فهرست مطالب

Otorhinolaryngology - Volume:29 Issue: 2, Mar 2017

Iranian Journal of Otorhinolaryngology
Volume:29 Issue: 2, Mar 2017

  • تاریخ انتشار: 1395/12/28
  • تعداد عناوین: 10
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  • Pradeep Pradhan*, Abhimanyu Anant, Vellore Pattabhiram Venkatachalam Pages 63-68
    Introduction
    To demonstrate surgical techniques and to compare the anatomical and functional outcomes between temporalis fascia and cartilage palisade grafting in type-I underlay tympanoplasty in patients with large/subtotal perforation.
    Materials And Methods
    Temporalis fascia and cartilage palisade grafting were conducted in Group A and Group B, respectively, each containing 30 patients with large/subtotal perforations. Pure tone audiogram (PTA) and speech reception thresholds (SRT) were performed preoperatively and at each postoperative visit; i.e. at the end of Month 1,3,6, and 24. A 10-dB closure of air bone gap (ABG) and a 10-dB improvement in SRT were considered significant.
    Results
    The graft uptake rates were 80% and 96.7% in Group A and Group B, respectively, at the end of 24 months. In total, 90% of Group A and 88% in Group B had significant improvement in hearing (ABG ≥10 dB). The mean improvement in SRT in the fascia and cartilage groups was 10 dB and 9 dB, respectively. Seventy-five percent of patients in Group A and 60% of patients in Group B had a significant gain in SRT.
    Conclusion
    Although both temporalis fascia and cartilage palisades can effectively be used for tympanic membrane (TM) grafting in difficult perforations, the latter is considered to be the better autograft, not only because of superior graft uptake but also because it results in a comparable hearing outcome.
    Keywords: Cartilage, Temporalis fascia, Tympanoplasty
  • Hossein Mahmoudi, Mohammad Hossein Baradaranfar, Nasim Behniafard, Mohammad Hossein Dadgarnia, Saeid Atighechi, Vahid Zand, Amin Baradaranfar, Sedighe Vaziribozorg Pages 69-74
    Introduction
    Bleeding is a common concern during functional endoscopic sinus surgery (FESS) that can increase the risk of damage to adjacent vital elements by reducing the surgeon’s field of view. This study aimed to explore the efficacy of topical tranexamic acid in reducing intraoperative bleeding.
    Materials And Methods
    This double-blind, randomized clinical trial was conducted in 60 patients with chronic rhinosinusitis with polyposis (CRSwP) who underwent FESS. Patients were randomly divided into two groups; tranexamic or salinetreatment. During surgery, normal saline (400 mL) or tranexamic acid (2 g) in normal saline with a total volume of 400 mL were used in the saline and tranexamic groups, respectively, for irrigation and suctioning. The surgeons’ assessment of field of view during surgery and intraoperative blood loss were recorded.
    Results
    Mean blood loss was 254.13 mL in the saline group and 235.6 mL in the tranexamic group (P=0.31). No statistically significant differences between the two groups were found in terms of other investigated variables, such as surgical field quality based on Boezzart’s scale (P=0.30), surgeon satisfaction based on a Likert scale (P=0.54), or duration of surgery (P=0.22).
    Conclusion
    Use of tranexamic acid (2 g in 400 mL normal saline) through washing of the nasal mucosa during FESS did not significantly reduce blood loss or improve the surgical field of view. Further studies with larger sample sizes and higher drug concentrations, and using other methods of administration, such as spraying or applying pledgets soaked in tranexamic acid, are recommended.
    Keywords: Bleeding, Rhinosinusitis, Polyposis, Tranexamic acid, Topical, Sinus, Surgery
  • Saba Arshi, Fatemeh Dehghani Firouzabadi, Babak Ghalehbaghi, Ali Dehghani Firouzabadi, Farhad Jalali, Mehdi Shekarabi, Reza Sirous, Mohammad Dehghani Firouzabadi Pages 75-81
    Introduction
    To evaluate the role of allergic-type and infectious-type cytokines in children with chronic otitis media with effusion (OME)
    Materials And Methods
    We investigated serum levels of interleukins (IL)-4, IL-5, and IL-13, along with interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α), by enzyme-linked immunosorbent assay (ELISA) in 35 children with OME and 28 healthy controls.
    Results
    Children with OME had significantly higher levels of IL-5 in comparison with the control group, ranging from 1 pg/ml in cases to 0.04 pg/ml in controls (P=0.009). However, after adjusting for confounding variables, there was no significant difference in serum levels of IL-13, IL-4, IFN-γ, or TNF-α between the two groups (P=0.287, P=0.627, P=0.793, and P=0.217, respectively)
    Conclusions
    The findings of this study suggest that in comparison with the control group, serum IL-5 levels were elevated in OME cases.
    Keywords: Interleukins, Inflammatory cytokines, Otitis media with effusion, pediatrics
  • Mohammad Faramarzi, Sareh Roosta, Mahboobe Dianat Pages 83-88
    Introduction
    The lenticular process of the incus succumbs to necrosis in chronic otitis media. Few researchers have addressed the issue of autograft incus preservation in the soft tissue of the tragus or mastoid cavity. Nonetheless, preservation of the incus in this method during the second stage of ossiculoplasty is a subject that is still up for debate. This study was carried out to demonstrate the hearing outcome after a modification of the incus interposition technique, which involved preserving it in the periauricular soft tissue.
    Materials And Methods
    In the primary operations, tympanoplasty was performed with a postauricular incision. At the end of the surgery, a small pocket was created to preserve the incus beneath the temporalis fascia. The second stage of ossiculoplasty was performed 6 to 18 months after the primary operation. Post-operative pure tone audiometry was analyzed after at least 12 months and was considered successful after achieving an air-bone gap (ABG) within 20 dB.
    Results
    In this paper, we analyzed 199 ears. The mean duration of follow up was 2.5 years. We achieved post-operative ABG within 20 dB in 157 patients (78.9% of patients).
    Conclusion
    This study indicates the efficacy and safety of incus interposition when it is preserved in the postauricular soft tissue.
    Keywords: Autologous grafts, Chronic suppurative otitis media, Incus interposition, Ossiculoplasty
  • Yaghoub Mahboubi Oskouei, Reza Farid Hosseini, Hamid Ahanchian, Lida Jarahi, Nazila Ariaee, Farahzad Jabbari Azad Pages 89-94
    Introduction
    The prevalence of atopic diseases has increased in recent decades dramatically. The most common aeroallergens in Northeastern Iran have not been fully defined. Define the most common aeroallergens in allergic patients based on the skin prick test (SPT) was aimed in this investigation.
    Materials And Methods
    This cross-sectional study enrolled 1,006 allergic patients (aged 1–86 years) from October 2010 to February 2014 referred to the Allergy clinics of Mashhad University of Medical Science. After completing a checklists including demographic information, the SPT was performed according to the patients’ history of aeroallergen sensitivity.
    Results
    Patients with symptoms of asthma allergic rhinitis, atopic dermatitis, and urticaria were enrolled . 97% of patients had a positive skin test to at least one aeroallergen. The most prevalent allergens were Russian thistle (Salsola kali) (50.2%), ash (Fraxinus excelsior) (36.7%), grass mix (29.1%), tree mix (21.6%), and pigweed mix (19.5%). Common allergens in patients with different symptoms of allergic disorders were as follows: asthma (Russian thistle, grass mix, ash, tree mix, and Dermatophagoides pteronyssinus); allergic rhinitis (Russian thistle,ash, grass mix, tree mix, and pigweed mix); urticaria (Russian thistle, ash, grass mix, pigweed mix, and tree mix) and atopic dermatitis (Russian thistle, grass mix, ash, tree mix, and pigweed mix). In the spring, the most prevalent allergens were Russian thistle, ash, grass mix, tree mix, and pigweed mix. In the summer, Russian thistle, ash, grass mix, tree mix, and pigweed mix accounted for the most prevalent allergens. During the autumn, Russian thistle, ash, grass mix, pigweed mix and lamb’s quarter were the most common aeroallergens, while in the winter, Russian thistle, ash, grass mix, pigweed mix, and tree mix were shown to be the most common aeroallergens.
    Conclusion
    Determination of the most common aeroallergens in this area is unavoidable in the diagnosis and management of allergic disorders. Understanding the prevalence of the most common aeroallergens such as Russian thistle in 50.2% of people or other common aeroallergens can help patients and specialists to more easily identify suspected allergens, reduce costs, and support immunotherapy of allergic patients in this area. Moreover, it is helpful in avoiding pollens or cross-reactions.
    Keywords: Allergens, Allergic feature, Pollen, Seasonal Allergy
  • Ali Goljanian Tabrizi *, Abbas Safavi Naeini, Nima Baradaran Pages 95-100
    Introduction
    Although several treatment approaches have been proposed for tinnitus, there are currently no Food and Drug Administration (FDA)-approved agents available to treat this condition. In this study, we evaluated the effect of gabapentin on the sensation of subjective tinnitus in patients with acoustic trauma referring to the ear, nose and throat (ENT) clinic of Taleghani Hospital during 2014.
    Materials And Methods
    In this double-blind, randomized clinical trial, 103 patients with tinnitus due to acoustic trauma who were referred to the ENT clinic of Taleghani Hospital during 2014 were randomized to the gabapentin (300 mg bid, n=55) or control (n=48) groups. The two groups were then compared before and after 6 weeks of treatment using a visual analog scale (VAS). At least a 30% reduction in VAS was considered a response to treatment.
    Results
    Differences between the two groups regarding sex, age, duration of disease, and audiometry results was not significant (P>0.05). After 6 weeks’ treatment, the VAS significantly decreased in both groups (P
    Conclusion
    We conclude that gabapentin 300 mg bid for 6 weeks is an effective treatment for acoustic tinnitus.
    In addition, the placebo effect in relieving tinnitus is remarkable.
    Keywords: Acoustic trauma, Gabapentin, Subjective tinnitus
  • Farahzad Jabbari Azad, Zahra Delavarian, Masoud Hatami *, Hosein Rahimi, Mohammad Reza Abdolvahedi Pages 101-108
    Introduction
    Extranodal Natural Killer (NK)/T-cell lymphoma (NKTCL) nasal type is a rare but well-known disease with poor prognosis. NKTCL is more prevalent in Asia and comprises about 7-10% of all non-Hodgkin lymphoma cases in this region. The characteristic clinical pattern of NKTCL is the destruction of the midline structures of the mid-face.
    Case Report: The present study examines a case of NKTCL in a 23-year-old man with a destructive ulcer of the palate and uvulae. Based on immunohistochemical results, after three months of delay, the definitive diagnosis was revealed to be Extranodal NK/T cell lymphoma. Following the third cycle of chemotherapy, the patient died due to sepsis and infection.
    Conclusion
    It is very common to misdiagnose NKTCL with other clinical conditions such as necrotizing stomatitis, deep fungal ulcers, Wegener’s Granulomatosis disease, etc. Delay in diagnosis can worsen the course of the disease and its prognosis.
    Keywords: Extranodal NK-T-cell lymphoma, Perforation, Palate, Uvula
  • Farzad Izadi, Aslan Ahmadi, Ali Daneshvar, Mahdi Safdarian* Pages 109-111
    Introduction
    Tapia’s syndrome is a rare complication of recurrent laryngeal and hypoglossal nerve paralysis due to anesthetic airway mismanagement or malpositioning of the patient’s head during surgery.
    Case Report:Here we present a case of Tapia's syndrome in a 22-year-old male after corrective jaw surgery under general anesthesia, with a long period of recovery, related to airway management procedures and/or overstretching of the neck during positioning for surgery.
    Conclusion
    Although it is a rare condition, every surgeon should be aware of Tapia’s syndrome in order to consider the correct positioning of the head and endotracheal tube during surgery and avoid this complication.
    Keywords: Airway Management, general anesthesia, Vocal Cord paralysis
  • Mehdi Bakhsaee, Mohammad Hassan Jokar, Zahra Mirfeizi, Elham Atabati, Somayeh Tarighat * Pages 113-116
    Introduction
    Spontaneous pneumomediastinum, pneumothorax, and subcutaneous emphysema are rare, but serious complications of inflammatory myopathies and occur more commonly in DM than PM. complications of dermatomyositis (DM) and polymyositis (PM), both of which can be fatal.
    Case Report:A 20-year-old woman was admitted with neck pain, dyspnea, cough, and fever. She had been diagnosed with dermatomyositis 21 months prior. A thorax computed tomography (CT) scan revealed ground glass opacities in her lungs, pneumomediastinum, pneumothorax, and subcutaneous emphysema. Despite intensive immunosuppressive therapy, clinical deterioration and radiological progression were observed, ultimately the patient died.
    Conclusion
    During the care for a patient with dermatomyositis, the otorhinolaryngologist should be cautious of rapidly progressive and fatal neck subcutaneous emphysema. For a patient with dermatomyositis and with normal bronchoscopy and esophagoscopy, the main treatment is control of dermatomyositis with medical therapy. Therefore, a tracheostomy and/or mechanical ventilation may not be necessary.
    Keywords: Dermatomyositis, Pneumomediastinum, Pneumothorax, Polymyositis, Subcutaneous emphysema
  • Lum Sai Guan*, Kong Min Han, Ngan Kah Wai, Mohd Razif Mohammad Yunus Pages 117-120
    Introduction
    Most metastatic lymph nodes from head and neck malignancy are solid. Cystic nodes are found in 33% - 61% of carcinomas arise from Waldeyer’s ring, of which only 1.8% - 8% originate are from the nasopharynx. Some cystic cervical metastases were initially presumed to be branchial cleft cyst. This case report aims to highlight the unusual presentation of cystic cervical metastasis secondary to nasopharyngeal carcinoma in a young adult. The histopathology, radiological features and management strategy were discussed.
    Case Report:A 36-year-old man presented with a solitary cystic cervical swelling, initially diagnosed as branchial cleft cyst. Fine needle aspiration yielded 18 ml of straw-coloured fluid. During cytological examination no atypical cells were observed. Computed tomography of the neck showed a heterogeneous mass with multiseptation medial to the sternocleidomastoid muscle. Histopathological examination of the mass, post excision, revealed a metastatic lymph node. A suspicious mucosal lesion at the nasopharynx was detected after repeated thorough head and neck examinations and the biopsy result confirmed undifferentiated nasopharyngeal carcinoma.
    Conclusion
    Cystic cervical metastasis may occur in young patients under 40 years. The primary tumour may not be obvious during initial presentation because it mimicks benign branchial cleft cyst clinically. Retrospective review of the computed tomography images revealed features that were not characteristic of simple branchial cleft cyst. The inadequacy of assessment and interpretation had lead to the error in diagnosis and subsequent management. Metastatic head and neck lesion must be considered in a young adult with a cystic neck mass.
    Keywords: Branchial cleft cyst, Metastasis, Nasopharyngeal carcinoma