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Erna Kentala

Publications and source records attributed to Erna Kentala.

15 recordsLinked to original sources
PubMed2007

Inheritance of Meniere's disease in the Finnish population.

OBJECTIVE: To study the inheritance of Ménière's disease in the Finnish population. DESIGN: A detailed questionnaire was sent to patients with symptoms resembling Ménière's disease previously examined at the Department of Otorhinolaryngology, Helsinki University Central Hospital, Finland. PATIENTS: The study population comprised 118 patients with symptoms resembling Ménière's disease. The patients were divided into groups based on the diagnostic criteria by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery. MAIN OUTCOME MEASURES: Relatives with Ménière's disease, geographic distribution of birthplaces of grandparents, symptoms, vestibular findings, and audiologic and otoneurologic tests. RESULTS: Approximately 15% of the patients with definite Ménière's disease were found to represent familial disease. The majority of these patients were female, and they had more severe and intense attacks compared with patients with sporadic Ménière's disease. The mode of inheritance is autosomal dominant with incomplete penetrance. CONCLUSIONS: A significant part of Ménière's disease is inherited. The use of genetic isolates in which genetic homogeneity can be assumed might lead to the identification of gene defects leading to Ménière's disease.

Female↗
PubMed2006

Case report: Meniere's disease and otosclerosis--different outcomes of the same disease?

The etiologies of Meniere's disease and otosclerosis are largely unknown. An association between these two diseases has been proposed on both a clinical and histopathologic basis but the causal relationship is controversial. In this paper we report two families in which both otosclerosis and Meniere's disease are inherited as independent phenotypes suggesting that the two diseases represent different outcomes of the same mutation. Thus the Meniere's disease occasionally seen in otosclerotic patients might not be caused by otosclerosis, but rather by a molecular defect leading to endolymphatic hydrops and/or clinical otosclerosis.

Aged↗
PubMed2006

Otolaryngologists' responses to errors and adverse events.

OBJECTIVES: The objectives of this study were to describe otolaryngologists' emotional reactions to errors and adverse events, their efforts to take responsibility, and their attempts to implement improvements. STUDY DESIGN AND METHODS: A retrospective, anonymous survey of 2,500 U.S. otolaryngologists who were members of the American Academy of Otolaryngology-Head and Neck Surgery about errors in their practice was conducted. Respondents were asked whether an error had occurred in their practice in the past 6 months and, if so, to describe the error, its consequences, and any corrective actions taken. Two aspects of these reports stood out, which were beyond the scope of the original study: the respondents' emotional responses and their corrective actions. RESULTS: The response rate was 18.6%. Two hundred ten (45%) respondents reported a total of 212 analyzable error reports and 230 corrective actions. Corrective actions included disclosure to the patient (20 [9%]), ameliorating the consequences of the event to the patient (107 [50%]), personal practice changes (14 [7%]), improvements in the respondent's practice or department (60 [28%]), and hospitalwide or broader corrective actions (19 [9%]). Emotional reactions to errors and adverse events were reported by 22 (10%) otolaryngologists, including regret, embarrassment, guilt, anxiety, loss of temper, and irritation. Legal action was mentioned by five physicians (2%). CONCLUSIONS: Otolaryngologists took actions not only to treat their patients, but also to improve patient care in their practice, department, hospital, or community. Emotional reactions to errors and adverse events are common and need to be addressed in medical training and practice.

Attitude of Health Personnel↗
PubMed2006

Determining the effectiveness of a vibrotactile balance prosthesis.

We present a quantitative method for characterizing the effectiveness of a balance prosthesis based on tactile vibrators. The balance prosthesis used an array of 12 tactile vibrators (tactors) placed on the anterior and posterior surfaces of the torso to provide body orientation feedback related to the angular position and velocity of anterior-posterior body sway. Body sway was evoked in subjects with normal sensory function and in vestibular loss subjects by rotating the support surface upon which a test subject stood with eyes closed. Tests were performed both with (tactor trials) and without (control trials) the prosthesis activated. Several amplitudes of support surface stimulation were presented with each stimulus following a pseudorandom motion profile. For each stimulus amplitude, a transfer function analysis characterized the amplitude (gain) and timing (phase) of body sway evoked by the support surface stimulus over a frequency range of 0.017 to 2.2 Hz. A comparison of transfer function results from the control trials of normal subjects with results from tactor trials of vestibular loss subjects provided a quantitative measure of the effectiveness of the balance prosthesis in substituting for missing vestibular information. Although this method was illustrated using a specific balance prosthesis, the method is general and could be applied to balance prostheses that utilize other technology.

Adult↗
PubMed2005

Vertigo and balance problems in children--an epidemiologic study in Finland.

OBJECTIVES: There is only scant data about the frequency and characteristics of vertigo in children. The aim of the study was to determine the prevalence and characteristics of vertigo and balance problems in children aged between 1 and 15 years. METHOD: One thousand and fifty children aged from 1 to 15 years from one child welfare unit and three schools in Helsinki University Hospital District received a questionnaire acquiring about their dizzy symptoms. RESULTS: Of 1050 eligible children, 938 (89%) or a caregiver completed a simple screening questionnaire, 8% had experienced vertigo and 23% of these it was so severe vertigo that it prevented their present activity. Reason for vertigo was unknown in one third of the children and 69% could name a provocative factor for their vertigo. CONCLUSION: Balance problems are not rare in children and can limit their daily activities.

Adolescent↗
PubMed2005

Vertigo and imbalance in children: a retrospective study in a Helsinki University otorhinolaryngology clinic.

OBJECTIVE: To determine medical characteristics of children with vertigo who visited an otorhinolaryngology (ENT) clinic during a 5-year period. DESIGN: A retrospective chart review carried out between 2000 and 2004. SETTING: Helsinki University Central Hospital tertiary referral center ENT clinic. SUBJECTS: A total of 119 children (63 girls and 56 boys), ranging in age from 7 months to 17 years (mean age, 10.9 years at examination). MAIN OUTCOME MEASURES: Patients were identified from the ENT clinic database based on hospital discharge codes, with data stored in the database and the SPSS program applied for statistical analysis. RESULTS: Only 0.7% of children visiting the hospital during the 5-year period had vertigo. Benign paroxysmal vertigo of childhood, migraine-associated dizziness, vestibular neuronitis, and otitis media-related dizziness accounted for vertigo in most of the children. CONCLUSIONS: Vertigo is a rare primary complaint of children in an ENT clinic. In achieving a diagnosis, the most valuable tools are medical history, an otoneurologic examination, electronystagmography, and audiography.

Adolescent↗
PubMed2005

Prevalence of Menière's disease in general population of Southern Finland.

OBJECTIVE: To study the prevalence of Menière's disease (MD) in the general population of Southern Finland. STUDY DESIGN AND SETTING: Prospective study based on population register data. A questionnaire was sent to 5000 randomly selected persons aged 12 years or more living in the Helsinki University Hospital area. We enquired about whether recipients had experienced vertigo associated with a moving sensation, hearing loss, or tinnitus. For exclusion purposes, we also asked about general illnesses, ear infections, former head and ear traumas, noise exposure, medication, and use of tobacco and alcohol. To assess the validity of the population-based study, we randomly selected a sample of 100 people among those reporting vertigo. They were clinically examined at our vestibular unit. The clinical examination was supplemented by audiologic and otoneurologic tests. RESULTS: The response rate was 63%. In the final study sample of 3116 people, 216 reported the triad of vertigo, hearing loss, and tinnitus. By using the most recent criteria of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery, we were able to identify 16 definite MD patients from the total sample, yielding a prevalence of 513 of 100,000 persons. Among the 16 MD subjects, 9 patients had already been diagnosed with MD and 1 patient was diagnosed during the clinical examination. A peak prevalence of 1709 of 100,000 was seen in the age group 61 to 70 years. CONCLUSIONS: Our population-based estimate of MD prevalence is much higher than in previous reports. EBM RATING: B-3.

Adolescent↗
PubMed2005

Development and validation of an objective instrument to measure surgical performance at tonsillectomy.

OBJECTIVES: The goals of this project were 1) to develop and validate an objective instrument to measure surgical performance at tonsillectomy, 2) to assess its interobserver and interobservation reliability and construct validity, and 3) to select those items with best reliability and most independent information to design a simplified form suitable for routine use in otolaryngology surgical evaluation. DESIGN: Prospective, observational data collection for an educational quality improvement project. METHODS: The evaluation instrument was based on previous instruments developed in general surgery with input from attending otolaryngologic surgeons and experts in medical education. It was pilot tested and subjected to iterative improvements. After the instrument was finalized, a total of 55 tonsillectomies were observed and scored during academic year 2002 to 2003: 45 cases by residents at different points during their rotation, 5 by fellows, and 5 by faculty. Results were assessed for interobserver reliability, interobservation reliability, and construct validity. Factor analysis was used to identify items with independent information. RESULTS: Interobserver and interobservation reliability was high. On technical items, faculty substantially outperformed fellows, who in turn outperformed residents (P < .0001 for both comparisons). On the "global" scale (overall assessment), residents improved an average of 1 full point (on a 5 point scale) during a 3 month rotation (P = .01). In the subscale of "patient care," results were less clear cut: fellows outperformed residents, who in turn outperformed faculty, but only the fellows to faculty comparison was statistically significant (P = .04), and residents did not clearly improve over time (P = .36). Factor analysis demonstrated that technical items and patient care items factor separately and thus represent separate skill domains in surgery. CONCLUSIONS: It is possible to objectively measure surgical skill at tonsillectomy with high reliability and good construct validity. Factor analysis demonstrated that patient care is a distinct domain in surgical skill. Although the interobserver reliability for some patient care items reached statistical significance, it was not high enough for "high stakes testing" purposes. Using reliability and factor analysis results, we propose a simplified instrument for use in evaluating trainees in otolaryngologic surgery.

Clinical Competence↗
PubMed2004

Progression of symptoms of dizziness in Ménière's disease.

OBJECTIVE: To evaluate the progression of symptoms of dizziness in Ménière's disease (MD) by disease duration. DESIGN: Prospective study of patients with MD. Patients were clinically examined, filled out a questionnaire concerning their symptoms, and were divided into 7 groups based on disease duration. SETTING: Tertiary referral clinic. PATIENTS: Sample of 243 consecutive patients with a definite diagnosis of MD who were referred to the vestibular laboratory. Disease duration varied from recent onset to 41 years. RESULTS: No differences were found in frequency, intensity, or duration of vertigo attacks between the different groups. Patients who had MD for less than 10 years experienced less continuous vertigo than those who had MD for more than 20 years. Seventy-five percent of patients who had MD for more than 20 years considered their vertigo attacks severe and 36% still had attacks 1 to 4 times per week. Nausea associated with vertigo was most common among those with a long disease history. CONCLUSION: Patients with MD can have severe symptoms of dizziness even after a 20-year disease history.

Activities of Daily Living↗
PubMed2004

Classification and consequences of errors in otolaryngology.

OBJECTIVE: To develop a preliminary classification system for errors in otolaryngology. METHODS: A retrospective, anonymous survey was distributed to 2,500 members of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Respondents were asked whether an error had occurred in their practice in the last 6 months, and if so, to describe the error, its consequences, and any corrective action taken. RESULTS: There were 466 (18.6%) responses. Two hundred ten (45% of respondents) otolaryngologists reported 216 errors. A classification system for errors in otolaryngology was developed. Errors were classified as related to history and physical (1.4%), differential or final diagnosis (1.4%), testing (10.4%), surgical planning (9.9%), wrong-site surgery (6.1%), anesthesia-related (3.3%), wrong drug/dilution on the surgical field (3.8%), technical (19.3%), retained foreign body (0.9%), equipment-related (9.4%), postoperative care (8.5%), medical management (13.7%), nursing/ancillary (0.5%), administrative (6.6%), communication (3.8%), and miscellaneous (0.9%). There were 78 cases of major morbidity and 9 deaths. If these data are representative, there may be more than 2,600 episodes of major morbidity and more than 165 deaths related to medical error in otolaryngology patients annually. CONCLUSIONS: Human error in otolaryngology occurs in all practice components, including diagnostic, treatment, surgical, communication, and administrative. Types of errors reported by otolaryngologists differ from those reported by other specialists. Error classification systems may need to reflect each specialty's realm of practice. Errors in otolaryngology cause appreciable morbidity and mortality. Quantitative study of errors and the development of targeted prevention and amelioration strategies should be a high priority.

Adolescent↗
PubMed2004

Quality and safety in a complex world: why systems science matters to otolaryngologists.

Almost all modern medical care is delivered in the setting of many overlapping systems. Each system may consist of multiple providers and in most cases electronic and mechanical components. Even "simple" outpatient care is delivered by teams of providers, administrators, and devices. Critically ill inpatients are cared for in extraordinarily complex systems with hundreds of human and non-human elements. The science of complex systems has exploded in recent decades, and there is a large body of knowledge about how such systems function effectively or ineffectively. Many principles of systems science are simple to understand and apply, but few Otolaryngologists are well educated about them. A basic knowledge of systems science will greatly improve the Otolaryngologist's ability to function in complex health care systems and to provide the best care for his or her patients.

Humans↗
PubMed2003

A practical assessment algorithm for diagnosis of dizziness.

OBJECTIVE: We sought to test a 3-parameter model for diagnosis of dizziness based on the type and temporal characteristics of the dizziness and on hearing status. STUDY DESIGN AND SETTING: We conducted a prospective blinded study at a tertiary referral neurotology practice. Before examination, patients completed a questionnaire reporting type and timing of dizziness symptoms and hearing status. Clinical diagnoses were compared with questionnaire results. RESULTS: Fifty-seven patients completed the questionnaire. We were able to correctly classify 21 (60%) of the 35 subjects who had a common otogenic cause of vertigo by the diagnostic algorithm. CONCLUSION: A simple classification of dizziness by type, timing, and hearing status can be self-reported by patients using a brief questionnaire. This classification scheme is as good as others of much greater complexity. SIGNIFICANCE: The simple classification scheme reported here is based on history alone and facilitates triage of dizzy patients into diagnostic groups for work-up and management.

Adult↗
PubMed2003

Reduction of postural sway by use of a vibrotactile balance prosthesis prototype in subjects with vestibular deficits.

To evaluate the effectiveness of a prototype vibrotactile balance prosthesis in maintaining balance during dynamic posturography, we studied 6 subjects with unilateral or bilateral vestibular deficit by means of Equitest computerized dynamic posturography (CDP). Their anterior-posterior (AP) sway at the small of the back was measured with a micromechanical rate gyroscope and a linear accelerometer. The resulting tilt estimate was displayed by a vibrotactile array attached to the torso. The vibration served as tilt feedback to the subject. Subject performance was evaluated with the tilt performance index (TPI), which is the inverse of the root-mean-square of tilt. We found that the balance prosthesis reduced the subjects' AP sway. The subjects' results without the balance prosthesis on CDP sensory organization tests (SOTs) 5 and 6 were compared to results with the prosthesis. The average TPI increased significantly (p < .05) when vibrotactile feedback was used as compared to the unaided condition. This finding was true for both SOTs 5 and 6. We conclude that vibrotactile feedback of estimated AP body tilt improved the subjects' ability to perform selected CDP tests. Some of the subjects were able to stand throughout the test with the device turned on, whereas they otherwise constantly fell.

Adult↗
PubMed2002

Generating decision trees from otoneurological data with a variable grouping method.

When medical data sets are modelled by machine learning methods, wealth of variables may be available. This paper deals with variable selection for decision tree induction in the context of two otoneurological data sets: vertigo data, and postoperative nausea and vomiting data. First, a variable grouping method based on measures of association and graph theoretic techniques was used to gain insight into data. Then, representations of learning data were defined using the information from discovered variable groups, and decision trees were generated. The use of variable grouping method was beneficial by revealing interesting associations between variables and enabling generation of accurate and reasonable decision trees that modelled the application areas from different viewpoints.

Data Collection↗