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Biomedical subjects

M Lindbaek

Publications and source records attributed to M Lindbaek.

30 records · Page 2Linked to original sources
PubMed1998

[Tympanometry at a health center].

We wanted to assess how much additional information could be gained from the results of tympanometry after first performing a clinical hearing examination at a mother and child clinic. 182 children aged from six months up to four years, had their hearing first examined clinically and afterwards by tympanometry. Pathological tympanograms were seen in 39% of the ears we examined, but most of them reverted to normal spontaneously at a later stage. There was little concordance between tympanometry and BOEL test in children aged six months and one year. Concordance between tympanometry and audiometry was fairly good in four-year old children. 27 children were referred to an ear, nose and throat specialist for evaluation, 11 of them as a result of tympanometry. Operative treatment was recommended for 17 of the children. In the anamnesis there was a connection between the parents perception of their child's hearing and the child having a cold and referral to an ear, nose and throat specialist. Tympanometry contributes to an early diagnosis of secretory otitis media, as well as being a means of helping parents understand the periodically poor middle ear function of their child.

Acoustic Impedance Tests↗
PubMed1998

[C-reactive protein in general practice. An important diagnostic tool in infections].

In just a few years C-reactive protein (CRP) has become an important test in the rapid elucidation of infections in Norwegian general practice. 33 general practitioners in the southern part of Vestfold county, continuously registered 546 consultations where a CRP analysis was performed. The protein was analyzed in 10% of all the consultations (range 3-31%). The general practitioners stated that the CRP analysis has great diagnostic impact in the elucidation of acute infections, but significantly less impact in routine examinations. The result contributed to a change in diagnosis in 30% of the patients where a diagnosis involving infection was considered. C-reactive protein contributed to a reduction in the prescribing of antibiotics in a quarter of the consultations. C-reactive protein is an important supplement to clinical investigation in the elucidation of infections in Norwegian general practice.

Adult↗
PubMed1998

Predictors of duration of acute sinusitis episodes treated with antibiotics.

OBJECTIVE: To evaluate which factors present at the onset of acute sinusitis predict the duration of illness among adult patients treated with antibiotics. DESIGN: Cohort study with a 30-day follow-up. SETTING: Norwegian general practice. SUBJECTS: Eighty-six adult patients with a clinical diagnosis of acute sinusitis confirmed by Computed Tomography. METHODS: Signs, symptoms and other variables present at the onset of treatment were dichotomized and analysed bivariately with duration of the sinusitis episode, using the log-rank test. Age, gender, and factors with p-values under 0.15 were modelled in a Cox regression analysis to assess independent predictors for illness duration. MAIN OUTCOME MEASURE: Duration of illness. RESULTS: Illness duration was significantly and positively associated with increasing age and with a higher clinical severity score at the onset of treatment. No other factors were independent predictors of illness duration. CONCLUSION: The age of the patient and the clinical severity of the sinusitis at the onset of treatment were independent predictors of illness duration in adult patients treated with antibiotics.

Acute Disease↗
PubMed1998

Antibiotic treatment of patients with mucosal thickening in the paranasal sinuses, and validation of cut-off points in sinus CT.

We compared the efficacy of penicillin V and amoxycillin treatment with placebo in 70 adult patients from Norwegian family practice with a clinical diagnosis of acute sinusitis and mucosal thickening on CT, but without fluid level or total opacification. The study was randomized and double-blind. Three different outcomes were evaluated; subjective status after 10 days of treatment, difference in clinical score between day 0 and day 10, and duration of the illness episode. Amoxycillin and penicillin V gave no better response to treatment than placebo, evaluated by all three outcome measures. The median duration of the sinusitis episode was 10 days in the amoxycillin- and placebo groups and 13 days in the penicillin-V group. In patients with a clinical diagnosis of acute sinusitis, fluid level and total opacification on CT are good criteria to differentiate between groups of patients that need or do not need antibiotic treatment.

Acute Disease↗
PubMed1996

Randomised, double blind, placebo controlled trial of penicillin V and amoxycillin in treatment of acute sinus infections in adults.

OBJECTIVES: To compare the effectiveness of penicillin V and amoxycillin with placebo in treatment of adult patients with acute sinusitis. DESIGN: Randomised, double blind, placebo controlled trial. SETTING: Norwegian general practice. SUBJECTS: 130 adult patients with a clinical diagnosis of acute sinusitis confirmed by computed tomography. MAIN OUTCOME MEASURES: Subjective status after three and 10 days of treatment, difference in clinical severity score between day 0 and day 10 as evaluated by the general practitioner, difference in score from computed tomography on day 0 and day 10, and duration of sinusitis. RESULTS: Amoxycillin and penicillin V led to significantly faster and better recovery than placebo. By day 10, 71 patients receiving antibiotic treatment- (86%) considered themselves to be recovered or much better compared with 25 (57%) receiving placebo. The mean (95% confidence interval) reductions in clinical severity scores by day 10 were 5.4 (5.0 to 5.8) for penicillin V, 5.5 (4.9 to 6.0 for amoxycillin, and 3.4 (2.8 to 4.0) for placebo. For the antibiotic groups combined the number of patients with the greatest degree of improvement on computed tomography (scale 0-16)-that is, score 5-16 on day 10-was 31/83 (37%) compared with 10/44 (23%) receiving placebo. The median duration of the sinusitis was nine days in the amoxycillin group, 11 days in the penicillin V group, and 17 days in the placebo group. CONCLUSION: Penicillin V and amoxycillin are significantly more effective than placebo in the treatment of acute sinusitis.

Acute Disease↗
PubMed1996

CT findings in general practice patients with suspected acute sinusitis.

PURPOSE: To study CT findings in general practice patients with a clinical diagnosis of acute sinusitis, and to examine the interobserver variation between 2 radiologists with regard to their CT evaluation. MATERIAL AND METHODS: Two hundred and one patients were examined with coronal CT images of the paranasal sinuses within 2 days of the clinical diagnosis. Patients with chronic sinusitis were excluded. Fluid level or total opacification of any sinus were used as evidence of sinusitis. RESULTS: One hundred and twenty-seven (63%) patients had fluid level or total opacification in a sinus region, most in more than one region. One hundred and fifteen had CT signs of sinusitis in the ethmoid region, 84 in the maxillary, 18 in the frontal, and 10 in the sphenoid. Forty-nine patients had a negative Ct. In the evaluation of interobserver agreement, the overall assessment of the CT yielded a kappa value of 0.70. CONCLUSION: The study demonstrated great variation in the CT findings in general practice patients with suspected acute sinusitis. More than one sinus region was affected in most patients in whom sinusitis was confirmed by CT imaging; the most common combination was ethmoid and maxillary sinuses. The interobserver agreement was substantial.

Acute Disease↗
PubMed1996

Use of symptoms, signs, and blood tests to diagnose acute sinus infections in primary care: comparison with computed tomography.

OBJECTIVES: This study evaluated different symptoms, signs, and blood tests in the diagnostic process of patients with a clinical diagnosis of acute sinusitis. METHODS: A total of 201 primary care patients in southern Norway aged 15 years or older with a clinical diagnosis of acute sinusitis were evaluated. Computed tomography (CT) was used as a reference standard to divide the patients into two groups: one with and one without confirmed sinusitis. Fluid level or total opacification of any sinus on CT were used as hallmarks of confirmed sinusitis. Blood tests that included erythrocyte sedimentation rate (ESR), C-reactive protein, and white blood count were taken. The patients were evaluated in a standardized way for the medical history and the clinical investigation. RESULTS: A total of 127 (63%) patients had fluid level or total opacification in one or more sinus regions. "Double sickening," purulent rhinorrhoea, purulent secretion in cavum nasi, and ESR > 10 had the highest likelihood ratios and were independently associated with acute sinusitis. CONCLUSIONS: This study confirms the uncertainty of the clinical diagnosis of acute sinusitis in primary care, based on the clinical evaluation alone. Only four symptoms and signs had a high likelihood ratio and were independently associated with acute sinusitis. A combination of at least three of these four symptoms and signs gave a specificity of .81 and a sensitivity of .66.

Acute Disease↗
PubMed1993

[Sinusitis in general practice--treatment and referral].

Sinusitis is usually diagnosed and treated in general practice. A questionnaire was sent to Norwegian general practitioners and to ear, nose and throat specialists to assess which treatment was preferred when treating patients with sinusitis. Penicillin is the drug chosen by both groups of doctors, with tetracycline in second place. A majority of the general practitioners state that they would prescribe 4 mill. IU per day, compared with the recommended 6-8 mill. IU. General practitioners with long clinical experience tend to prescribe tetracycline more often than the sample group of doctors as a whole. Various alternative treatments are used, but the majority of the general practitioners recommend only topical nasal decongestants and paracetamol. Systemic nasal decongestants are still considered relevant in the treatment of sinusitis. Less than half the general practitioners had treated children younger than 12 years of age for sinusitis. 63% state that they periodically treat patients with sinusitis after a consultation by telephone. While Norwegian general practitioners seldom refer patients with acute sinusitis to ear, nose and throat specialists, the majority of patients with recurrent sinusitis are referred.

Anti-Bacterial Agents↗
PubMed1993

[Sinusitis in general practice--a diagnostic challenge].

Sinusitis is a common problem in general practice, but diagnosis is often difficult. The greatest clinical challenge is to distinguish between purulent and nonpurulent sinusitis. This differential diagnosis has consequences for treatment. A questionnaire was sent to a randomized sample of Norwegian general practitioners and to all ear, nose and throat specialists in private practice. 79% of the general practitioners felt that diagnosis is more uncertain for sinusitis than for otitis media. When anamnestic questions and clinical findings were grouped, it was shown that general practitioners consider pain to be much more relevant in the differential diagnosis than purulent secretion. The ear, nose and throat specialists consider pain and purulent secretion to be equally important in the differential diagnosis. Pain in cheek and forehead, and pain in the upper teeth are regarded as the most relevant single anamnestic symptoms. Duration of illness is considered to have little differential diagnostic relevance. Among supplementary tests only C-reactive protein is regarded as helpful. X-ray and erythrocyte sedimentation rate are evaluated as far less relevant.

Clinical Competence↗