Tonsil surgery in Sweden 2013–2015. Indications, surgical methods and patient-reported outcomes from the National Tonsil Surgery Register

Hallenstål, Niclas; Sunnergren, Ola; Ericsson, Elisabeth; Hemlin, Claes; Söderman, Anne-Charlotte Hessén; Nerfeldt, Pia; Odhagen, Erik; Ryding, Marie; Stalfors, Joacim

doi:10.1080/00016489.2017.1327122

Cited by 32 publications

(39 citation statements)

References 18 publications

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“…Parents may also have felt more obligated to complete the questionnaire as part of their responsibility for their child's health, which may be a stronger motivator than adult patients' responsibility to themselves for their own health. Consistent with prior studies, there were more females in our adult sample [2,[7][8][9] and more males in our pediatric sample [2,8,10,11]. However, there were no differences in mail response rates between male and female patients in this study, regardless of their age group.…”

supporting

confidence: 90%

“…Quality control of tonsillectomy has been ongoing in Sweden for many years [1][2][3] and has now been introduced in other Nordic countries. Such quality control efforts are important for monitoring surgical outcomes and maintaining optimal patient care.…”

Section: Introductionmentioning

confidence: 99%

“…However, the findings from these questionnaires are only valid if the patients who respond to them adequately represent the patient population being assessed, in this case, patients undergoing tonsillectomy. Response rates to quality control questionnaires have varied in prior studies, sometimes being as low as 48.1% [2], which can lead to bias due to nonresponses. However, little is known about how nonresponders might differ from those who respond to the mailed questionnaires, and therefore, the extent of nonresponder bias in tonsillectomy quality control is unknown.…”

Section: Introductionmentioning

confidence: 99%

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Self-Reported Complications after Tonsillectomy: Comparison of Responders and Nonresponders to a Mailed Questionnaire

Haye

Døsen

TarAngen

et al. 2020

International Journal of Otolaryngology

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Some studies of tonsillectomy outcomes have low response rates to mailed quality control questionnaires. is study evaluated the effect of nonresponders to mailed questionnaires about posttonsillectomy complications by determining whether mail responders and nonresponders differ. Questionnaires were mailed to patients 3-6 weeks after tonsillectomy to assess postoperative complications, defined as contact with a private practitioner and/or hospital readmission related to postsurgical bleeding, pain, or infection. Nonresponders to the mailed questionnaire were interviewed by telephone 7-11 weeks postoperatively, and responses of mail and telephone responders were compared. Of 818 patients undergoing tonsillectomy during the study period, 66.3% responded by mail, and 29.5% were interviewed by telephone, for a total response rate of 95.7%. e mail response rate was significantly higher among parents of pediatric patients than among adult patients (71.4% versus 58.7%, p < 0.001). In the pediatric group, overall complication rates were 65% higher among mail responders than telephone responders (20.9% versus 12.7%, p � 0.049), likely due to their higher rates of both visits to private practitioners and infection, as there were no differences in rates of pediatric readmission, bleeding, or pain between the responder groups. Among adult patients, mail and telephone responders did not differ with respect to their overall complication rate (40.9% versus 34.1%, p � 0.226) or their rates of readmission or bleeding. However, similar to the pediatric group, visits to a private practitioner were slightly more common among adult mail responders than telephone responders (30.6% versus 21.1%, p � 0.065), as were reports of pain (p � 0.001) and infection (p � 0.006). Studies relying on mailed questionnaires with low response rates likely overestimate the rate of minor complications handled outside the hospital, but rates of major complications involving readmission are unlikely to be seriously biased by low response rates. Supplementing mailed questionnaires with telephone interviews may increase the validity of surgical outcome studies.

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supporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Self-Reported Complications after Tonsillectomy: Comparison of Responders and Nonresponders to a Mailed Questionnaire

Haye

Døsen

TarAngen

et al. 2020

International Journal of Otolaryngology

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“…Differences in MFI values between tonsil and blood PDCs were assessed with two-way ANOVA using the Sidak multiple comparisons test and were considered statistically significant at p , 0.05. ****p , 0.0001. recurrent tonsillitis, tonsillar hypertrophy, and obstructive sleep apnea (75). Often the underlying cause of enlarged tonsils is not investigated in great detail.…”

Section: Discussionmentioning

confidence: 99%

Human Blood and Tonsil Plasmacytoid Dendritic Cells Display Similar Gene Expression Profiles but Exhibit Differential Type I IFN Responses to Influenza A Virus Infection

Vangeti

Gertow

et al. 2019

The Journal of Immunology

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Influenza A virus (IAV) infection constitutes an annual health burden across the globe. Plasmacytoid dendritic cells (PDCs) are central in antiviral defense because of their superior capacity to produce type I IFNs in response to viruses. Dendritic cells (DCs) differ depending on their anatomical location. However, only limited host-pathogen data are available from the initial site of infection in humans. In this study, we investigated how human tonsil PDCs, likely exposed to virus because of their location, responded to IAV infection compared with peripheral blood PDCs. In tonsils, unlike in blood, PDCs are the most frequent DC subset. Both tonsil and blood PDCs expressed several genes necessary for pathogen recognition and immune response, generally in a similar pattern. MxA, a protein that renders cells resistant to IAV infection, was detected in both tonsil and blood PDCs. However, despite steady-state MxA expression and contrary to previous reports, at high IAV concentrations (typically cytopathic to other immune cells), both tonsil and blood PDCs supported IAV infection. IAV exposure resulted in PDC maturation by upregulation of CD86 expression and IFN-α secretion. Interestingly, blood PDCs secreted 10-fold more IFN-α in response to IAV compared with tonsil PDCs. Tonsil PDCs also had a dampened cytokine response to purified TLR ligands compared with blood PDCs. Our findings suggest that tonsil PDCs may be less responsive to IAV than blood PDCs, highlighting the importance of studying immune cells at their proposed site of function.

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“…Larger studies are warranted to study these matters further. However, it can be difficult to get access to benign tonsils removed at all relevant ages since tonsillar disease mostly affects children and younger adults and tonsils in Sweden are removed at a mean age of 13.3 years …”

Section: Discussionmentioning

confidence: 99%

Mapping of human papilloma virus, p16, and epstein‐barr virus in non‐malignant tonsillar disease

Holm

Schindele

Allard

et al. 2019

Laryngoscope Investig Oto

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Objectives Due to their location in the entrance of the aero‐digestive tract, tonsils are steadily exposed to viruses. Human papilloma virus (HPV) and Epstein‐Barr virus (EBV) are two potentially oncogenic viruses that tonsils encounter. The incidence of HPV positive tonsillar cancer is on the rise and it is unknown when infection with HPV occurs. Aim To investigate if tonsils are infected with HPV and EBV, to study the co‐expression of HPV and its surrogate marker p16, and to evaluate the number of EBV positive cells in benign tonsillar disease. Materials and Methods Tonsils from 40 patients in a university hospital were removed due to hypertrophy, chronic or recurrent infection. These were analyzed for presence of HPV, its surrogate marker p16, and EBV. HPV was studied using PapilloCheck (a PCR method), while p16 was identified in epithelial and lymphoid tissue with immunohistochemistry and EBV using EBER‐ISH (Epstein‐Barr encoding region–in situ hybridization). Results HPV was not detected, and p16 was present at low numbers in all epithelial samples as well as in 92.5% of the lymphoid tonsillar samples. At least one EBER‐positive cell was seen in 65% of cases. Larger numbers of EBER‐expressing cells were only seen in two cases. Conclusion These findings demonstrate that EBV and HPV infect tonsils independently, but further studies are warranted to confirm their infectious relationship. Level of Evidence Cross‐sectional study

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Tonsil surgery in Sweden 2013–2015. Indications, surgical methods and patient-reported outcomes from the National Tonsil Surgery Register

Abstract: The NTSRS provides an opportunity to survey tonsil surgery in Sweden and to launch and follow up improvement programmes as desired.

Cited by 32 publications

References 18 publications

Self-Reported Complications after Tonsillectomy: Comparison of Responders and Nonresponders to a Mailed Questionnaire

Self-Reported Complications after Tonsillectomy: Comparison of Responders and Nonresponders to a Mailed Questionnaire

Human Blood and Tonsil Plasmacytoid Dendritic Cells Display Similar Gene Expression Profiles but Exhibit Differential Type I IFN Responses to Influenza A Virus Infection

Mapping of human papilloma virus, p16, and epstein‐barr virus in non‐malignant tonsillar disease

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