Otorhinolaryngology and Head & Neck Surgey

The field of Otorhinolaryngology and Head & Neck Surgey includes many vital structures: sensory organs such as hearing and balance, taste and smell, areas for respiration, swallowing, cheewing and facial expression. The neck includes the voice which is of vital importance for human communication.

Otolaryngology and Head & Neck Surgery includes medical and surgical treatment options. Our field originally developed over 100 years ago as highly specialized surgery with our roots in general surgery.

Main responsibility: Göran Laurell, Professor

Table of contents 

Studies on Bell´s Palsy (Idiopathic Facial Nerve Paralysis)

Each year 2,000 subjects in Sweden are struck by peripheral facial palsy. Of these 75% are of unknown origin, i.e. Bell’s palsy. In 2001 we initiated a double-blind randomized multicentre study comparing prednisolone, valacyclovir, the combination of the two active drugs and placebo. The results show a beneficial effect on time to recovery and a better outcome for patients treated with prednisolone whereas no beneficial effect was found with valacyclovir. Further analyses are in progress and so far three dissertations, based on this large study, have been published.

Members of the group
Lars Jonsson
Mats Engström
Thomas Berg
Nina Bylund

Molecular Radionuclide Targeting of Head and Neck Cancer 

Cancer cells differ from normal cells in many ways, for example by different protein expressions on the cell surface. In targeted radionuclide therapy (TRT), we take advantage of these differences, by using e.g. antibodies to target these structures, and by arming these “missiles” with radionuclides. By delivering the radioactivity directly to the tumour cells, small metastases and disseminated tumour cells can be found and eradicated in the body. By using radionuclides as warheads, multidrug resistance can be avoided, and the need to target every single tumor cell is reduced.

There is great potential for targeted radionuclide therapy in the treatment of head and neck cancer. In this disease there is a vast need for a systemic treatment that is effective in locating or treating metastases at distant sites and minimal residual disease at the local and regional levels. Furthermore, head and neck cancer is intrinsically radiosensitive, and is therefore especially suitable for TRT.

In the Head and Neck Targeting Group, we are studying several steps in the targeting process. Different protein structures, targeting molecules and radionuclides are assessed, and the different properties of the constructed radioconjugates are evaluated. By creating and evaluating novel tumour seeking radioconjugates, we hope to provide more sensitive and specific methods for identifying and treating head and neck cancer, and hopefully help improve long-term survival rates for this patient group in the future. 

Members of the group
Marika Nestor, Principal Investigator
Karl Sandström
Anna-Karin Haylock
Kristina Lundberg
Tomas Ekberg
Göran Laurell
Eva Lindell Jonsson

We have a well-functioning collaboration with the research group of Professor Sophia Hoper at the Royal Institute of Technology (KTH), Sweden since several years. We also have well-established collaborations with Dr Tolmachev and Dr Orlova, Uppsala University, Sweden, experts in molecular imaging, and with Dr Sandström at the Nuclear Medicine Department at Akademiska Hospital, Uppsala, Sweden, for molecular imaging studies. We also collaborate with Professor Sir David Lane at the University of Dundee, Scotland, and IMCB in Singapore, Professor John McCafferty (University of Cambridge, UK) and Dr Ronny Falk (Royal Institute of Technology, KTH, Sweden). Our group has also well functioning connections with Dr Greg Adams, Fox Chase Cancer Center, Philadelphia, USA, Dr Jacek Capala, NCI/NIH, Washington D.C., USA, Professor Guus van Dongen, Free University Medical Center, Amsterdam, The Netherlands, and Professor Reidar Grénman, Department of Otolaryngology and Head & Neck. Surgery, University of Turku, Finland.

Swallowing Disorders and Nutrition in Patients with Head and Neck Cancer

Swallowing problems and impairment of nutritional status are common in patients with head and neck cancer and may remain for a long period of time after termination of treatment. In prospective studies we aim to increase the knowledge on changes in swallowing function and malnutrition in patients with head and neck cancer The overall goal is to reduce sequelae after treatment and improve the quality of life for the patients.

Exogenous Hearing Loss and Otoprotectants Preventing Damage to Hearing and Balance

Cisplatin is a mainstay in the treatment of testicular cancer and used as a first-line treatment of a number of different malignant solid tumors. Hearing loss is a major side-effect of cisplatin and may cause treatment interruption. In this research project we are aiming to map cisplatin transport to and within the cochlea and establish methods for otoprotection by performing mechanistic and otoprotective studies. The round window membrane (RWM) is a possible local entry route for pharmacological clinical treatment of inner ear disorders and is used for experimental as well as clinical studies. Further insights into the mecahnisms of cisplatin ototoxicity and how to prevent these will be obtained.

Members of the group
Göran Laurell, Principal Investigator
Pernilla Videhult-Pierre
Birgitta Linder
Per Olof Eriksson
Sahar Nikkhou Aski Karolinska universitetssjukhuset
Victoria Hellberg, Capio,
Cecilia Engmér Berglin, Karolinska universitetssjukhuset
S Allen Counter, Harvard University, USA

Upper Respiratory Airways

Form and function of the upper airways in adults treated for unilateral cleft lip and palate: Nasal form and function is of concern to cleft palate patients. The aim of the study was to analyze the form and function of the nasal airways and quality of life in adults operated for unilateral cleft lip and palate (UCLP). All UCLP-patients born 1960-1987, treated at the Cleft lip and palate (CLP)-center, Uppsala University Hospital, Sweden, were invited to participate. Seventy-six percent (n=83) of the patients participated at an average of 32 years after primary surgery. The patients had been treated according to the same protocol except for palate closure, which was performed in one stage until 1977 and two stages thereafter. An age-matched control group underwent the same examinations. 

Members of the group
Mats Holmström, Principal Investigator
Maria Mani
Staffan Morén
Valdemar Skoogx
Örnolfur Thorvardsson
Erika Reiser
Anna Andlin-Sobocki
Lilian Stålhammar

Snoring and Sleep Apnea in Women – Risk Factors, Signs and Consequences

In 2000, 7,051 women ≥ 20 years from the general population answered a questionnaire on snoring and sleep disturbances. Furthermore, 230 snoring women and 170 women regardless of snoring status were investigated with polysomnography, blood sampling and anthropometric measurements. Of these, 132 participants now underwent an ocular and endoscopic examination of their upper airways. Several findings in the upper airways characterised normal-weight women with an apnea-hypopnea index (AHI) ≥ 10. In women with BMI of > 25, no pharyngeal characteristics predicted sleep apnea. When adjusting for age, obesity, smoking, AHI and sleep parameters, several aspects of daytime sleepiness correlated to snoring independently of AHI. No symptoms correlated to AHI independently of snoring. 

Strong correlations were found between obesity and inflammatory markers. AHI and nocturnal hypoxia correlated to all markers except MPO. When adjusting for age, obesity and smoking, only IL-6 and TNFα were independently associated with nocturnal hypoxia. No independent relationship was found between systemic inflammation and AHI. In conclusion, age and obesity influence the prevalence of snoring and sleep apnea in women from the general population. Other risk factors differ according to body habitus. Daytime symptoms appear to be independently related to the snoring per se, while systemic inflammation is mainly attributed to obesity. 

Further studies, based on the large European GALEN and RHINE studies, aim to investigate how airway disease (rhinitis, rhinosinusitis, asthma and chronic bronchitis) influence quality of sleep, snoring and obstructive sleep apnea syndrome. The aim is also to study the influence of airway disease on life of quality and to find out if anatomical conditions relate to the severity of obstructive sleep apnea syndrome. 

Members of the group
Malin Svensson
Caroline Bengtsson
Eva Lindbergx
Lars Jonsson
Mats Holmström
Jenny Theorell-Haglöw
Christer Jansson


Exercise induced laryngeal Obstruction (E-ILO) is an important differential diagnosis to Exercise-induced Asthma (EIA). In patients where upper airway problems are suspected, we have since 2005 used videolaryngoscopy during exercise (CLE-test) to identify the cases with laryngeal obstruction as explanation for the symptoms. Several projects are running to elucidate questions concerning EILO and Vocal Cord Dysfunction (VCD).

To map the breathing problems during exercise, all 13-14 year-old children in Uppsala (n=3815) received a questionnaire in January 2011. A random selected group of children from this study will in 2012 and 2013 be tested by EIA-tests and CLE-test to find the number of both EIA and EILO in this cohort. It is likely that EIA as well as EILO will be found among these children.

As 80% of the patients are young females, one project is started to elucidate the influence from female sex hormones. This study is in co-operation with the Department of Gynecology and Obstetrics. In another project a neuromuscular explanation for a sub-group of the patients is studied.

Members of the group
Leif Nordang
Katarina Norlander
Staffan Morén
Christine Ölander


Principal investigator: Helge Rask-Andersen, Professor 

Cochlear Implants and Otology

The EAS technique has been applied for cochlear implantations which has its approach through the round window membrane – a technology for an improved non-traumatic technique as compared with the conventional cochleostoma approach. The group has performed more than 1000 skull base procedures since 1988 and all data are followed through a computer-based program. Our experience from ABI surgery in adults became the basis for hosting the first international symposium on ABI treatment here in Uppsala in 2010. CI surgery in children is undergoing rapid changes since they will probably be re-implanted two or three times during their lifetime. A non-traumatic surgery technique is of utmost importance. Miniaturization of devices enables a change of the surgical approach from cochleostomy to round window insertion. The round window technique seems more atraumatic and may preserve residual inner ear function. The unit possesses a temporal bone bank. The bank consists of 325 inner ear molds and 85 micro-dissections displaying anatomical landmarks including the facial nerve. The bank is used for training of international surgeons and for scientific purposes.

Surgical quality control follow-up studies and life quality data are analysed following surgery of otosclerosis and atresia. Computor-based analyses are made after skull base surgery, cholesteatoma and cochlear implant surgery.

Nanoparticle Based Inner Ear Therapy

Uptake, toxicity and localisation of different nanoparticles (NPs) in spiral ganglion cells in vitro have been anlysed within an EU-project. Several experiments on nanotargeting the TrkB molecule on auditory nerves have been performed. Using various targeting molecules it has been possible to show a selective up-take of NP in neurons compared to glia cells. 

Molecular Studies of the Human Ear

Distribution and significance of connexins in the human cochlea have been analysed as also the expression of electric synapses in the human auditory nerve and prestin. In vitro analyses of NF2 cells and Nanoparticle mediated gene transfer of merlin and receptor mediated pharmacotherapy are under way (NanoEar project). Aquaporin has been identified. Freshly obtained human tissue has been analysed with high resolution SEM. Gene analyses are performed with expression of hair cell markers (Math-1/Atoh1 and Myosin VIIA).

Studies on Regeneration

Stem cells/neurospheres were isolated from the spiral ganglion and differentiated into inner ear specific nerve cells. Transplantation studies of spiral ganglion progenitor cells from GFP-transgenic mice into the rat inner ear, in vitro and in vivo, are performed in collaboration with the Karolinska hospital.

Experimental studies of in vitro cultured auditory nerve cells have been made such as the effects of axotomy, guidance molecules, growth factors and electric stimulation. 

Members of the group
Helge Rask-Andersen, Professor
Marja Boström
Wei Liu
Karin Strömbäck
Niklas Danckwardt-Lillieström
Lennart Edfeldt
Anders Kinnefors
Elsa Erixon
Konrad Konradsson

D. Brackmann, Professor, Hitselberger, Linthicum, HEI/HEC, Los Angeles, USA
A. Schrott-Fischer, Professor, Innsbruck University Hospital, Austria
W. Baumgartner, Professor, Vienna ENT Clinic, Gstoettner, Austria
H. Löwenheim, Professor, Tübingen University Hospital, Germany
T. Yeo, Professor, Catholic General Hospital, Seoul, S. Korea
L. Sennaroglu, Professor, Ankara, Turkey
V. Colletti, Professor, Verona, Italy
I. Pykkö, Professor, Tampere, Finland
T. Lenarz, Professor, Hannover, Germany