فهرست مطالب

Otorhinolaryngology - Volume:30 Issue: 5, Sep - Oct 2018

Iranian Journal of Otorhinolaryngology
Volume:30 Issue: 5, Sep - Oct 2018

  • تاریخ انتشار: 1397/06/14
  • تعداد عناوین: 10
|
  • Tengku Siti Hajar Haryuna*, Agustinus Hamonangan Winston Purba, Farhat Farhat, Widayat Alviandi Pages 247-253
    Introduction

    This study aimed to show the potency of curcumin as an antiapoptotic agent that decreases the apoptotic index in the cochlea lateral wall in ototoxic rat models.

    Materials And Methods

    A total of 24 Rattus norvegicus were divided into eight groups: Group 1 (control group), Group 2 (gentamicin ()), Group 3 (gentamicin curcumin 20 mg/day), Group 4 (gentamicin curcumin 40 mg/day), Group 5 (gentamicin curcumin 20 mg/day for 7 days), Group 6 (gentamicin curcumin 40 mg/day for 7 days), Group 7 (curcumin 20 mg/day for 3 days gentamicin), and Group 8 (curcumin 40 mg/day for 3 days gentamicin). After the division, the rats were terminated in order to measure the apoptotic index using a terminal deoxynucleotidyl transferase (TdT) dUTP nick-end labeling (TUNEL) assay in the fibroblasts of the cochlea lateral walls. The data were analyzed using analysis of variance (ANOVA), and P

    Results

    Administration of gentamicin showed significant differences (P

    Conclusion

    This study concluded that the apoptotic index can be decreased by curcumin and has a preventive benefit toward ototoxic rat models. The administration of curcumin depended on the dose and duration.

    Keywords: Apoptosis, Curcumin, Cochlea, Gentamicin, Prevention, Rats
  • Jahangir Ghorbani, Shima Arastou *, Ali Safavi Naeini, Nasim Raad, Mahboobeh Karimi Galougahi, Alireza Jahangirifard, Nader Akbari Dilmaghani Pages 255-260
    Introduction
    Bleeding during functional endoscopic sinus surgery (FESS) is an important issue for both anesthesiologists and surgeons as it can affect the safety and efficiency of the procedure. We compared the efficacy of tranexamic acid (TXA) and clonidine in reducing blood loss and improving surgical field visualization during FESS.
    Materials And Methods
    In a double-blind, randomized, clinical trial, 52 patients, American Society of Anesthesiologists (ASA) physical status 1–2, aged 13–75 years, suffering from rhinosinusitis with or without polyposis, and who were candidates for FESS, were enrolled. The first group received intravenous TXA 15 mg/kg diluted in 100 ml normal saline, administered during 10-min infusion after induction.
    In the second group, 0.2 mg oral clonidine was given 1 to 1.5 hours before surgery. Duration of surgery, hemoglobin level, heart rate, blood pressure, and quality of surgical field based on Boezzart's scale and surgeon satisfaction based on Likert's scale were recorded in both groups.
    Results
    In total, 52 patients, 27 (51.9%) males and 25 (48.07%) females were studied. Twenty-two (42.3%) and 30 (57.7%) were in the TXA and clonidine groups, respectively. The mean pre- and post-surgical hemoglobin level showed no meaningful difference between the two groups. The same result was obtained for blood pressure and heart rate at different time points (P>0.05). Mean anesthesia time (P=0.859), mean surgical time (P=0.880), surgeon's satisfaction of the surgical field (P=0.757) and surgical field quality at different time points revealed no significant difference between the two groups.
    Conclusion
    Premedication with oral clonidine and intravenous TXA has the same effect on bleeding during FESS, surgical field visualization, and surgeon satisfaction.
    Keywords: Bleeding, Rhinosinusitis, Clonidine, Polyposis, Tranexamic acid, Sinus, Surgery
  • Farnaz Mohajertehran, Hossein Ayatolahi, Kamran Khazaeni, Mohammadtaghi Shakeri, Nooshin Mohtasham * Pages 261-271
    Introduction
    Head and neck squamous cell carcinoma (HNSCC) is one of the most common cancers in the world. Extra- and intra-cellular high-mobility motor box 1 (HMGB1) proteins are invovled in the pathogenesis and prognosis of cancer. Regarding this, the present study was conducted with the aim of investigating the expression of HMGB1 protein and mRNA levels in the blood, tumor tissue, and marginal normal tissue of patients with head and neck squamous cell carcinoma (HNSCC)usingthequantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry (IHC).
    Materials And Methods
    This study was performed on 88 patients with HNSCC, who referred to the otorhinolaryngology and oral pathology departments, affiliated to Mashhad University of Medical Sciences, Mashhad, Iran, and a group of healthy subjects (i.e., control group) matched in terms of age and gender.RNA was collected from fresh tumor tissues, marginal tissues, and blood, followed by the implementation of quantitative PCR on the specimens.Furthermore, the expression of HMGB1 in tumor and normal margins was evaluated by means of IHC. Thedata were analyzed in SPSS software.
    Results
    According to the results,the expression levels of HMGB1 protein and mRNA were significantly higher in the tumor tissue than in the normal margin tissues (P
    Conclusion
    The findings revealed a higher increase in the levels of mRNA and HMGB1 protein in HNSCC, compared to those in the normal margin tissues. In addition, HMGB1 mRNA showed a significant expression in the tissue and blood of the patients with lymph node involvement.
    Keywords: Biomarker, Early diagnosis, Head, neck squamous cell carcinoma (HNSCC), High-mobility motor box (HMGB1), Lymph node involvement
  • Pragya Singh, Shraddha Jain *, Disha Methwani, Sanika Kalambe, Deepshikha Chandravanshi, Sagar Gaurkar, Prasad T. Deshmukh Pages 273-281
    Introduction
    Chronic otitis media (COM) has been broadly classified into mucosal and squamous subtypes. COM types are associated with erosion of the ossicular chain. The aim of the present study was to correlate the type of COM, the site of perforation/retraction, and the type of disease pathology with the pattern and degree of ossicular chain necrosis.
    Materials And Methods
    A prospective cross-sectional study was performed in 76 cases of COM, who were subjected to tympanomastoidectomy. Pre-operative findings were compared with per-operative ossicular chain status and pathology.
    Results
    Incus was found to be the most vulnerable ossicle for erosion, followed by malleus and suprastructure of stapes. The pattern of multiple ossicle involvement was more common. Ossicular chain erosion was more common in squamous COM than mucosal COM (X2=66.25; P=0.0001) and in the presence of cholesteatoma and granulations. Ossicular necrosis was most common in squamous disease with cholesteatoma, followed by squamous disease with granulations, mucosal disease with granulations, and inactive mucosal disease in that order.
    Conclusion
    The degree of ossicular necrosis has a positive correlation with the type of disease pathology, being higher in squamous disease than in mucosal disease. The pattern of ossicular necrosis varies with the site of origin of the disease and the pattern of spread of cholesteatoma, being variable for pars tensa and pars flaccida squamous disease.
    Keywords: Chronic otitis media, Granulations, Mucosal otitis media, Necrosis, Ossicles, Pars flaccida cholesteatoma, Pars tensa cholesteatoma, Squamous otitis media, Tympanomastoidectomy
  • Pradipta-Kumar Parida, Kalaiarasi Raja *, Arun Alexander Pages 283-290
    Introduction
    Laryngotracheal trauma is a rare life-threatening emergency that requires early identification and immediate intervention. Here, we present 26 patients with laryngotracheal trauma from a tertiary hospital in India. The aim was to describe the clinical presentation and management of laryngotracheal trauma patients.
    Materials And Methods
    This was a retrospective study of laryngotracheal trauma patients treated between January 2011 and March 2016. Patients who presented with a breach in the laryngotracheal framework were included, while those who had penetrating neck injuries superficial to strap muscles/platysma, burn injuries, caustic ingestion, or endotracheal injuries were excluded from the study.
    Results
    Of 253 patients with neck injury, 26 (23 adults, three children; 21 males, five females; age range, 5-60 years) presented with a breach in the laryngotracheal framework (15 blunt neck-trauma patients and 11 penetrating neck-trauma patients). The most common cause of neck injury was road traffic accidents, seen in 12 patients (46.2%). Computed tomography (CT) was performed in all blunt trauma cases and in four patients with penetrating trauma. All penetrating trauma patients underwent neck exploration. Twelve blunt trauma patients (46.1%) were managed conservatively, while three (11.5%) required surgical intervention. The most common neck exploration finding noted in patients with a penetrating injury was fracture of the thyroid cartilage, which was seen in eight patients (30.8%). Twenty patients (76.9%) had a normal voice, five patients (19.2%) had a hoarse voice, and one patient (3.8%) had a breathy voice post treatment.
    Conclusion
    Early intervention of laryngotracheal trauma is crucial. The role of a CT scan is essential in decision making in blunt trauma cases.
    Keywords: Arytenoid cartilage, Larynx, Laryngeal cartilages, Neck injury
  • Nasser-Naghib Mohamed, Mohammad-Vaheed El-Anwar * Pages 291-295
    Introduction
    To present and assess a newly designed autoclavable, reusable tube shield for an endotracheal tube (ETT) during laser laryngeal surgery.
    Materials And Methods
    This study included patients scheduled for endolaryngeal laser surgery. A carbonated stainless-steel hemisphere shield (~1.5×0.6 mm) connected to a silk thread passing through a hole in its middle near upper edge was used. Under general anesthesia, patients were intubated orally using a small cuffed polyvinyl ETT, filling the cuff with saline. When the laser was used, the shield was applied either to the side of the tube or anterior to it, depending on the site of the laser procedure. The shield could easily be repositioned when needed during surgery.
    Results
    In 25 cases (six cordectomy for glottic carcinomas and 19 posterior cordotomy for bilateral vocal cord paralysis), application of the shield over the ETT was easy and the shield could be easily and simply fitted in all cases, with change in position achieved easily during the work as required. The shield over the ETT could not be penetrated by the laser, regardless of the gas composition or laser energy. No intraoperative complications were encountered in any of our cases. Recovery was event-free in all patients without the need for admission to an intensive care unit.
    Conclusion
    The newly designed autoclavable reusable stainless-steel shield designed for an ETT could be safely, easily, and effectively used during laser laryngeal surgery with low cost and easy availability. However, comparative and multicenter studies are still needed.
    Keywords: Endotracheal tube, Ignition, Laser, Larynx, Laryngoscopy, Voice, Protection
  • Ranjitha Rao, Deviprasad Dosemane *, Bhagyashree Jaipuria, Debarshi Saha, Manisha Narayan, Kanishka Rao Pages 297-300
    Introduction
    Primary mantle cell lymphoma (MCL) of the palatine tonsil without involvement of the regional lymph nodes is rarely reported.
    Case Report: A 52-year-old male presented with complaints of a change in his voice over 3 months, with neither sore throat nor fever. Physical examination revealed right-sided grade IV and left-sided grade III tonsillar enlargement with prominent vessels. The patient underwent bilateral tonsillectomy. An initial histopathological report revealed chronic tonsillitis on the left side and suspicion of atypical lymphoproliferative disorder on the right. Immunohistochemically, the neoplastic cells were positive for Bcl2, CD20, CD5 and Cyclin D1 and negative for CD10, Bcl6 and CD3; thus a diagnosis of MCL was confirmed.
    Conclusion
    MCL of the tonsil is rare. The microscopic diagnosis is challenging as the picture is very similar compared with other types of small cell lymphomas. A detailed immunohistochemistry panel is required for an accurate diagnosis.
    Keywords: Immunohistochemistry, Lymphoma, Mantle Cell Lymphoma, Waldeyer's ring, Tonsil
  • Pradeep Pradhan *, Dillip-Kumar Samal, Chappity Preetam, Pradipta-Kumar Parida Pages 301-304
    Introduction
    Complications of acute sinusitis affecting multiple sites are very uncommon in the antibiotic era. However, a significant proportion of patients (5–40%) suffering from acute sinusitis can have these complications mostly due to the delayed diagnosis of the disease. Patients can have variable presentations according to the site and extent of the infection.
    Case Report: A 21-year-old male student presented with subperiosteal abscess and a brain abscess with a history of acute sinusitis. The patient had short history of left-side hemiplegia with foot drop. Endoscopic orbital decompression was performed and the subperiosteal abscess was drained when it did not respond to medical treatment. Complete clinical and radiological recovery was achieved after 1 month of medical treatment.
    Conclusion
    Complications affecting the multiple sites in acute sinusitis is very uncommon in the antibiotic era.
    A proper history and thorough clinical examination along with a radiological evaluation are key factors in the final diagnosis of the patients with suspected complications. A quick multidisciplinary approach among otorhinologsts, ophthalmologists and general physicians is always necessary to avoid unwanted life-threatening complications.
    Keywords: Foot drop, Sinusitis, Subperiosteal, brain abscess
  • Mohamed Dhaha *, Souheil Jbali, Sawsen Dhambri, Maroua Mahjoub, Slim Touati, Said Gritli Pages 305-308
    Introduction
    Laryngocele is an air-filled dilatation of the laryngeal saccule that extends upward within the false vocal folds. Different etiologies lead to laryngocele congenital malformation, weakness of the laryngeal tissues and increased intralaryngeal pressure. Laryngocele may be a secondary iatrogenic complication following subtotal laryngectomy.
    Case Report: We report the case of a 61-year-old patient who presented an external laryngomucocele 8 years after a supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP). We focus on the clinical aspects and therapeutic attitude, then discuss the physiopathological conditions that could generate this late complication.
    Conclusion
    Laryngocele after subtotal laryngectomy should be considered a late iatrogenic complication. Histological examination is necessary after surgical management of laryngocele, as the association with cancer is frequent.
    Keywords: Cricohyoidoepiglottopexy, Laryngeal cancer, Laryngocele, Subtotal laryngectomy
  • Alireza Mirzaei, Mozhdeh Zabihiyeganeh *, Ala Haqiqi Pages 309-313
    Introduction
    Cocaine-induced midline destructive lesions (CIMDL) are complications of regular nasal cocaine inhalation. CIMDL can mimic systemic diseases with positive anti-neutrophil cytoplasmic antibodies (ANCA), such as granulomatosis with polyangiitis (GPA).
    Case Report: In this article, we describe the case of a young woman who presented with nasal perforation induced by cocaine, along with positive perinuclear ANCA test (proteinase 3 antigen), misdiagnosed as limited GPA. The patient was treated with immunosuppressive therapy, which partially improved her symptoms. Admittance of cocaine use aided in the diagnosis of CIMDL. This patient was advised to stop cocaine use. Three-month follow-up revealed no further complications.
    Conclusion
    Considering the seropositivity of ANCA in both CIMDL and GPA, early diagnosis of CIMDL and its differentiation from GPA is crucial, and clinicians play an important role in this regard. Lack of distinct histologic characteristics of vasculitis or unresponsiveness to standard therapeutic regimens may favor the diagnosis of CIMDL syndrome. It is crucial to recognize that these conditions may have similar presentations, so that undesired and potentially toxic treatments can be prevented.
    Keywords: Anti-neutrophil cytoplasmic antibody, Cocaine, Granulomatosis