnal oxygen saturation status. No subject in the control group had a history of OSAS or hypertension. Body weight was higher in the OSAS patients than in the controls (P less than 0.001). Fifty per cent (31 out of 61) of the OSAS patients had systemic hypertension; 17 of these 31 were on pharmacological antihypertensive treatment. Neither the systolic nor the diastolic blood pressures were found to correlate to the severity of the OSAS (desaturation index). The heart rate was higher at rest in the OSAS patients with or without systemic hypertension compared to the controls with or without a blood pressure level above 165/95 mmHg (P less than 0.05 and P less than 0.01, respectively). Left ventricular (LV) internal dimensions as assessed by echocardiography did not differ between the two groups, while the interventricular septum and the LV posterior wall were thicker in the OSAS group. Thus, the LV mass and the LV mass index were significantly higher among the OSAS patients (P less than 0.001 and P less than 0.001). The LV mass index was approximately 15% higher among the 30 normotensive OSAS patients with no history of cardiac disease compared with the normotensive controls (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Long-term results with a simple surgical treatment of bilateral vocal cord paralysis.
Since 1979, we have treated patients suffering from bilateral vocal cord paralysis with laterofixation of one vocal cord, a simple and comparatively atraumatic method. To evaluate the long-term results of this method of laterofixation, 11 consecutive patients were examined at least 5 years postoperatively regarding breathing capacity, voice function, and swallowing ability. Breathing capacity was assessed by determination of orolaryngeal (upper) airway resistance and spirometry. Voice function was judged by two listening panels. Swallowing ability was studied by barium contrast radiography. Postoperative improvement of breathing capacity was, in most cases, found to be long lasting. Furthermore, there was no deterioration of voice function, nor were there aspiration problems during the postoperative follow-up period. We suggest this method of laterofixation as the treatment of choice in patients suffering from breathing difficulties due to bilateral vocal cord paralysis.
Aged↗
[Respiratory problems during sleep cause blood gas disorders and illness during the daytime].
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Adult↗
[A snoring plate--an individual preventive device against snoring is not very effective].
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Acrylic Resins↗
Cricoarytenoid arthritis may be a case of emergency.
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Arthritis↗
Evaluation of a new 'anti-snoring device'.
A new 'antisnoring device' based on the principle to induce a conditioned response was evaluated in 8 patients with habitual snoring. When patients snore the device starts to vibrate, making the snorers turn to the side position. Out of the 8 patients, 4 definite responders were identified. In these individuals the cumulative overnight sound produced above 40 dBA was clearly reduced. Moreover, these patients reported decreased daytime hypersomnolence but no change in sleep quality after using the antisnoring device for 4 weeks. Sleep staging did not reveal any significant changes in sleep architecture. However, two patients in the responder group were found to have increased rapid eye movement sleep time and time spent in stage 3 and 4, respectively. No changes in oxygen saturation were found in the responder or the nonresponder groups. The results indicate that the anti-snoring device may be useful to decrease snoring and to improve sleep in a subgroup of habitual snorers. The data do, however, not provide further information on the characteristics of this subgroup.
Adult↗
Is high and fluctuating muscle nerve sympathetic activity in the sleep apnoea syndrome of pathogenetic importance for the development of hypertension?
Muscle nerve sympathetic activity was recorded in six patients with the sleep apnoea syndrome (SAS). Compared with age- and sex-matched control patients, an increased activity during wakefulness was found. Sleep apnoic events were associated with sequencies of progressively increasing sympathetic activity followed by a sudden reduction of activity. The high sympathetic activity associated with SAS may be important in the development of the systemic hypertension commonly seen in these patients.
Blood Pressure↗
Severe airway obstruction caused by laryngeal rheumatoid arthritis.
Ankylosis of the cricoarytenoid joints due to rheumatoid arthritis (RA) may cause upper airway obstruction by fixation of the vocal cords in the midline. In early stages, this condition usually results in minor symptoms which are easily overlooked. It may, however, very rapidly, e.g., in association with an upper respiratory tract infection, become life-threatening. It is essential to diagnose this condition early to avoid emergency situations. In 5 patients with classic RA and in one patient with juvenile RA severe laryngeal obstruction was operated on using a new simple technique consisting of a mobilization of the arytenoid cartilages and laterofixation of one of the vocal cords.
Adult↗
A microbiological study of secretory otitis media using an anaerobic technique.
A serious anaerobic sampling and cultivation technique was used in order to obtain representative samples from 45 middle ear effusions in 30 patients with longstanding secretory otitis media (SOM). Despite the fact that an accurate sterilizing procedure was performed, 16% disclosed contaminated samples from the ear canal and tympanic membrane. Among the remaining samples, middle ear bacteria were found in 30% of which Staphylococcus epidermidis and Haemophilus influenzae contributed to the major part. Anaerobes were only occasionally found. The amount of bacteria found was sparse in all cases. It can be concluded that the inflammatory process in SOM is not maintained by anaerobic bacteria within the middle ear cavity.
Bacteria, Anaerobic↗
Overestimation of inspiratory upper airway resistance.
Inspiratory resistance was found to be 10-50% larger than the expiratory in a model of the upper airways. This was most likely caused by a high kinetic energy component in the airstream close to the constriction reducing the lateral pressure in excess of what could be explained by the frictional pressure drop. Consequently, the inspiratory resistance was overestimated. During expiratory flow, on the other hand, the kinetic energy component at the same site in the trachea was smaller and similar to that in the mouthpiece resulting in an apparently adequate assessment of expiratory resistance. These results may explain why previous authors have found equal inspiratory and expiratory upper airway resistance although the vocal cords abduct during inspiration and adduct during expiration. Pressures obtained by means of the tracheal puncture appeared to be more reliable compared to those obtained from puncture of the cricothyroid membrane.
Air Pressure↗
A simple operation for bilateral vocal cord paralysis.
To reduce the laryngeal obstruction in bilateral vocal cord paralysis, a new method of laterofixation was developed. The method is technically simple and less traumatic than previously published methods. No peroperative tracheostomy is needed. During surgery two needles are inserted through the thyroid cartilage. A nylon thread is passed through the needles and the needles are then withdrawn. The thread thus forms a permanent loop around the vocal cord. The effects of the laterofixation on breathing and on the voice are documented by assessment of upper airway resistance and by two listening panels respectively. Thirteen patients have been operated upon so far. In most cases the breathing was improved and the influence on the voice was moderate and adjustable. If needed the possibility to perform a more extensive surgical procedure still remains. We suggest our method of laterofixation to be the first treatment of choice in patients suffering from bilateral vocal cord paralysis.
Adult↗
Spirometric indices in the assessment of laryngeal obstruction.
To determine if spirometric indices allow detection and quantification of a laryngeal obstruction, we obtained oro-laryngeal airway resistance (Ro1) and several spirometric indices in 43 patients with various laryngeal diseases. Assuming Ro1 greater than or equal to 0.2 kPa/(1/s) to imply a laryngeal obstruction, the highest sensitivity was found for FIV1 = 2.0 1 (forced inspiratory volume in one second) being about 84% at a specificity of about 88%. The highest correlation coefficients (r = 0.72-0.83) were obtained between Ro1 and MIF50/MEF50 (the ratio between maximum expiratory and inspiratory flow at 50% of vital capacity) and between I/Ro1, and PIF (peak inspiratory flow), MIF50 and FIV1. In conclusion spirometric indices allow detection of a laryngeal obstruction in the majority of cases, but do not appear adequate for a quantitative assessment in an individual patient.
Adolescent↗
Bell's palsy and herpes simplex virus.
The possible association of some viral infections with the onset of Bell's palsy was examined in a study of 142 patients. The number of probable recent viral infections, as judged by increase in antibody titers or presence of IgM antibodies, did not differ statistically from that found in a sex- and age-matched control group. However, a higher prevalence of herpes simplex virus (HSV) antibodies was found in the patient group with both a complement-fixation (CF) test and a radioimmunoassay (RIA). Moreover, titers of HSV CF antibodies and antibodies against HSV envelope antigens (RIA) were higher in the patient group. The possibility of reactivated HSV infection and transient demyelination of the facial nerve being causatively associated with Bell's palsy is discussed.
Adult↗
Tracheotomy--a satisfactory method in the treatment of acute epiglottitis. A clinical and functional follow-up study.
A follow-up study, including clinical examination, X-ray and function tests, of 27 children with acute epiglottitis treated with tracheotomy at the ENT-Department, Mölndal Hospital during 1971-1975 has been performed. The function tests were an important part of the investigation and included measurement with the He-dilution technique, flow--volume curves and the forced oscillation technique. No child had any detectable tracheal stenosis or any other serious per- or postoperative complication. The only complication at all was one ugly scar on the neck. The tracheotomized patient needs very little sedation and the time spent at the intensive care unit can be shorter than for those patients treated with nasotracheal intubation.
Acute Disease↗