The aim of the study was to investigate the effect of preventive exercise therapy on radiation-induced trismus in head and neck cancer. Eighty-nine patients (n = 89) with newly diagnosed head and neck cancer were included and randomized to either the preventive exercise intervention group (n = 45) or the control group. (n = 44). The intervention group was instructed to perform jaw opening exercises once daily. No differences were found in mouth opening capacity between the intervention and the control groups in the first year after oncological treatment. At the 6-month follow-up, the prevalence of trismus was 7

BACKGROUND:Acute vestibular syndrome (AVS) causes sudden and continuous vertigo, dizziness, and postural instability and is a common reason for emergency department visits, most commonly due to vestibular neuritis and, in rare cases, stroke. Vestibular rehabilitation (VR) is an evidence-based exercise therapy that facilitates vestibular compensation and is effective in chronic vestibular disorders. However, evidence for VR in acute vertigo remains limited and, despite guideline support, it remains underused in practice. Internet-based VR has demonstrated benefit in chronic dizziness but has not been evaluated in acute vertigo. This study aimed to evaluate the efficacy of an internet-based VR tool compared with standard care (written instructions) in reducing vestibular symptoms after acute onset vertigo. METHODS AND FINDINGS:A multicentre, randomised, evaluator-blinded superiority trial was conducted across nine hospitals in Sweden. Adults with ongoing AVS were recruited within 1-7 days after symptom onset and randomised (1:1) to six weeks of internet-based VR with personalised, progressively adjusted home exercises or to written instructions for home-based VR exercises. The primary outcome was the between-group difference in vestibular symptoms at six weeks measured using the Vertigo Symptom Scale Short Form (VSS-SF; range 0-60), with a difference of ≥3 points prespecified as clinically significant. Secondary outcomes included dizziness-related disability, walking speed, and balance. Of 184 randomised participants, 183 were included in the analyses (94 online VR; 89 written instructions; median age 56 years). In the intention-to-treat analysis, both groups improved at six weeks, with no significant between-group difference (adjusted mean difference -2.0 points, 95% CI -4.9 to 0.9; p = 0.18). Per-protocol analyses were consistent (-1.7 points, 95% CI -4.7 to 1.3; p = 0.27). Over 12 weeks, both groups showed reduced vestibular symptoms and improved disability, balance, and walking speed, without significant between-group differences. No serious adverse events were attributed to the interventions, and compliance was high in both groups. CONCLUSIONS:Internet-based VR was not superior to written instructions in reducing vestibular symptoms six weeks after acute onset vertigo. Both groups demonstrated improvement from baseline, with no statistically significant between-group differences. These findings suggest that ensuring access to vestibular rehabilitation exercises may be more important than the specific mode of delivery after acute onset vertigo, and internet-based tools represent viable alternatives for patients who prefer or may benefit from a digital format. TRIAL REGISTRATION:Clinicaltrials.gov NCT05056324. https://clinicaltrials.gov/study/NCT05056324. Registered on September 24, 2021.

OBJECTIVE:This study aimed to describe voice function and health related quality of life (HRQL) from before radiotherapy and up to 10 years post treatment for laryngeal cancer. METHODS:Patients were consecutively included at the time of diagnosis of laryngeal cancer. Voice recording was performed, along with the patient's perception of voice function and HRQL before radiotherapy and at 1 month, 1, 5 and 10 years after completion of radiotherapy. Perceptual evaluation of voice quality was performed on all occasions. RESULTS:Twenty-two participants with follow-up data from before radiotherapy up to 10 years following treatment for laryngeal cancer were included in the study. Perceptual analyses of voice quality demonstrated a general improvement over time in most domains of the perceptual evaluations after completion of radiotherapy. Roughness demonstrated a deterioration during the first year, but after that there were improvements up to 10 years. Self-perceived communication function improved from before radiotherapy up to 5 years, to thereafter deteriorate slightly. The HRQL domains demonstrated in general better or similar values at 10 years compared to before radiotherapy. CONCLUSION:Most patients demonstrated a voice quality impairment to some degree at 10 years following radiotherapy for laryngeal cancer, with no substantial changes compared to 5 years postradiotherapy. HRQL and self-perceived function also demonstrated differences during the same time, with the highest degree of symptoms immediately after radiotherapy, to thereafter improve over time; however, with communicative difficulties to some extent deteriorating after 5 years.

OBJECTIVE:A previous placebo-controlled crossover study of intratympanic latanoprost-a drug commonly used for glaucoma treatment-showed positive effects on hearing, tinnitus, and vertigo in patients with long-standing Ménière disease (MD). We aimed to test the safety and efficacy of intratympanic treatment with latanoprost 0.0005% versus placebo in patients with active MD concerning speech discrimination in noise, hearing, tinnitus, and vertigo. STUDY DESIGN:A prospective, randomized, double-blind, placebo-controlled study over 3 months in patients with active stage II to III MD. SETTING:Twelve otolaryngology referral centers across Sweden. INTERVENTION:Patients were allocated to intratympanic injection of latanoprost 0.0005% administered as a single injection on day 1, or 3 injections over 3 consecutive days, or placebo administered as a single injection or 3 injections over 3 consecutive days. MAIN OUTCOME MEASURES:The primary outcome was change in speech discrimination in noise, assessed using phonetically balanced monosyllabic Swedish words (PB S/N+4dB), from baseline (day 1) to day 14. Secondary outcomes were change in pure tone average measured at 0.25, 0.5, 1, 2, 3, 4, 6, and 8 kHz, tinnitus according to the Tinnitus Handicap Inventory (THI) score and vertigo measured at 2, 4, 6, and 8 weeks after the first injection. Hearing, tinnitus, and vertigo were also assessed according to a Likert scale scored from 0 to 10. Days with vertigo attacks lasting ≥20 minutes were registered twice a week by patients. LS means were compared for each outcome measure. RESULTS:When comparing latanoprost (1 or 3 injections) with placebo (1 or 3 injections), no statistically significant difference was seen for the change in speech discrimination in noise from baseline to day 14, 0.4 (95% CI: -4.5; 5.3), P=0.88. None of the secondary efficacy measures showed a statistically significant difference between latanoprost and placebo. Latanoprost treatment was well tolerated. CONCLUSIONS:In this placebo-controlled study, latanoprost was not more effective than placebo in the treatment of MD and did not improve speech discrimination in noise, hearing, and tinnitus or vertigo symptoms.

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is one of the most frequently diagnosed cause of dizziness among older adults. OBJECTIVE: To investigate the prevalence of BPPV and positional symptoms of dizziness and nystagmus among 75-year-olds and to identify factors associated with BPPV and positional dizziness and nystagmus. METHODS: In this cross-sectional population-based study of 75-78-year-olds in Gothenburg, 887 participants were examined with questions regarding dizziness and health and social factors. A total of 681 participants underwent the Dix-Hallpike test or the side-lying test for BPPV using Video Frenzel goggles. RESULTS: In total 32% reported problems with dizziness ( n = 887). The prevalence of BPPV was 4% in the unweighted and 4.5% in the weighted analyses, compensating for selective attrition of women and participants with previous positional dizziness. Positional dizziness without nystagmus was found in 2% and nystagmus without dizziness was found in 9%. Individuals with BPPV and positional dizziness experienced more dizziness in everyday life compared with those with normal tests, while those with positional nystagmus did not. CONCLUSIONS: The estimated prevalence of BPPV among 75-year-olds was 4.5%. Despite weighted analyses, the true prevalence may be higher since many participants with dizziness refused testing. Dizziness was associated with fear and discomfort so strong that around 20% of the participants declined testing.

Purpose This study aimed to assess swallowing and laryngeal function at long-term follow-up in patients treated for severe COVID-19 in the ICU.Methods Thirty-six patients with severe COVID-19 were prospectively examined with fiberendoscopic evaluation of swallowing (FEES) about 6 and 12 months after ICU discharge. Comparison with initial FEES examinations during the time in hospital was performed in 17 patients. Analysis of swallowing function and laryngeal features was performed from video recordings. Twenty-five participants responded to Eating Assessment Tool, Voice Handicap Index, and the Hospital Anxiety and Depression Scale at follow-up.Results Penetration to the laryngeal vestibule (PAS >= 3) was seen in 22% and silent aspiration (PAS = 8) in 11% of patients on at least one swallow at follow-up. Fourteen percent had obvious residue in the vallecula and/or pyriform sinuses after swallowing thick liquid or biscuits. Self-reported eating and swallowing difficulties were found in 40% of patients. Abnormal findings in the larynx were present in 53% at follow-up. Thirty-three percent had reduced or impaired vocal fold movement, of whom 22% had bilateral impaired abduction of the vocal folds. Possible anxiety and depression were found in 36% and 24% of responders, respectively.Conclusion Although a majority of patients appear to regain normal swallowing function by 1 year after treatment for severe COVID-19, our results indicate that dysphagia, abnormal laryngeal function, and anxiety/depression may remain in a substantial proportion of patients. This suggests that swallowing and laryngeal function, and emotional symptoms, should be followed up systematically over time in this patient group.

Dizziness is a common complaint among older adults and one of the most important risks for falls. Objectives. This study aimed to report falls, physical capacity, and self-rated health in men and women with and without dizziness in a population-based sample of 70-year-olds, and to investigate which factors may be associated with falls and dizziness. Methods. A cross-sectional population-based sample from 1203 70-year- olds (644 women, 559 men, response rate 72%) was surveyed regarding dizziness, falls, physical capacity, medications, and self-rated health. Physical capacity level was assessed using the six-minute walk test, chair stand test, and tandem standing test with eyes opened and closed. Results. Dizziness was more commonly reported among women than among men (p < 0.0001) and associated with decreased self-rated health and physical levels among both men and women. Dizzy women tended to fall more often, performed worse in fitness measurements (chair stand, tandem standing), exercised less frequently, and went for walks less often than non-dizzy women. The number of medications and dizziness were identified as having significant associations with falls. Conclusions. To experience dizziness already at the age of 70 affects health and physical levels in both men and women, and dizzy women tended to fall more often than non-dizzy women. We suggest that dizziness among older adults should be carefully evaluated regarding medications, physical function, and treatable causes, and when needed, postural training and vestibular rehabilitation should be initiated to avoid future falls and improve quality of life.

Objective:This study aimed to compare older adults reporting dizziness to those not reporting dizziness regarding health-related quality of life (HRQL), distress due to dizziness, and balance confidence. A secondary aim was to investigate potential association between HRQL, number of falls, balance confidence, and distress due to dizziness. Methods:Patients coming for bone density measurements answered questions regarding occurrence of dizziness. Patients reporting dizziness on a daily or weekly basis were considered eligible and invited for investigation at the Ear, Nose and Throat clinic at Södra Älvsborg Hospital, Sweden. Patients not reporting dizziness were considered eligible as controls. All patients answered the Dizziness Handicap Inventory (DHI), Activity Balance Confidence Scale (ABC-scale), and Euro-QoL-5D-3L questionnaires. Results:A total of 55 dizzy patients came for physical investigation and answered the questionnaires and 47 non-dizzy participants only answered the questionnaires. The dizzy participants reported lower levels of balance confidence, lower HRQL, more prior falls, and higher levels of distress due to dizziness than the non-dizzy controls. Lower levels of balance confidence and higher level of distress due to dizziness were each associated with lower HRQL. Conclusion:Dizziness, unsteadiness, and low balance confidence are associated with HRQL in a negative way. This is important to consider when measuring HRQL in a senior population, since a sensation of unsteadiness may indirectly contribute to low HRQL together with other symptoms. Level of evidence:2b.

Objective: The aim of this article is to evaluate older women who report dizziness on a daily or weekly basis, but not seeking medical care for their problems, for levels of patient-reported outcome measures related to dizziness, balance confidence, vestibular impairment, benign paroxysmal positional vertigo walking speed, Timed Up and Go (TUG), balance confidence, depression, and anxiety. Study Design: Cross-sectional survey. Setting: Secondary referral center. Patients: Patients coming for bone density measurements answered questions regarding occurrence of dizziness. Women reporting dizziness on a daily or weekly basis were considered eligible and invited for investigation at the Ear, Nose, and Throat clinic at Södra Älvsborg Hospital, Sweden. Main Outcome Measure: Patients completed the Dizziness Handicap Inventory (DHI), Activities-specific Balance Confidence Scale, and Hospital Anxiety and Depression Scale and were investigated with the video Head Impulse Test, for benign paroxysmal positional vertigo, walking speed, and TUG test. Results: Fifty-two female patients were enrolled. Associations were found between high levels of DHI and high distress due to dizziness, and low levels of balance confidence and reduced walking speed and TUG test time. Participants with higher DHI levels reported higher levels of both depression and anxiety. No associations were found between levels of DHI and results on vestibular tests. Conclusion: Women reporting higher levels of distress due to dizziness had reduced walking speed and reported less balance confidence and higher levels of anxiety and depression. The findings support the theory that DHI captures aspects of overall self-rated wellbeing and function rather than structural vestibular deficits.

Dizziness and vertigo affect around 15% of adults annually and represent common reasons for contacting health services, accounting for around 3% of all emergency department visits worldwide. Vertigo is also associated with excessive use of diagnostic imaging and emergency care and decreased productivity, primarily because of work absenteeism. Vestibular rehabilitation is an evidence-based treatment for chronic dizziness and supervised group exercise therapy has recently been shown to be effective after vestibular neuritis, a common cause of acute onset vertigo. However, such interventions are not readily available and there is a need for more easily accessible tools. The purpose of this study is to investigate the effects on vestibular symptoms of a 6-week online vestibular rehabilitation tool after acute onset vertigo, with the aim of aiding vestibular rehabilitation by presenting a more accessible tool that can help to reduce recovery time. Three hundred twenty individuals diagnosed with acute vestibular syndrome (AVS) will be recruited from multiple hospitals in Sweden and the effects of an online vestibular rehabilitation tool, YrselTräning, on vestibular symptoms after acute onset vertigo will be compared to standard care (written instructions leaflet) in a two-armed, evaluator-blinded, multicenter randomized controlled trial. The primary outcome will be the Vertigo Symptom Scale Short Form (VSS-SF) score at 6 weeks after symptom onset. Secondary outcomes include effects of the intervention on activities of daily living, mood and anxiety, vestibular function recovery, mobility measures, health economic effects, and the reliability of the Swedish VSS-SF translation. Participants using the online vestibular rehabilitation tool are expected to recover earlier and to a greater extent from their symptoms as compared to standard care. Since up to 50% of people with AVS without treatment develop persistent symptoms, effective treatment of AVS will likely lead to a higher quality of life and help reduce the societal costs associated with dizziness and vertigo. Clinicaltrials.gov NCT05056324 . Registered on September 24, 2021.

Abstract Background Critically ill COVID-19 patients may develop acute respiratory distress syndrome and the need for respiratory support, including mechanical ventilation in the intensive care unit. Previous observational studies have suggested early tracheotomy to be advantageous. The aim of this parallel, multicentre, single-blinded, randomized controlled trial was to evaluate the optimal timing of tracheotomy. Methods SARS-CoV-2-infected patients within the Region Västra Götaland of Sweden who needed intubation and mechanical respiratory support were included and randomly assigned to early tracheotomy (≤ 7 days after intubation) or late tracheotomy (≥ 10 days after intubation). The primary objective was to compare the total number of mechanical ventilation days between the groups. Results One hundred fifty patients (mean age 65 years, 79% males) were included. Seventy-two patients were assigned to early tracheotomy, and 78 were assigned to late tracheotomy. One hundred two patients (68%) underwent tracheotomy of whom sixty-one underwent tracheotomy according to the protocol. The overall median number of days in mechanical ventilation was 18 (IQR 9; 28), but no significant difference was found between the two treatment regimens in the intention-to-treat analysis (between-group difference: − 1.5 days (95% CI − 5.7 to 2.8); p = 0.5). A significantly reduced number of mechanical ventilation days was found in the early tracheotomy group during the per-protocol analysis (between-group difference: − 8.0 days (95% CI − 13.8 to − 2.27); p = 0.0064). The overall correlation between the timing of tracheotomy and days of mechanical ventilation was significant (Spearman’s correlation: 0.39, p < 0.0001). The total death rate during intensive care was 32.7%, but no significant differences were found between the groups regarding survival, complications or adverse events. Conclusions The potential superiority of early tracheotomy when compared to late tracheotomy in critically ill patients with COVID-19 was not confirmed by the present randomized controlled trial but is a strategy that should be considered in selected cases where the need for MV for more than 14 days cannot be ruled out. Trial registration NCT04412356 , registered 05/24/2020. Graphic abstract

Abstract Objective This article aimed to investigate older adults visiting a geriatric institution for a bone density measurement who reported dizziness on a daily or weekly basis (but who are not seeking care for dizziness), according to BPPV, vestibular function, walking abilities, and frequency of falls. Methods Patients coming for a bone density measurement answered questions regarding occurrence of dizziness. Patients having dizziness on a daily or weekly basis were considered eligible for the study and invited for investigation at the Ear, Nose, and Throat clinic at Södra Älvsborg Hospital, Sweden. The patients answered questions about history of dizziness, medications, and comorbidities. They were also investigated for BPPV, vestibular deficits using the video head impulse test (vHIT), walking speed, Timed Up and Go test (TUG), and for perception of verticality and horizontality and Romberg test. Results A total of 55 patients with dizziness were included. Fifteen (27%) were diagnosed with BPPV. Forty (73%) patients reported falling during the previous year, including 11 with BPPV. Dizziness when turning in bed was more common among patients with BPPV and increased the risk of BPPV 8‐fold. Conclusion BPPV is common among older adults with dizziness, including among those not seeking medical care. It is important to identify older adults with BPPV and treat the condition since BPPV may contribute to falls. Asking about dizziness when turning in bed can help to distinguish patients with increased risk for BPPV and older adults with dizziness should be investigated for BPPV even when typical history is lacking. Level of evidence: 4

The outbreak of SARS-CoV-2 has led to a sharp rise in intensive care unit (ICU) admissions and consequently a need to perform tracheotomies on patients with Covid-19. A number of guidelines have been published with recommendations for the timing of tracheostomy in Covid-19 patients, suggesting tracheotomy should be delayed until day 14-21 of mechanical ventilation.  We present the first 66 patients treated in the ICU at Södra Älvsborg hospital in Sweden as a result of Covid-19. A total of 29 patients received a tracheostomy, median time 9 days post oral intubation, which is earlier than recommended. The mortality rate was 21%, which is slightly lower than reported from The Swedish Intensive Care Registry (25%). None of the doctors performing tracheotomies developed Covid-19 linked to the tracheotomy procedure.

Objective This study aimed to compare antibiotic treatment with clindamycin versus penicillin V or G in terms of time to recovery and recurrence in patients with peritonsillar infection, including both peritonsillar cellulitis and peritonsillar abscess. Method This retrospective cohort study examined the records of 296 patients diagnosed with peritonsillar infection. Based on the ENT doctor's choice of antibiotics, patients were divided into clindamycin and penicillin groups. Results Mean number of days in follow up was 3.5 days in the clindamycin group and 3.4 days in the penicillin group. The recurrence rate within 2 months was 7 per cent in the clindamycin group and 4 per cent in the penicillin group. Conclusion This study found no significant differences in either recovery or recurrence between the groups. This supports the use of penicillin as a first-line treatment, considering the greater frequency of adverse effects of clindamycin shown in previous studies, as well as its profound collateral damage on the intestinal microbiota, resulting in antibiotic resistance.

ObjectivesThis study aimed to investigate the rate of dizziness and occurrence of benign paroxysmal positional vertigo in the elderly by physical examination in those reporting dizziness symptoms when lying down or turning over in bed.MethodsA total of 498 people, aged 70-85 years, were asked to complete a questionnaire regarding dizziness symptoms. Subjects answering that they became dizzy in bed were asked to participate in a physical examination and diagnostic manoeuvres investigating benign paroxysmal positional vertigo.ResultsA total of 324 participants (65 per cent) completed the questionnaire. More than one-quarter (29 per cent) reported dizziness and 32 (10 per cent) reported dizziness when turning in bed. Of these 32 persons, 22 (69 per cent) underwent a physical examination. Six participants tested positive for benign paroxysmal positional vertigo.ConclusionTen per cent of the elderly participants reported positional symptoms, and 6 out of 22 fulfilled diagnostic criteria for benign paroxysmal positional vertigo. Furthermore, benign paroxysmal positional vertigo was established despite a delay between questionnaire completion and investigation, emphasising that this type of dizziness may not be a self-limiting disorder.

Dizziness is common among older people and falling is a feared complication. The purpose of this study was to investigate the presence of dizziness and its association with falls, walking speed and fear of falling, including sex differences, among 79-year-olds. Secondary purposes were to describe the relationship between dizziness and falls to number of medications and diseases. The study consisted of the fifth cohort of Gothenburg’s H70 birth cohort studies. A sample of 662 79-year-olds (404 women, 258 men) were investigated with questions regarding dizziness, previous falls and falls efficacy [estimated according to the falls efficacy scale Swedish version (FES (S))]. Functional tests included self-selected and maximal walking speed over 20 m. Dizziness was reported among 51% of the women and by 58% of the men (p = 0.12). Approximately, 40% had fallen during the past 12 months (41% women, 38% of the men, p = 0.48). Dizziness was related to a higher risk of falls among women (OR 2.63 (95% CI 1.67−4.14, p < 0.0001), but not among men (OR 1.07, 95% CI 0.63−1.82, p = 0.8). Dizzy individuals had lower scores on FES (S) (p < 0.01), more medications (p < 0.001) and diseases (p < 0.001) than those without dizziness. Participants who reported dizziness walked 10% slower than participants without dizziness (p < 0.001). Women with dizziness more often reported falls compared to women without dizziness—a trend that was not seen among men. Persons with dizziness walked slower. Many medications increased risk of falling; hence, number of medications alone might help pinpoint risk groups for falling.

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the single most common cause of vestibular vertigo and is characterised by short episodes of rotational vertigo precipitated by changes in head positions like lying down or turning in bed.OBJECTIVE: This study aims to assess useful questions when suspecting benign paroxysmal positional vertigo (BPPV) caused dizziness as well as identifying if a single question can be useful in identify or distinguish patients with BPPV from other dizziness aetiology.METHOD: A total of 149 patients admitted due to dizziness were included.Patients answered a questionnaire and were investigated for BPPV with diagnostic manoeuvres.RESULT: Two of the 15 questions were of diagnostic importance.Dizziness when laying down or turning in bed, increased likelihood of BPPV by an odds ratio (95% confidence interval) of 60 (7.47-481.70).Continuous dizziness duration as opposed to lasting seconds decreased likelihood of BPPV with an odds ratio of 0.06 (0.01-0.27).CONCLUSION: Vertiginous attacks by turning or laying down in bed together with dizziness <1 minute, are important questions and strongly related to BPPV.Such questions are important when taking a medical history and may help to early identify BPPV, also for non-medical staff, as well as reduce the need of further investigations.

Purpose. The aim of the present study was to investigate the effects of voice rehabilitation in patients treated with radiotherapy for laryngeal cancer.Method. A total of 42 patients with laryngeal cancer who are treated with radiotherapy with curative intent participated in a randomized controlled study. The collected data were voice range profiles (VPRs) and patient-reported outcome (PRO) instruments for measurement of self-perceived communication function (Swedish Self-Evaluation for Communication Experiences after Laryngeal cancer (S-SECEL)) and health related quality of life (HRQL) (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30/Head and Neck module). Data were collected 1 month (pre voice rehabilitation), 6 months, and 12 months postradiotherapy. Of the patients, 19 received voice rehabilitation, whereas 23 constituted a control group.Results. There were several statistically significant improvements in the study group concerning the HRQL and self-perceived communication function. The largest improvements occurred between occasions 1 (prevoice rehabilitation) and 2 (6-month postradiotherapy) and then remained constant. VRP area demonstrated a statistically significant difference when comparing changes over time, where the study group improved more than the control group.Conclusion. HRQL and self-perceived communication function showed improvement in the study group and trends of impairment in the control group. This result might suggest that it would be beneficial for the patients as well as in a health economic perspecitve, to receive voice rehabilitatiom to make a faster improvement of the HRQL and self-perceived communication function.