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  • Interview with doc Johan Hellgren in connection with the XXXIII Otol. Congress, Gothenburg

    Caption: Dr. Med. Johan Hellgren is in charge of the ENT department at the Institution of Clinical Sciences as well as ENT-specialist and chief physician at the ENT clinic in Sahlgrenska Hospital, specialising in nose/sinus diseases and face traumatology.

    In his role as speaker in NOLF, the Nordic Otolaryngolocial Society and president of the meeting, Johan Hellgren opened the XXIII Congress of the Nordic Association of Otolaryngology, welcomed travelling speakers, ENT doctors and ENT nurses  and thanked the exhibitors for their support.

    Fact box: XXIII Congress of The Nordic Association of Otolaryngology held in Gothenburg Sweden May 31th – June 3rd 2017 was arranged by the Nordic Association of Otorhinolaryngology and the Swedish Association for Otorhinolaryngology, Head & Neck Surgery. The congress, a joint venture of the national Nordic ENT-associations of Denmark, Finland, Iceland, Norway and Sweden, attracted some 750 visitors.The Opening Ceremony began stilily with a drum concert followed by two lectures: * Key Note Lecture by professor Claes Möller ”From Cell to society – on genetic hearing losses, past, present and future”. * Gunnar Holmgren Lecture ”ENT – where are we today” by professor William Coman, Brisbane, Australia.

    John Hellgren XXIII ENT Congress President:
    We work in an area with many facets in continuous change. Our Nordic scientific meeting keeps us up to date, engaged and competent.
    Despite a busy schedule as the manager and overseer of the congress docent Johan Hellgren took the time to answer some questions from our journalist, questions about the structure of this year’s meeting and about the developments within the area ENT and Head and Neck.

    Questions and answers

    Q:The XXIII Congress of The Nordic Association of Otolaryngology 2017 is held in Gothenburg for the second time in 100 years. Nordic ENT meetings have been going on for a long time, beginning in Copenhagen in 1911, which suggests that they are needed. What is the ambition of this year’s congress?

    We are focusing on improved health care within ENT and H&N with a Nordic perspective. That includes scientific updates; clinical excellence; training and review of care quality. Colleagues and ENT nurses are presented with a full scientific programme that covers the many subfields within the speciality. Examples of subjects within our speciality that our conference will shed light on are e.g. breathing disturbances during sleep in children, dental sinusitis, tracheostomy, deaf-blindness, implantable hearing aids and acute vertigo

    Q:What are the most important news or innovations during the congress?

    Let me briefly mention some news, which are presented at the congress.

    * An important cooperation project is new national guidelines for tracheostomy, which are brought forward by SFAI (Swedish Anaestesia and Intensive care association) and SFOHH (Swedish ENT and Head and Neck association). The background is a variation in the competence of the health care sector with regard to the insertion of tracheostomy tubes with patient damage as a result.

    * There is innovation when it comes to the monitoring of sleep apnoea in children with sleep disorders, an area I am active in myself btw. It is important to be able to measure sleep apnoea in children but often technically difficult as the electrodes used for measuring often fall off. Now it is instead suggested that the child will sleep without a pyjamas and that the parents film the child’s sleep around 4 am. Then it is possible to see signs of breathing pauses. In children it is enough to have 1 breathing pause per hour in order to have the disease.

    * Robot assisted surgery within ENT is on-going. Experience from the ENT clinic at SUS in Lund is positive. The robots were from the beginning designed for ”large surgery”. The adaption of the method to ENT has demanded some technical adjustments.

    * Standardized treatment plans; the Danish method for cancer treatment planning is now being introduced to ENT. That is great news.

    Q:You have researched and published studies on sinus infections, sinusitis a large common health problem. A sub diagnosis, dental sinusitis has had its own seminar here. What is the background?

     Dental sinusitis is a problem, which has been given much greater awareness lately. The disease can be cured if the precipitating factor, the infected root, is fixed. Dental sinusitis results in the sinuses, which normally are sterile and carbon dioxide filled, becoming infected by a persisting overlooked infected after root filling in some of the teeth of the upper jaw. The patient seeks helps from his ENT doctor but an antibiotic treatment only helps temporarily.
    – The problem is the difficulty with discovering the tooth infection. The traditional oral X-ray from the dentist often does not show the whole tooth or alternatively, an infected root is hidden behind a healthy root. An examination with CBCT (Cone Beam Computed Tomography), which gives a three dimensional image of the whole tooth is necessary for a proper overview of the situation. A problem in this regard, is that CBCT is found primarily with specialist dentists. It can therefore be difficult for an ordinary dentist to make the diagnosis without a referral.

    Q:The pharmaceutical industry is in a clear minority among the companies exhibiting at the congress. Instruments, implants and machines for relief of breathing problems are dominating. How do you see the need for pharmaceuticals for e.g. otitis: 

    In general we are quite ok with the drugs that we have for treatment of ear infections. In case of otitis the use of systemic antibiotics are decreasing slowly over time with Holland as the role model.
    – When it comes to mastoiditis there is an ongoing project ”Mastoiditis in Sweden” a national study which aims at giving better understanding about which individuals are affected by mastoiditis and how serious the disease progression and fallouts are. The study is looking at all new cases of mastoiditis in the period 2008-2018. The hope is that the study can help with the formation of national common treatment recommendations. The study is taking place in cooperation with all ENT sites in Sweden. A general advice with regard to ear infections is: Strong diagnosis!

    Q. Is it difficult to differentiate the diagnosis AOM from SOM?

    There are some over diagnosis and thereby over treatment of AOM in Sweden. In a GP’s office, which normally uses handheld otoscopes it can sometimes be difficult to separate AOM from SOM, but if an ear microscope is available the differential diagnosis is no major problem.

    Q:What are you seeing as future needs with regard to pharmaceuticals within ENT?

    The future is here! Major changes are already happening. Both within head and neck cancer as well as benign cases like nasal polyps, surgery has a leading position within the ENT specialty. As it looks now, new effective drugs will replace this surgery.
    – Cancer cells can defend themselves against the immune system of the body, which is designed to kill the cancer cells. This tumour reaction has now been mapped and new drugs, which can stop the defense mechanisms of the tumours, are now being tested.
    – Within the whole area of cancer new medicines are in use, such as immunologically based drugs, Johan Hellgren ends.




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