Publikasjoner
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Schippert, Ana Carla Soares Portugal; Grov, Ellen Karine; Silvola, Juha Tapio & Bjørnnes, Ann Kristin
(2025).
Enhancing surgical care for torture survivors: healing trauma, promoting recovery, and advancing best practices.
BMC Surgery.
25.
doi:
10.1186/s12893-025-03042-0.
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Background
A significant proportion of refugees and asylum seekers have experienced torture, leading to complex, long-term physical and psychological health needs. Many require surgical care for trauma-related injuries but often face barriers such as fear, mistrust, and a lack of trauma-specific knowledge among healthcare professionals. In surgical settings, the absence of trauma-informed practices can contribute to retraumatisation, misdiagnosis, and inadequate care. This narrative review provides an overview offering clinical insights to underscore the importance of trauma-informed, interdisciplinary approaches in the surgical care of torture survivors.
Literature search
This narrative review is based on a targeted literature search conducted across PubMed, Google Scholar, Scopus, and Web of Science between August 2023 and January 2024. Relevant articles were identified through keyword-based searches and manual reference screening. The review focused on literature addressing somatic and surgical care for torture survivors, with an emphasis on trauma-informed approaches. An iterative process was used until thematic saturation was achieved.
Review of literature
Torture survivors frequently suffer from chronic physical conditions—such as brain injuries, fractures, contractures, hearing loss, and genitourinary damage—that may require surgical intervention. Despite these needs, they often face significant barriers to care, including fear, mistrust, and a lack of trauma-specific competence among healthcare professionals. The literature highlights that many survivors receive conflicting diagnoses and inadequate treatment within surgical services, contributing to confusion and loss of trust. Surgical teams are often unprepared to identify signs of torture or manage their complex psychological and physical effects. A trauma-informed, interdisciplinary approach is essential to address these gaps.
Conclusions
Surgical care for torture survivors must integrate trauma-informed practices at all stages to ensure safety, dignity, and effective treatment. Interdisciplinary collaboration is essential. Further research is needed to evaluate these approaches and understand their long-term impact on surgical treatment outcomes.
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Wales, Jeremy; Muyshondt, Pieter G. G.; Silvola, Juha Tapio; Livens, Pieter; Gladiné, Kilian & Dirckx, Joris J. J.
[Vis alle 7 forfattere av denne artikkelen]
(2025).
Minimally Invasive Intraoperative Laser Vibrometry (MIVIB) —A Peroperative Method to Measure Fixation of the Ossicular Chain.
Laryngoscope Investigative Otolaryngology (LIO).
10(3).
doi:
10.1002/lio2.70158.
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Background
Conductive hearing loss requires the surgeon to evaluate ossicular movement to plan and execute surgery. An objective assessment of the ossicular chain with laser vibrometry would likely improve the results of ossiculoplasty.
Methods
Minimally invasive intraoperative laser vibrometry (MIVIB), a fast and accurate technique, using a continuous time-domain signal that stimulates the Med-El FMT transducer attached to the malleus in a temporal bone model, was used to evaluate artificial fixation of the ossicular chain.
Results
Through this analysis method, differing incus velocity responses were seen between simulated single and multiple ossicle fixations in frequencies above 1000 Hz (</> −25 dB respectively). The incus–umbo velocity ratio was shown to detect stapes fixation in both multiple and single ossicle fixations (> −20 and > −10 dB, respectively) highlighting the importance of determining between single and multiple ossicle fixations first.
Conclusion
MIVIB provides an objective assessment of the ossicular chain to identify specific fixations and therefore assist the surgeon in improving surgical outcomes.
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Potsakis, Stavros; Silvola, Juha Tapio & Grov, Ellen Karine
(2025).
Hearing, smell, and cognitive function after cancer treatment.
BMC Cancer.
25(1).
doi:
10.1186/s12885-025-14861-y.
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Abstract Objective This study investigates the sensory and cognitive impact of cancer and its treatment, focusing on possible chemotherapy-induced hearing and olfactory impairment, and cognitive function. The primary aim is to evaluate the effectiveness and feasibility of an extended test battery for assessing sensory and cognitive function in cancer patients, providing foundational knowledge for a larger study. A secondary aim is to examine associations between chemotherapy types and sense-neurodegenerative function. Design An observational cross-sectional, pilot study evaluated hearing, olfactory function, and cognitive function in first-line chemotherapy patients without prior brain injuries and ototoxic or otological histories. Self-reported outcomes on communication strategies, tinnitus and olfaction were collected. Data analysis applied descriptive statistics with t-tests, and Fisher´s exact tests to compare auditory, olfactory, and cognitive performance between treatment groups. Study sample Thirteen cancer survivors ( n = 13), six ( n = 6) females and seven ( n = 7) males who received two different types of chemotherapy. Results No significant differences were observed between the chemotherapy groups in audiological and olfactory tests, cognitive assessment, or self-reported outcomes. However, among those receiving platinum-based chemotherapy, participants reported greater use of communication strategies in specific areas. Conclusion No significant differences in hearing, olfactory, cognitive, and self-reported outcomes were found when examining cancer patients receiving two different chemotherapy types. The study highlights the need for advanced diagnostic tools to detect hearing, olfactory, and cognitive function in cancer survivors.
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Sjövall, Atte; Mustanoja, Ella; Lyyski, Annina; Auvinen, Petri; Silvola, Juha Tapio & Aarnisalo, Antti
[Vis alle 8 forfattere av denne artikkelen]
(2024).
Microbiome of the External Auditory Canal: Changes after Long-Term Hearing Aid Use.
Otology & Neurotology.
ISSN 1531-7129.
45(6),
s. 696–702.
doi:
10.1097/MAO.0000000000004198.
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Objective To investigate the microbial changes of long-term hearing aid use culture independently. Study design Cross-sectional study. Patients Fifty long-term hearing aid users and 80 volunteer controls with asymptomatic ears. Intervention External auditory canal (EAC) sampling with DNA-free swabs. Main Outcome Measures Microbial communities in the samples were investigated with amplicon sequencing of the 16S rRNA gene. Results The final analysis contained 48 hearing aid users, 59 controls. Twenty-four samples were excluded because of low sequence count, recent use of antimicrobials and/or corticosteroids, recent cold, or missing health status. The groups showed significant differences in bacterial diversity (beta div., p = 0.011), and hearing aid users showed lower species richness than the control group (alpha div., p < 0.01). The most frequent findings in both groups were Staphylococcus auricularis, Alloiococcus otitis, Cutibacterium acnes, Corynebacterium otitidis, and Staphylococcus unclassified sp. Hearing aid users' samples presented more Corynebacterium tuberculostearicum than the control samples. Common EAC pathogens, such as Staphylococcus aureus or Pseudomonas aeruginosa were rare. Conclusion Long-term hearing aid use lowers bacterial diversity and modulates the EAC microbiome. The changes mostly affect commensals. Lowered diversity may predispose individuals to EAC conditions and needs more research.
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Silvola, Juha Tapio & Sinkkonen, Saku T.
(2024).
Primary and revision myringoplasty in children: Long-term outcome and analysis of the factors influencing the results.
Journal of Otology.
ISSN 1672-2930.
19,
s. 85–90.
doi:
10.1016/j.joto.2024.04.001.
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Objective Assess the long-term outcome of pediatric myringoplasty. Methods Tympanoplasty type I, myringoplasty, was performed on 85 children (91 consecutive operations, 74 primary and 17 revisions) under 16 years of age. The perforations were sequela either to acute or chronic inflammatory middle ear disease. Medial grafting technique was employed with temporalis fascia. Adenoidectomy was performed earlier on all but five children. The preoperative observation period exceeded one year for all patients. The mean follow-up was 5.4 (SD 3.6) years. Results The long-term graft take rate was 84% for primary myringoplasty, and 53% for revision operations. The re-perforations were associated with postoperative discharge, subtotal or total perforation and revision surgery. In the cohort, sixty ears (66%) were completely healthy (intact tympanic membrane in normal position without adhesions and with good mobility) after follow-up. Spontaneous healing took place in 37% after re-perforation. The preoperative ventilation tube treatment did not affect the outcome and there were no differences between age groups. Preoperative sonotubometry or Valsalva test results did not correlate with outcome. Four ears needed a ventilation tube during the follow-up due to poor ventilation. The mean pure tone thresholds improved significantly after operation. Conclusions Myringoplasty in children is a reliable procedure without age restrictions. One year of preoperative observation excludes most unstable ears, and high tendency of spontaneous healing after re-perforation suggests the need for a lengthy follow-up before revision surgery.
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Schippert, Ana Carla Soares Portugal; Grov, Ellen Karine; Dahl-Michelsen, Tone; Silvola, Juha Tapio; Sparboe-Nilsen, Bente & Danielsen, Stein Ove
[Vis alle 9 forfattere av denne artikkelen]
(2024).
Preventing retraumatisation in torture survivors during surgical care: results of a guideline-development project and qualitative study exploring healthcare providers' experiences.
BMJ Open.
14(8).
doi:
10.1136/bmjopen-2023-083388.
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Objectives - Insufficient training and the absence of guidelines increase the risk of retraumatisation in torture survivors during surgical procedures. This study aims to develop guidelines to mitigate this risk and gather healthcare professionals’ experiences treating torture survivors and insights on the guideline’s feasibility and acceptability.<p> <p>Design - The study was conducted in two phases. Phase ‘a’ involved developing guidelines based on reviews of torture survivors’ encounters in somatic care and potential retraumatisation triggers, as well as a qualitative study on survivors’ experiences during surgical interventions. The development process adhered to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles and the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument for methodological rigour. Phase ‘b’ involved focus groups and individual interviews with healthcare professionals to explore challenges in caring for torture survivors and to evaluate the guidelines.<p> <p>Setting - The study, conducted from May to August 2023, involved participants from surgical departments in three hospitals in southern and southeastern Norway.<p> <p>Participants - Twenty-one healthcare professionals, including surgeons, anaesthesiologists, nurses and a dentist, participated in the study. Both focus group interviews and individual interviews were conducted.<p> <p>Results - Phase ‘a’: guidelines comprising six sections were developed: an introduction, general guidelines and four sections covering the preoperative, perioperative and postoperative surgical stages. Phase ‘b’: healthcare professionals struggled to understand torture’s complexities and identify survivors’ unique needs. They faced challenges using interpreters and assisting patients with strong reactions. While the guidelines were viewed as practical and useful for raising awareness, their length was questioned.<p> <p>Conclusions - We provide recommendations for preventing retraumatisation in torture survivors undergoing surgical treatment. The guidelines may serve as a starting point for offering safe and individualised care to torture survivors. Teaching institutions and hospitals may incorporate the guidelines into healthcare professionals’ education.
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Sjövall, Atte; Pätäri-Sampo, Anu; Silvola, Juha Tapio; Aarnisalo, Antti & Laulajainen-Hongisto, Anu
(2023).
Acute otitis externa and auricular erysipelas; causative pathogens, antimicrobial susceptibility and treatment strategies of tertiary referral centre patients.
European Journal of Clinical Microbiology and Infectious Diseases.
ISSN 0934-9723.
42(8),
s. 1025–1029.
doi:
10.1007/s10096-023-04621-w.
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Pöyhönen, Leena; Silvola, Juha Tapio; Poe, Dennis; Rautiainen, Markus & Kivekäs, Ilkka
(2023).
Balloon dilation improves both the hearing level and the quality of life in patients suffering from obstructive Eustachian tube dysfunction.
European Archives of Oto-Rhino-Laryngology.
ISSN 0937-4477.
doi:
10.1007/s00405-023-08231-2.
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Abstract Purpose Chronic obstructive Eustachian tube dysfunction (OETD) can lead to tympanic membrane (TM) retraction and middle ear effusion (MEE) which can cause conductive hearing impairment, which among other ear symptoms can lower the quality of life (QoL). In this prospective study we assess hearing results and subjective changes in QoL following balloon Eustachian tuboplasty (BET) in treatment of OETD. Methods Totally 25 ears with TM retraction and 18 ears with MEE due to chronic OETD underwent BET as the sole intervention. Outcomes including otoscopy, ability to perform the Valsalva maneuver, tympanometry, audiometry, Eustachian tube inflammation scale and the Glasgow Benefit Inventory questionnaire (GBI) were obtained on all patients preoperatively and 6 months postoperatively. Results Hearing thresholds improved statistically significantly ( p < 0.05) with means of 3 dB in the TM retraction group and 9 dB in the MEE group. Total GBI results indicated a positive influence on patients’ QoL. Valsalva success rate was 80% in patients with TM retraction and 67% in patients with MEE. Tympanometry results improved in 50% of TM retraction patients and in 33% of MEE patients. Conclusions Here we demonstrated that the BET has a positive impact on patients’ conductive hearing loss and QoL in patients with TM retraction or MEE. Results were better in TM retraction group than in MEE group.
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Schippert, Ana Carla Soares Portugal; Dahl-Michelsen, Tone; Grov, Ellen Karine; Sparboe-Nilsen, Bente; Silvola, Juha Tapio & Bjørnnes, Ann Kristin
(2023).
Torture survivors' experiences of receiving surgical treatment indicating retraumatization.
PLOS ONE.
18(10).
doi:
10.1371/journal.pone.0287994.
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Due to the invasive nature of surgical procedures and the involvement of medical personnel, torture survivors may experience re-traumatization during surgical treatment. This study aimed to explore torture survivors’ experiences of re-traumatization during surgical treatment as well as the process by which trauma-related emotions and responses are evoked during surgical treatment for torture survivors. Eight men, aged 45 to 72, from four different countries, who have lived in Norway for 6–40 years, were recruited. We assessed torture and surgical care experiences through in-depth interviews, and the data were analyzed using thematic analysis, resulting in five themes: (1) Interactions with healthcare providers, (2) Reactions during treatment, (3) Triggers causing re-experiences, (4) Avoidance, and (5) Suggestions to healthcare providers. In this study, survivors reported challenges receiving surgical treatment, indicating re-traumatization and difficulty returning to daily life following treatment. Participants reported little collaboration in care-related decision-making processes, lack of recognition of torture by healthcare providers involved in surgical care and experiencing healthcare professionals’ attitudes as a source of perplexity, frustration, and despair. Exacerbation of torture memories throughout treatment and re-experiencing of trauma symptoms aggravated these difficulties. Our findings suggest that surgical treatment can remind torture survivors of the traumatic aspects of torture, eliciting strong reactions and feelings like those experienced during torture.
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Schippert, Ana Carla Soares Portugal; Grov, Ellen Karine; Dahl-Michelsen, Tone; Silvola, Juha Tapio; Sparboe-Nilsen, Bente & Danielsen, Stein Ove
[Vis alle 8 forfattere av denne artikkelen]
(2023).
Re-traumatization of torture survivors during treatment in somatic healthcare services: A mapping review and appraisal of literature presenting clinical guidelines and recommendations to prevent re-traumatization.
Social Science and Medicine.
ISSN 0277-9536.
323.
doi:
10.1016/j.socscimed.2023.115775.
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Abstract
Rationale
The number of torture survivors is on the rise, posing issues for their care in healthcare settings. Even healthcare experts with training in refugee care are unaware of the health difficulties faced by torture survivors. Any medical evaluation or treatment has the potential to re-traumatize torture survivors, thereby reactivating trauma symptoms without applicable guidelines to prevent re-traumatization.
Objective
Our objective was to identify, characterize, evaluate, and organize current, available evidence presenting existing recommendations and suggestions to prevent re-traumatization during the treatment of torture survivors’ physical diseases in healthcare services.
Methods
A comprehensive search of electronic databases was conducted. Gray literature coverage was obtained by searching for publications from relevant associations and healthcare organizations focusing on torture survivors. Clinical practice guidelines (CPGs) and research focusing on somatic healthcare services for adult torture survivors, regardless of study design, were eligible for review. Studies that concentrated on psychiatric departments were excluded. To conduct an overview of the available research and describe the scope and distribution of evidence, a mapping review methodology was used.
Results
Forty out of 13,111 initial citations met our criteria. There were two guidelines, and text and opinion statements predominated. Two authors independently assessed the risk of bias in each primary research study using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for the research design.
Conclusions
This mapping review identifies triggers that may re-traumatize torture survivors during treatment and makes recommendations for prevention. Only a few studies have considered torture survivors' perspectives on treatment and re-traumatization. According to the findings of the mapping review, healthcare providers should consider survivors’ biopsychosocial situations, cultural sensitivity, and personal attitude changes. They must also identify tortured patients and determine when professional interpreters should be used.
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Sjövall, Atte; Laulajainen-Hongisto, Anu & Silvola, Juha Tapio
(2023).
Laser, radiofrequency or tympanostomy knife? Comparison of surgical methods in tympanostomy treatment of young children and predictive value of tympanometry.
International Journal of Pediatric Otorhinolaryngology.
ISSN 0165-5876.
165.
doi:
10.1016/j.ijporl.2023.111443.
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Objectives To investigate tympanostomy tube (TT) treatment in young children, with special interest in bloodless surgical methods (laser and radiofrequency), myringosclerosis formation and tympanometric testing. Methods This prospective study includes 76 children whose 121 ears with middle ear effusion were treated with tympanostomy tubes. Myringotomy was performed with CO2 laser in 37, radiofrequency in 40 and myringotomy knife in 44 ears. The ears were evaluated with otomicroscopy and tympanometry preoperatively and postoperatively every 3–4 months until spontaneous tube extrusion. Results All tubes extruded spontaneously (mean 12.8 months, range 3–36 months), with no persistent perforations or cholesteatomas. CO2 laser and radiofrequency inserted tympanostomy tubes extruded faster (mean 11 months) compared to incisional myringotomy (mean 15 months, p = 0.002). Myringosclerosis was noted in 25 (21%) ears after treatment. There was a tendency to less myringosclerosis with bloodless techniques, but the difference was not significant. Flat tympanograms on the day of procedure predicted continuation of ventilation problems also after TT treatment (p = 0.003). Ears with preoperative type B tympanogram had significantly more myringosclerosis 21/75 (28%) compared with type A and C tympanograms 4/41 (10%) (p = 0.032). Conclusions While all myringotomy methods were effective and safe, the traditional incisional myringotomy with a tympanostomy knife is still a good, feasible and cost-effective myringotomy method. No surgical removal of tympanostomy tubes is needed before 3 years of uncomplicated tympanostomy treatment. Tympanometry turned out to be a useful tool in prediction of post TT treatment ventilation problems of the middle ear.
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Rødvik, Arne Kirkhorn; Torkildsen, Janne von Koss; Wie, Ona Bø; Tvete, Ole; Skaug, Ingebjørg & Silvola, Juha Tapio
(2023).
Consonant and vowel confusions in well-performing adult cochlear implant users, measured with a nonsense syllable repetition test.
International Journal of Audiology.
ISSN 1499-2027.
doi:
10.1080/14992027.2023.2177893.
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Objective The study’s objective was to identify consonant and vowel confusions in cochlear implant (CI) users, using a nonsense syllable repetition test. Design In this cross-sectional study, participants repeated recorded mono- and bisyllabic nonsense words and real-word monosyllables in an open-set design. Study sample Twenty-eight Norwegian-speaking, well-performing adult CI users (13 unilateral and 15 bilateral), using implants from Cochlear, Med-El and Advanced Bionics, and a reference group of 20 listeners with normal hearing participated. Results For the CI users, consonants were confused more often than vowels (58% versus 71% correct). Voiced consonants were confused more often than unvoiced (54% versus 64% correct). Voiced stops were often repeated as unvoiced, whereas unvoiced stops were never repeated as voiced. The nasals were repeated correctly in one third of the cases and confused with other nasals in one third of the cases. The real-word monosyllable score was significantly higher than the nonsense syllable score (76% versus 63% correct). Conclusions The study revealed a general devoicing bias for the stops and a high confusion rate of nasals with other nasals, which suggests that the low-frequency coding in CIs is insufficient. Furthermore, the nonsense syllable test exposed more perception errors than the real word test.
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Grønseth, Torstein; Ovchinnikov, Kirill; Carlsen, Harald; Benth, Jurate Saltyte; Diep, Dzung B. & Unge, Magnus Von
[Vis alle 7 forfattere av denne artikkelen]
(2022).
Lugol's solution and Gentian violet eradicate methicillin-resistant Staphylococcus aureus biofilm in skin wound infections.
International Wound Journal.
ISSN 1742-4801.
doi:
10.1111/iwj.13846.
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The study aimed to evaluate the antibacterial efficacy of Lugol's solution 5% and Gentian violet 1% against methicillin-resistant Staphylococcus aureus (MRSA) biofilm in vivo. The bactericidal efficacy for treatment of MRSA-biofilm skin wound infection was tested in a murine model. Luciferase-tagged S. aureus Xen31, a MRSA-strain derived from S. aureus ATCC-3359130, was used for infection. Wounds were made in the skin of mice and infected with MRSA. The mice were treated with Lugol's solution and Gentian violet. Application of the antimicrobial agents started 24 hours post infection and was repeated daily for five-days. The antimicrobial effect on the biofilm bacteria was evaluated by measuring bioluminescence from MRSA daily for seven-days. Lugol's solution and Gentian violet showed a significant reduction in luminescent signals from the first assessment day to all subsequent days (P < .001). Lugol's solution and Gentian violet effectively eradicated MRSA in biofilm in vivo and could be alternatives or in addition to topical antibiotics when MRSA-biofilm wound infection is suspected.
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Schippert, Ana Carla Soares Portugal; Grov, Ellen Karine; Dahl-Michelsen, Tone; Silvola, Juha Tapio; Sparboe-Nilsen, Bente & Danielsen, Stein Ove
[Vis alle 8 forfattere av denne artikkelen]
(2021).
Development and evaluation of guidelines for prevention of retraumatisation in torture survivors during surgical care: Protocol for a multistage qualitative study.
BMJ Open.
11:e053670(11),
s. 1–11.
doi:
10.1136/bmjopen-2021-053670.
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Introduction: Healthcare professionals working in somatic departments are not trained to recognise signs of torture or provide appropriate healthcare to torture survivors, which may result in retraumatisation during surgical treatment. Methods and analysis: This protocol outlines a four-stage qualitative-method strategy for the development and evaluation of guidelines for prevention of retraumatisation of torture survivors during surgical care. The systematic search for literature review in stages 1 and 2 was conducted in August 2019 and March 2021, respectively, using nine databases. The search strategies employed in stage 1, without imposing any date limits, resulted in the inclusion of eight studies that addressed inadequate healthcare strategies associated with retraumatisation. The clinical guidelines review in stage 2 will include publications from 2000 onwards, which will be appraised using the Appraisal of Guidelines Research and Evaluation Version II instrument. Following multi-institutional recruitment in Norway, stage 3 will explore survivors’ experiences of receiving surgical treatment using indepth interviews (n=8–12), which will be audio-recorded, transcribed verbatim and analysed using the interpretative phenomenological analysis approach. In stage 4a, based on the findings from stages 1, 2 and 3, a set of clinical guidelines for preventing retraumatisation during surgical treatment will be developed. Next, the feasibility and acceptability of the guidelines will be assessed in stage 4b in three interdisciplinary focus group interviews (n=5 per group) and text condensation analyses. Ethics and dissemination: The Regional (South-East C) Committee for Medical and Health Research Ethics approved the study in May 2021 (#227624). In stages 3 and 4, an informational letter and an informed consent form will be distributed to the participants to sign before the interview. The study results will be disseminated through publications, conference presentations, and national and local public forums to healthcare professionals, service managers, policymakers and refugee-supporting agencies.
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Sjövall, Atte; Aho, Velma T.E.; Hyyrynen, Taneli; Kinnari, Teemu J.; Auvinen, Petri & Silvola, Juha Tapio
[Vis alle 8 forfattere av denne artikkelen]
(2021).
Microbiome of the Healthy External Auditory Canal.
Otology & Neurotology.
ISSN 1531-7129.
42(5),
s. e609–e614.
doi:
10.1097/MAO.0000000000003031.
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Objective: To investigate the microbiota of the healthy external auditory canal (EAC) culture-independently and to evaluate the usefulness of the swabbing method in collecting EAC microbiota samples. Study Design: Cohort study. Patients: Fifty healthy asymptomatic working-age volunteers. Intervention: Samples were harvested with DNA-free swabs from the volunteers’ EACs. Main Outcome Measures: Amplicon sequencing of the 16S rRNA gene was used to characterize the microbial communities in the samples. Results: The swabbing method is feasible for EAC microbiota sample collection. The analyzed 41 samples came from 27 female and 14 male subjects; 4 samples were excluded due to recent antimicrobial treatment and 5 because of low sequence count or suspected contaminant microbes. The four most frequent amplicon sequence variants in the microbiota data were Staphylococcus auricularis, Propionibacterium acnes, Alloiococcus otitis, and Turicella otitidis. Typically, the dominant amplicon sequence variant in a sample was one of the most frequent bacteria, but there were also subjects where the dominant species was not among the most frequent ones. The genus Alloiococcus was least common in females who reported cleaning their ears. Subjects with a high relative abundance of Alloiococcus typically had a low abundance of Staphylococcus, which may be a sign of the two being competing members of the microbial community. Conclusions: The most common bacteria in the microbiome of the healthy EAC were Staphylococcus auricularis, Propionibacterium acnes, Alloiococcus otitis, and Turicella otitidis. The EAC microbiota seems more diverse and individualized than previously thought. Also, ear cleaning habits seem to alter the EAC microbiome.
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Silvola, Juha Tapio
(2020).
Endoscopic findings and long-term hearing results for pediatric unilateral conductive hearing loss.
International Journal of Pediatric Otorhinolaryngology.
ISSN 0165-5876.
133.
doi:
10.1016/j.ijporl.2020.109983.
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Objectives Analyze reasons for unilateral conductive hearing loss (CHL) with unknown etiology in children. Introduction Unilateral conductive hearing loss (HL) without known etiology can be undiagnosed despite of hearing screening programs. It can be difficult to find the reason for HL and to make a treatment plan. Middle ear endoscopy gives hard-evidence diagnosis and basis for an individual treatment plan. Methods and material Prospective clinical follow-up study for a cohort of generally healthy elementary school age children with unilateral conductive HL with unknown etiology. The study population was 192 children, of which 46 had a HL of at least 25 dB with more than 10 dB conductive component. Mean age was 8.7 years. Preoperative tests included otomicroscopy, bone- and air-conduction audiogram, tympanometry, stapes reflex tests, Rinne and Weber test and Otoacoustic emissions. The children underwent endoscopy of the middle ear with an individual treatment plan and long-term follow-up. The aim was to explore etiology and to give a treatment plan for hearing loss. Follow-up included air- and bone conduction hearing tests annually or every other year. Mean follow-up was 5.2 years. Results A clear etiological finding was found in 36 (78%) ears, stapes anomaly (23) as the most common (64%) finding. Other findings were two cholesteatomas, 2 status after trauma, 5 middle ear anomalies, 5 incus fixations and one incus erosion. Air conduction hearing improved spontaneously during follow-up in 81% (17/21, 2 dropouts) of the stapes anomaly ears (mean 11,3 dB, range 4–32 dB), and none of these ears showed hearing deterioration. In the incus fixation group, one ear showed hearing deterioration. There were no major complications for exploration, and 5 minor postoperative infections. Conclusions The most common reason for pediatric unilateral conductive hearing loss was stapes anomaly/fixation. The HL does not deteriorate. Hearing loss in stapes anomalies shows a tendency for spontaneous recovery. Stapes surgery can be postponed or avoided.
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Falkenberg-Jensen, Benedicte Margrethe; Jablonski, Greg; Silvola, Juha Tapio; Kristiansen, Joanna Fenn & Hopp, Einar
(2020).
CT imaging of the Eustachian tube using focal contrast medium administration: a feasibility study in humans.
Acta Radiologica Open.
9,
s. 1–6.
doi:
10.1177/2058460119900435.
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Background Several methods of imaging the Eustachian tube have been tested in the last century, although neither has led to an established method. The introduction of balloon Eustachian tuboplasty (BET) has revived the request for Eustachian tube (ET) visualization in patients with chronic Eustachian tube dysfunction. Many institutions perform preoperative computed tomography (CT) scans of the temporal bone and epipharynx before BET. Purpose We hypothesize that the injection of a contrast medium into the tympanic cavity is safe and feasible and can evolve the CT scan by visualizing the ET lumen and, potentially, the level of obstruction. This study is the initial feasibility study for such a human application. Material and Methods Ten minutes before a CT scan, diluted iodixanol was injected into the middle ear in 18 patients planned for BET due to otitis media with effusion. Five patients with Meniere’s disease were controls. Any immediate or delayed adverse events were recorded. Masking of adjacent bony structures in the middle ear on the CT images was evaluated and the most caudally visible contrast medium between the middle ear and epipharynx recorded. Results There were no serious adverse events. One patient reported transitory vertigo. The contrast medium did not mask middle ear structures, apart from the tympanic membrane. The level of contrast medium passage could be assessed. Conclusion Visualizing the ET lumen in humans using intratympanic contrast medium is feasible and safe and does not obscure other valuable image information in a preoperative CT scan.
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Grønseth, Torstein; Vestby, Lene Karine; Nesse, Live Lingaas; Unge, Magnus Von & Silvola, Juha Tapio
(2020).
Bioactive glass S53P4 eradicates Staphylococcus aureus in biofilm/planktonic states in vitro.
Uppsala Journal of Medical Sciences.
ISSN 0300-9734.
125(3),
s. 217–225.
doi:
10.1080/03009734.2020.1765908.
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Background: Increasing antimicrobial resistance to antibiotics is a substantial health threat. Bioactive glass S53P4 (BAG) has an antimicrobial effect that can reduce the use of antibiotics. The aim of this study was to evaluate the antimicrobial efficacy of BAG in vitro on staphylococci in biofilm and in planktonic form. Secondary aims were to investigate whether supernatant fluid primed from BAG retains the antibacterial capacity and if ciprofloxacin enhances the effect. Methods: BAG-S53P4 granules, <45 µm, primed in tryptic soy broth (TSB) were investigated with granules present in TSB (100 mg/mL) and after removal of granules (100, 200, and 400 mg/mL). The efficacy of BAG to eradicate Staphylococcus aureus biofilm in vitro was tested using 10 different clinical strains and 1 reference strain in three test systems: the biofilm-oriented antiseptic test based on metabolic activity, the biofilm bactericidal test based on culturing surviving bacteria, and confocal laser scanning microscopy (CLSM) combined with LIVE/DEAD staining. Results: Exposure to 48 h primed BAG granules (100 mg/mL) produced bactericidal effects in 11/11 strains (p = 0.001), and CLSM showed reduction of viable bacteria in biofilm (p = 0.001). Supernatant primed 14 days, 400 mg/mL, reduced metabolic activity (p < 0.001), showed bactericidal effects for 11/11 strains (p = 0.001), and CLSM showed fewer viable bacteria (p = 0.001). The supernatant primed for 48 h, or in concentrations lower than 400 mg/mL at 14 days, did not completely eradicate biofilm. Conclusion: Direct exposure to BAG granules, or primed supernatant fluid, effectively eradicated S. aureus in biofilm. The anti-biofilm effect is time- and concentration-dependent. When BAG had reached its full antimicrobial effect, ciprofloxacin had no additional effect.
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Moene, Lise Carine Johansen; Hauge, Mats; Silvola, Juha Tapio & Bachmann-Harildstad, Gregor
(2019).
In vitro surface temperature of nasal balloons during hot water inflation.
Rhinology Online.
doi:
10.4193/Rhinol/19.012.
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Background: Posterior epistaxis is often treated with nasal packing by balloon compression or gauzes, and in refractory cases, with ligation of the sphenopalatine artery. These methods are painful, require admission and imply a substantial risk of complications. It has been shown that hot water irrigation is effective to stop bleeding. However, the hot water procedure is associated with patient discomfort, and temperatures over 520C may cause tissue necrosis. The use of nasal balloons filled with hot water may potentially be equally effective and cause less discomfort, but has not yet been studied. The aim of this study was to determine the surface temperature of nasal balloons when filled with hot water. Methodology: An in vitro study was performed to determine surface temperature of Epistat® and Rapid Rhino® nasal balloons when filled with water at different temperatures. Results: There was a strong correlation between inserted water temperature and maximum temperature at Epistat® balloon surface. Maximum surface temperature occurred during the first 30 seconds after water insertion and there was a rapid temperature decline irrespective of inserted water temperature. There was a similar correlation for Rapid Rhino®. However, surface temperatures were in general lower, maintained for a longer period and the peak temperature occurred later. Conclusions: Hot water inflation in nasal balloons seems to be feasible and is unlikely to cause tissue necrosis with inserted water temperatures of 600C or less.
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Silvola, Juha Tapio; Sinkkonen, Saku T; Wanscher, Jens; Westman, Eva; Holm, Niels H. & Ovesen, Therese
(2019).
The status of Eustachian tube balloon dilations in Nordic countries.
World Journal of Otorhinolaryngology - Head and Neck Surgery (WJOHNS).
ISSN 2095-8811.
5(3),
s. 148–151.
doi:
10.1016/j.wjorl.2019.09.002.
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There is no unanimous consensus for indications of eustachian tube balloon dilation (ETBD). Nordic countries have relatively similar hospital organizations and treatment guidelines. Therefore, it was logical to organize a consensus meeting of ETBD. The symposium: Nordic Experiences on Eustachian Tube Balloon Dilation, in Copenhagen, 30–31 March, 2017. The panellists from Denmark, Finland, Norway and Sweden and the attendees of the meeting agreed a consensus on the following issues: Candidates, Definition of Eustachian Tube Dysfunction, Diagnostic Work up, Differential Diagnosis, Contraindications, ETBD Procedure, Complications, Follow-up, and Outcomes. The article also presents the status for ETBD in each of these countries. Thereafter the consensus statement has been discussed in the national societies and meetings for ear surgeons in each of these countries. It can be assumed that surgeons in the hospitals of these Nordic countries generally follow the recommendations from the consensus meeting.
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Rødvik, Arne Kirkhorn; Tvete, Ole; Torkildsen, Janne von Koss; Wie, Ona Bø; Skaug, Ingebjørg & Silvola, Juha Tapio
(2019).
Consonant and Vowel Confusions in Well-Performing Children and Adolescents With Cochlear Implants, Measured by a Nonsense Syllable Repetition Test.
Frontiers in Psychology.
10,
s. 1–17.
doi:
10.3389/fpsyg.2019.01813.
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Although the majority of early implanted, profoundly deaf children with cochlear implants (CIs), will develop correct pronunciation if they receive adequate oral language stimulation, many of them have difficulties with perceiving minute details of speech. The main aim of this study is to measure the confusion of consonants and vowels in well-performing children and adolescents with CIs. The study also aims to investigate how age at onset of severe to profound deafness influences perception. The participants are 36 children and adolescents with CIs (18 girls), with a mean (SD) age of 11.6 (3.0) years (range: 5.9–16.0 years). Twenty-nine of them are prelingually deaf and seven are postlingually deaf. Two reference groups of normal-hearing (NH) 6- and 13-year-olds are included. Consonant and vowel perception is measured by repetition of 16 bisyllabic vowel-consonant-vowel nonsense words and nine monosyllabic consonant-vowel-consonant nonsense words in an open-set design. For the participants with CIs, consonants were mostly confused with consonants with the same voicing and manner, and the mean (SD) voiced consonant repetition score, 63.9 (10.6)%, was considerably lower than the mean (SD) unvoiced consonant score, 76.9 (9.3)%. There was a devoicing bias for the stops; unvoiced stops were confused with other unvoiced stops and not with voiced stops, and voiced stops were confused with both unvoiced stops and other voiced stops. The mean (SD) vowel repetition score was 85.2 (10.6)% and there was a bias in the confusions of [i:] and [y:]; [y:] was perceived as [i:] twice as often as [y:] was repeated correctly. Subgroup analyses showed no statistically significant differences between the consonant scores for pre- and postlingually deaf participants. For the NH participants, the consonant repetition scores were substantially higher and the difference between voiced and unvoiced consonant repetition scores considerably lower than for the participants with CIs. The participants with CIs obtained scores close to ceiling on vowels and real-word monosyllables, but their perception was substantially lower for voiced consonants. This may partly be related to limitations in the CI technology for the transmission of low-frequency sounds, such as insertion depth of the electrode and ability to convey temporal information.
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Rødvik, Arne Kirkhorn; Torkildsen, Janne von Koss; Wie, Ona Bø; Storaker, Marit Aarvaag & Silvola, Juha Tapio
(2018).
Consonant and vowel identification in cochlear implant users measured by nonsense words: A systematic review and meta-analysis.
Journal of Speech, Language and Hearing Research.
ISSN 1092-4388.
61(4),
s. 1023–1050.
doi:
10.1044/2018_JSLHR-H-16-0463.
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Purpose The purpose of this systematic review and meta-analysis was to establish a baseline of the vowel and consonant identification scores in prelingually and postlingually deaf users of multichannel cochlear implants (CIs) tested with consonant–vowel–consonant and vowel–consonant–vowel nonsense syllables. Method Six electronic databases were searched for peer-reviewed articles reporting consonant and vowel identification scores in CI users measured by nonsense words. Relevant studies were independently assessed and screened by 2 reviewers. Consonant and vowel identification scores were presented in forest plots and compared between studies in a meta-analysis. Results Forty-seven articles with 50 studies, including 647 participants, thereof 581 postlingually deaf and 66 prelingually deaf, met the inclusion criteria of this study. The mean performance on vowel identification tasks for the postlingually deaf CI users was 76.8% (N = 5), which was higher than the mean performance for the prelingually deaf CI users (67.7%; N = 1). The mean performance on consonant identification tasks for the postlingually deaf CI users was higher (58.4%; N = 44) than for the prelingually deaf CI users (46.7%; N = 6). The most common consonant confusions were found between those with same manner of articulation (/k/ as /t/, /m/ as /n/, and /p/ as /t/). Conclusions The mean performance on consonant identification tasks for the prelingually and postlingually deaf CI users was found. There were no statistically significant differences between the scores for prelingually and postlingually deaf CI users. The consonants that were incorrectly identified were typically confused with other consonants with the same acoustic properties, namely, voicing, duration, nasality, and silent gaps. A univariate metaregression model, although not statistically significant, indicated that duration of implant use in postlingually deaf adults predict a substantial portion of their consonant identification ability. As there is no ceiling effect, a nonsense syllable identification test may be a useful addition to the standard test battery in audiology clinics when assessing the speech perception of CI users.
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Falkenberg-Jensen, Benedicte; Hopp, Einar; Jablonski, Greg Eigner; Pripp, Are Hugo & Silvola, Juha Tapio
(2018).
The cartilaginous Eustachian tube: Reliable CT measurement and impact of the length.
American Journal of Otolaryngology.
ISSN 0196-0709.
39(4),
s. 436–440.
doi:
10.1016/j.amjoto.2018.04.010.
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Purpose: Balloon dilation of the Eustachian tube is a treatment option for obstructive Eustachian tube dysfunction. The desired balloon position is in the cartilaginous portion. However, the balloon catheter may slide into the bony portion without the surgeon's knowledge. Knowing the length of the cartilaginous portion may improve catheter positioning, but there is no published research on measuring this portion selectively or on whether the length has an impact on development of disease or treatment outcome. To evaluate whether a measurement obtained from CT images is valuable and accurate, to standardize the manner of which the length is measured, and to compare our radiologic measurements to procedural findings, we designed a combined study. Further, we tested the length's influence on development of disease and treatment outcome. Methods: Anatomical end points of the cartilaginous part of the Eustachian tube were unambiguously defined. The length was retrospectively measured bilaterally in 29 CT examinations by two radiologists, and repeated by one after two weeks. New reformats and measurements were made after 18 months for 10 of the patients. Prospectively 10 patients were included in a study where the length measured on CT was compared to per-procedural measurements based on catheter insertion depth to isthmus. Various parameters including length and treatment outcome were measured in 69 patients and 34 controls. Results: Correlation was adequate to excellent in all comparisons. The length of the cartilaginous Eustachian tube did not predict treatment outcome or disease development. The lengths were significantly shorter in females. Conclusion: Measuring the cartilaginous portion of the Eustachian tube on CT images is precise and reproducible, and reflects the length measured intraoperatively. However, it does not seem have a prognostic value.
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Pöyhönen, Leena; Kivekäs, Ilkka; Silvola, Juha Tapio; Poe, Dennis & Rautiainen, Markus
(2018).
Mucociliary function of the eustachian tube in the
eustachian tube dysfunction.
Acta Oto-Laryngologica.
ISSN 0001-6489.
doi:
10.1080/00016489.2018.1562218.
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Luukkainen, Veera; Kivekäs, Ilkka; Silvola, Juha Tapio; Jero, Jussi & Sinkkonen, Saku T
(2018).
Balloon eustachian tuboplasty: Systematic review of long-term outcomes and proposed indications.
The Journal of International Advanced Otology.
ISSN 1308-7649.
14(1),
s. 112–126.
doi:
10.5152/iao.2018.4769.
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Balloon Eustachian tuboplasty (BET) aims to improve the function of the Eustachian tube (ET). The objective of this study was to review the longterm outcome of BET and present the process and results of outlining indications for BET by the Finnish Otosurgical Society. The literature review is based on a database search performed in May 2017. The search resulted in 100 individual articles, which were screened for relevance. Five articles fulfilled the inclusion criteria (follow-up ≥12 months). Five additional articles (follow-up, 6–11 months) were analyzed to obtain supportive information. The proposed BET indications were constituted in the 2016 annual meeting of the Finnish Otosurgical Society. The workshop included a review of the Eustachian tube physiology, middle ear aeration mechanisms, and BET outcome studies. Thereafter, the members of the Society first voted and then discussed 14 cases in order to conclude whether BET was indicated in each case, and subsequently, a consensus statement on the indications for BET was outlined. The long-term follow-up studies were heterogeneous regarding the Eustachian tube dysfunction (ETD) definition, patient selection, follow-up duration, additional treatments, and outcome measures. The current, but limited, evidence suggests that BET is effective in the long-term. However, more long-term studies with uniform criteria and outcome measures as well as placebo-controlled studies are needed. The proposed indications for BET by the Finnish Otosurgical Society include chronic bothersome symptoms referring to ETD, ETD-related symptoms when pressure changes rapidly, or recurring serous otitis media. With the current evidence, we suggest treating only adults with BET.
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Grønseth, Torstein; Vestby, Lene Karine; Nesse, Live Lingaas; Thoen, Even; Habimana, Olivier & Unge, Magnus Von
[Vis alle 7 forfattere av denne artikkelen]
(2017).
Lugol's solution eradicates Staphylococcus aureus biofilm in vitro.
International Journal of Pediatric Otorhinolaryngology.
ISSN 0165-5876.
103,
s. 58–64.
doi:
10.1016/j.ijporl.2017.09.025.
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Objectives
The aim of the study was to evaluate the antibacterial efficacy of Lugol's solution, acetic acid, and boric acid against Staphylococcus aureus biofilm.
Methods
The efficacy of Lugol's solution 1%, 0.1%, and 0.05%, acetic acid 5% or boric acid 4.7% for treatment of Staphylococcus aureus biofilm in vitro was tested using 30 clinical strains. Susceptibility in the planktonic state was assessed by disk diffusion test. Antiseptic effect on bacteria in biofilm was evaluated by using a Biofilm-oriented antiseptic test (BOAT) based on metabolic activity, a biofilm bactericidal test based on culturing of surviving bacteria and confocal laser scanning microscopy combined with LIVE/DEAD staining.
Results
In the planktonic state, all tested S. aureus strains were susceptible to Lugol's solution and acetic acid, while 27 out of 30 tested strains were susceptible to boric acid. In biofilm the metabolic activity was significantly reduced following exposure to Lugol's solution and 5% acetic acid, while boric acid exposure led to no significant changes in metabolic activities. In biofilm, biocidal activity was observed for Lugol's solution 1% (30/30), 0.1% (30/30), and 0.05% (26/30). Acetic acid and boric acid showed no bactericidal activity in this test. Confocal laser scanning microscopy, assessed in 4/30 strains, revealed significantly fewer viable biofilm bacteria with Lugol's solution (1% p < 0.001, 0.1% p = 0.001 or 0.05% p = 0.001), acetic acid 5% for 10 min (p = 0.001) or 30 min (p = 0.015), but not for acetic acid for 1 min or boric acid.
Conclusion
Lugol's solution 1.0% and 0.1% effectively eradicated S. aureus in biofilm and could be an alternative to conventional topical antibiotics where S. aureus biofilm is suspected such as external otitis, pharyngitis and wounds.
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Falkenberg-Jensen, Benedicte; Silvola, Juha Tapio; Laurvik, Helene; Lervik, Andreas; Kristiansen, Joanna & Jablonski, Greg
[Vis alle 7 forfattere av denne artikkelen]
(2016).
CT imaging of the eustachian tube using focal contrast medium administration: a feasibility study.
Laryngoscope Investigative Otolaryngology (LIO).
1(4),
s. 83–87.
doi:
10.1002/lio2.24.
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Objectives: We aim to develop an imaging technique for visualization of the Eustachian tube (ET) lumen. Study Design: A prospective, experimental study in an animal model and in human cadaver specimens. Methods: Applying iodixanol to the middle ear in two human temporal bone specimens, followed by computed tomography (CT) examinations, we optimized contrast dilution, CT algorithm, and head positioning for visualization of contrast passage through the ET. Myringotomy was performed on eight rabbits. Based on the cadaver study, a 20% iodixanol solution was applied to the middle ear, and subsequent CT scans were performed to observe iodixanol in the epipharynx. For some animals, the procedure was repeated on the contralateral ear. We performed the procedure twice on four subjects. Twenty examinations were included. Iodixanol appearance in the ET and the epipharyngeal orifice was assessed qualitatively on CT scans. The tympanic membrane was inspected after 1 or 2 weeks, and histopathological examination of six contrast-exposed temporal bones was performed. Results: The cadaver study provided information on imaging technique and contrast dosage. In rabbits, iodixanol passed through the ET in 19 of the 20 ears. Qualitatively, optimal visualization was seen after 9 to 12 minutes. Clinical inspection after 1 or 2 weeks revealed normal middle ear status. Histopathological samples showed no sign of inflammatory reaction in the tympanic membrane, middle ear, or ET. Conclusion: Iodixanol application to the middle ear is feasible, safe, and demonstrates patency of the ET
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Nordfalk, Karl Fredrik; Rasmussen, Kjell; Hopp, Einar; Bunne, Marie; Silvola, Juha Tapio & Jablonski, Greg
(2016).
Insertion Depth in Cochlear Implantation and Outcome
in Residual Hearing and Vestibular Function.
Ear and Hearing.
ISSN 0196-0202.
37(2),
s. e129–e137.
doi:
10.1097/AUD.0000000000000241.
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Silvola, Juha Tapio; Kivekäs, Ilkka & Poe, Dennis S.
(2014).
Balloon dilation of the cartilaginous portion of the Eustachian tube.
Otolaryngology - Head and Neck Surgery (OTO).
ISSN 0194-5998.
151(1),
s. 125–130.
doi:
10.1177/0194599814529538.
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Rødvik, Arne Kirkhorn; Tvete, Ole; Skaug, Ingebjørg; Torkildsen, Janne von Koss; Wie, Ona Bø & Silvola, Juha Tapio
(2022).
Consonant and Vowel Confusions in Well-Performing Children and Adolescents With Cochlear Implants, Measured by a Nonsense-Word Repetition Test.
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Goplen, Frederik Kragerud; Hess-Erga, Jeanette; Opheim, Leif Runar; Silvola, Juha Tapio; Stene, Brit Kari & Törpel, Jörg
[Vis alle 8 forfattere av denne artikkelen]
(2022).
Buegangsdehiscens.
Tidsskrift for Den norske legeforening (Tidsskriftet).
ISSN 0029-2001.
142(2),
s. 140–143.
doi:
10.4045/tidsskr.21.0426.
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Buegangsdehiscens er en tilstand med plagsomme øresymptomer og svimmelhet forårsaket av en defekt i benet mellom det indre øret og midtre skallegrop. Sykdommen er ufarlig, og for mange pasienter er det tilstrekkelig med en god forklaring på symptomene samt råd om mestringsstrategier, balansetrening og eventuelt bruk av hørselstekniske hjelpemidler. Ved uttalte plager kan kirurgisk behandling være aktuelt.
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Rødvik, Arne Kirkhorn; Tvete, Ole; Torkildsen, Janne von Koss; Wie, Ona Bø; Skaug, Ingebjørg & Silvola, Juha Tapio
(2019).
Perception of speech features compared for two groups of cochlear implant stimulation strategies.
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Rødvik, Arne Kirkhorn; Skaug, Ingebjørg; Torkildsen, Janne von Koss; Tvete, Ole; Perold, Jennifer & Wie, Ona Bø
[Vis alle 7 forfattere av denne artikkelen]
(2018).
Can consonant and vowel perception in well-performing Afrikaans- and Norwegian-speaking cochlear implant users be assessed by a cross-linguistic nonsense syllable repetition test?
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Rødvik, Arne Kirkhorn; Tvete, Ole; Wie, Ona Bø; Torkildsen, Janne von Koss; Skaug, Ingebjørg & Silvola, Juha Tapio
(2017).
Consonant and vowel repetition in children with cochlear implants measured by a nonsense syllable hearing test.
Fulltekst i vitenarkiv
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Grønseth, Torstein; Vestby, Lene Karine; Nesse, Live Lingaas; Unge, Magnus Von; Thoen, Even & Silvola, Juha Tapio
(2016).
The effect of Lugol’s solution and boric acid on Staphylococcus aureus biofilm.
Fulltekst i vitenarkiv
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Rødvik, Arne K; Silvola, Juha Tapio; Torkildsen, Janne von Koss & Wie, Ona Bø
(2014).
Speech sound identification by children and adults with cochlear implants.
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Rødvik, Arne K; Silvola, Juha Tapio; Torkildsen, Janne von Koss & Wie, Ona Bø
(2014).
Speech sound identification by adults and children with a cochlear implant.
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Publisert
31. okt. 2016 13:09
- Sist endret
28. apr. 2023 12:43
