An HPV-Vaccinated Patient With Human Papillomavirus-Positive Oropharyngeal Squamous Cell Carcinoma.

This case report describes an extremely early-onset case of human papillomavirus­positive oropharyngeal squamous cell carcinoma in a Norwegian woman in her early 20s.

Characteristics and prognosis of primary treatment-naïve oral cavity squamous cell carcinoma in Norway, a descriptive retrospective study.

OBJECTIVES: Incidence of oral cavity squamous cell carcinomas is rising worldwide, and population characterization is important to follow for future trends. The aim of this retrospective study was to present a large cohort of primary oral cavity squamous cell carcinoma from all four health regions of Norway, with descriptive clinicopathological characteristics and five-year survival outcomes. MATERIALS AND METHODS: Patients diagnosed with primary treatment-naïve oral cavity squamous cell carcinomas at all four university hospitals in Norway between 2005-2009 were retrospectively included in this study. Clinicopathological data from the electronic health records were compared to survival data. RESULTS: A total of 535 patients with primary treatment-naïve oral cavity squamous cell carcinomas were identified. The median survival follow-up time was 48 months (range 0-125 months) after treatment. The median five-year overall survival was found to be 47%. Median five-year disease-specific survival was 52%, ranging from 80% for stage I to 33% for stage IV patients. For patients given treatment with curative intent, the overall survival was found to be 56% and disease-specific survival 62%. Median age at diagnosis was 67 years (range 24-101 years), 64 years for men and 72 years for women. The male: female ratio was 1.2. No gender difference was found in neither tumor status (p = 0.180) nor node status (p = 0.266), but both factors influenced significantly on survival (p<0.001 for both). CONCLUSIONS: We present a large cohort of primary treatment-naïve oral cavity squamous cell carcinomas in Norway. Five-year disease-specific survival was 52%, and patients eligible for curative treatment had a five-year disease-specific survival up to 62%.

Birth characteristics and acute otitis media in early life.

OBJECTIVE: To assess whether preterm birth and low birth weight were associated with single and recurrent episodes of acute otitis media (AOM) the first 18 months of life. METHODS: The study population consisted of 33,192 children in the Norwegian Mother and Child Cohort, conducted at the Norwegian Institute of Public Health. The majority of all pregnant women in Norway were invited to participate and the response rate was 44%. Participating women received questionnaires during pregnancy and when the child was 6 and 18 months. Main outcome measures were maternal reports of AOM at ages 6, 11 and 18 months. Information on birth weight and gestational age was obtained from the Medical Birth Registry of Norway. Regression analyses were performed controlling for a variety of potential confounders. RESULTS: Preterm birth was slightly associated with both single and recurrent episodes of AOM the first 18 months of age. The adjusted relative risk (aRR) for having any episode of AOM was 1.37, 95%CI (1.12-1.68) if born before week 33, and the aRR for having recurrent AOM was 1.34, 95%CI (1.01-1.77) if born in weeks 33-36 (reference group: >or=37 weeks). A corresponding tendency was not found for low birth weight. CONCLUSIONS: The finding indicates a modest increased risk of having AOM in children born preterm, and preterm birth seems to be more important than low birth weight in determining risk of having AOM in early life.

Surgery for otitis media and infectious susceptibility in 10-year old school children.

OBJECTIVES: Assess infectious susceptibility in children previously operated for otitis media and evaluate reliability of parental reported otitis media surgery in the same group of children. METHODS: Population based, cross-sectional survey of 10-year olds in the city of Oslo, Norway studying otitis media and surgical intervention in n=3406 with reliability assessments in a subset of n=2027. RESULTS: Ten percent of children had otitis media surgery. Peak age was 2.5 years for adenoidectomy and tympanostomy tubes and 3 years for myringotomy. The crude odds ratio (cOR) with 95% confidence interval (95% CI) for one or more episodes of otitis media at 10 years in children with previous otitis media surgery was 3.4 (2.7-4.4). Intervention after the child was 4 years increased the risk further, crude odds ratio 4.2 (2.9-6.1). Kappa coefficients for agreement in answers to questions on otitis media surgery performed in children between 0 and 4 years were 0.9 for adenoidectomy, 1.0 for tympanostomy tubes, and 0.6 for myringotomy. CONCLUSION: Otitis media in 10-year old children was associated with previous surgical intervention, particularly when performed after 4 years of age. Parental reports of tympanostomy tubes and adenoidectomy in early childhood were found reliable.

Trends in otitis media surgery: a decrease in adenoidectomy.

OBJECTIVE: Large variability in adenoidectomies and tympanostomy tube insertions between Norway and Finland has been suggested, but not yet confirmed. Objective is to compare trends in paediatric adenoidectomies and tympanostomy tube insertions for Norway and Finland from 1999 to 2005. METHODS: National Finnish and Norwegian databases (STAKES and NPR) provided information on children between 0 and 7 years operated in the years 1999-2005. Surgical rates were viewed in the light of child density, age and gender, and compared bi-nationally. RESULTS: Adenoidectomies were more common in Finland throughout the study period. Adenoidectomies in both countries decreased markedly from 1999 to 2005. The Finnish adenoidectomy rates were reduced from 212 to 133 per 10,000 children, equivalent Norwegian figures were 84 and 44 per 10,000 children. Tympanostomy tube insertions increased from 97 to 147 per 10,000 children in Finland in the same study period. In Norway the rates were more stable, 119 and 123 per 10,000 in 1999 and 2005, respectively. Peak-age for otitis media surgery was the second year of life in Finland, sixth in Norway. Boys were more frequently operated on in both countries. CONCLUSION: Our study confirmed differences in the approach to otitis media surgery and revealed a decreasing trend in adenoidectomies in both countries. Similar data from other countries is needed to confirm the latter.

Acute mastoiditis in Norway: no evidence for an increase.

OBJECTIVE: In a large Norwegian newspaper in November 2005, an otolaryngologist at Rikshospitalet claimed that the increasing number of children hospitalized for acute mastoiditis was worrying and questioned the restrictive use of antibiotics in Norway. Based on latter he recommended that all children below age 2 with symptoms of uncomplicated acute otitis media should receive antibiotics. Our purpose was to incidence variation and characteristics of acute mastoiditis in children. METHODS: Registry based study with complete data on hospitalization for acute mastoiditis and cortical mastoidectomy in Norway during 1999-2005. RESULTS: Three hundred and ninety-nine Norwegian children aged 0-16 years were included. The incidence of acute mastoiditis in children below 2 ranged from 13.5 to 16.8 per 100,000 during the study period. Corresponding numbers for children 2-16 years were 4.3-7.1 per 100,000 children. No incidence increase was found during the study period. Age-specific incidence revealed a peak during the second and third year of life, and acute mastoiditis was most common in boys. Cortical mastoidectomy was equally common in the young and older age group, 22% received surgery. For children aged 2 and above, significantly fewer children were hospitalized for acute mastoiditis media during the period July, August and September. CONCLUSION: Despite the introduction of restrictive Norwegian guidelines for antibiotic treatment of acute otitis media in children aged 1 year and above, our data did not give evidence for an increase in acute mastoiditis. Except for the high incidence of acute mastoiditis in young children, hospitalization characteristics were remarkably similar in children below and above 2 years.

Early acute otitis media: predictor for AOM and respiratory infections in schoolchildren?

OBJECTIVE: It has been reported that acute otitis media (AOM) and respiratory infectious morbidity still are common in schoolchildren. However, the significance of early initiation of AOM on later respiratory infections is not known. The aim of the study was to assess whether early initiation of AOM is a predictor for AOM and other respiratory infections in schoolchildren, and if environmental exposures and host factors in early life predict later AOM. METHODS: A population-based, prospective study of 3754 children born in Oslo in 1992/93, of which 2549 children were followed from birth to 10 years. Main outcome measures were questionnaire-based information on AOM and other respiratory infections at ages 6 months, 1 year and 10 years. RESULTS: Of the 190 (5.3%) children with one or more episodes of AOM before 6 months, 97 (51.1%) remained susceptible the next 6 months. The total number of children with one or more episodes of AOM from 6 to 12 months was 812 (25.1%). Of the 336 (13.2%) with AOM at 10, 95 (28.3%) also had AOM the first year of life. One or more episodes of tonsillopharyngitis or lower respiratory infections were experienced in 624 (24.4%) of the children at 10 years. There was a predominance of boys with AOM the first year of life, while girls were more prone to AOM at age 10. AOM the first year of life was not strongly associated with AOM at age 10 with crude and adjusted odds ratios 1.3 (95% CI 1.0-1.6) and 1.2 (95% CI 0.9-1.5), respectively. A corresponding tendency was found for other respiratory infections (tonsillopharyngitis or lower respiratory infections) at age 10. Tobacco smoke exposure at birth, early life atopic eczema and otitis media surgery increased the risk of AOM at age 10. CONCLUSIONS: We found no strong association between early AOM and AOM and other respiratory infections in schoolchildren. Parental smoking at birth, early life atopic eczema and female gender were only weakly associated with AOM in 10-year olds while otitis media surgery was strongly associated with AOM in schoolchildren.

Otitis media surgery: large variability between Finland and Norway.

OBJECTIVE: Bi-national comparison of surgical treatment for paediatric otitis media. METHODS: Registry based cross-sectional study with complete data on surgery for otitis media in 2002; 21,811 Finnish and Norwegian children aged 0-16 years. RESULTS: Total rates for otitis media surgery were 82.5 and 146.5 per 10,000 children in Norway and Finland, respectively. Adenoidectomies were four times more frequently performed in Finland and rates for tympanostomy tube insertions differed 2-3-fold, Finland having the higher rate. The contrast in surgery rates was most striking in the age group 0-2 years. Further, the more sparsely populated regions had significantly higher overall surgery rates. CONCLUSION: The large variability in the incidence of otitis media surgery between two similar countries questions whether present guidelines ensure equal treatment in similarly affected children and pinpoints the difficulty in giving advice on age, time and type of surgery.

Acute otitis media in schoolchildren: allergic diseases and skin prick test positivity.

CONCLUSIONS: Single and repeated episodes of acute otitis media (AOM) in 10-year-old children were associated with reported allergic disease. Further, skin prick test (SPT)-negative children with reported asthma and allergic rhinoconjunctivitis had increased risk of AOM. We suggest that optimal treatment of allergic symptoms may have an effect on AOM in school children. OBJECTIVE: The objective of the study was to estimate associations between AOM, allergic diseases and SPT positivity in 10-year-old children. MATERIALS AND METHODS: Population-based cross-sectional study of 3406 10-year-old children living in Oslo. Main outcome measures were questionnaire-based information on AOM and reported physician-diagnosed allergic diseases with symptoms during the last year. In addition, 2657 children were skin prick tested. Logistic regression analyses were performed to estimate associations and control for potential confounders. RESULTS: One or more episodes of AOM were present in 13.8% (n=470) of the children; 9.7% (n=331) had single episodes, while 4.1% (n=139) had two or more infections. We found a statistically significant association between AOM and reported allergic diseases, strongest for AOM and asthma with odds ratio 2.7 (95% confidence interval 1.8-4.0) and 2.3 (95% confidence interval 1.3-4.3) for single and two or more episodes of AOM, respectively. The risk for AOM was increased in asthmatic SPT-negative children compared with asthmatic SPT-positive children, the odds ratios were 3.0 (1.7-5.4) and 1.5 (0.8-2.8), respectively. The same tendency was found for allergic rhinoconjunctivitis.

Paediatric otitis media surgery in Norway.

CONCLUSIONS: In Norway there are large, regional differences in the incidence of surgery and combinations of surgery for otitis media. OBJECTIVES: A descriptive study of complete national administrative data on frequency of surgery for otitis media in 2002. MATERIALS AND METHODS: This study analysed anonymous patient data from the Norwegian patient registry for 2002 and measured rates of tympanostomy tube insertions, myringotomy and the combinations of adenoidectomies and tympanostomy tubes and myringotomy, respectively. Surgical rates were assessed by region and variations within the country were evaluated. RESULTS: The peak age for surgical treatment of otitis media was 5 years. Tympanostomy tubes were inserted in more than half of the children treated and the analysis showed considerable regional variation in the rates and in choice of surgical treatment.

Finnish adenoidectomy and tympanostomy rates in children; national variation.

OBJECTIVES: To assess upper respiratory surgery rates in Finnish children and compare the rates of adenoidectomy and tympanostomy tubes in 2002 with the 1987 cohort. METHODS: Descriptive study of national upper respiratory surgery in Finland in 1987 and 2002; adenoidectomies, tympanostomy tubes and combination of these two. Surgical rates were viewed in the light of child density and number of primary care physicians and otorhinolaryngologists. RESULTS: Rates of adenoidectomy and tympanostomy tubes were highest in Western Finland and lowest in Eastern Finland (p<0.00001). Peak-age for adenoidectomy and tympanostomy tubes was in the second year of life. Surgery was most common in boys (p<0.00001). Both the numbers of otorhinolaryngologists and operations increased from 1987 to 2002; the largest surgery increase, 7.3%, was found in Western Finland. CONCLUSION: Large national differences in rates of paediatric adenoidectomy and tympanostomy tubes in Finland propose that national guidelines have not had an impact on the selection of children for surgery.