amin amali

A sleep apnea monitor (BM2000A) is a wrist-worn device that measures oxygen saturation and pulse rate during sleep. This study aimed to evaluate the efficacy of the watch-like BM2000A for screening obstructive sleep apnea (OSA).BM2000A; Home sleep apnea testing; Obstructive sleep apnea; Polysomnography; Wrist pulse oximeter 102 patients complaining of sleep breathing disorders were included; 81% were men and 19% were women. All participants underwent overnight simultaneous polysomnography (PSG) and BM2000A sleep monitoring. The number of apneas and hypopneas, apnea-hypopnea index (AHI), percentage of time spent with oxygen saturation under 90%, average oxygen saturation, lowest oxygen saturation, and duration of sleep were computed by the BM2000A and PSG. Then, these parameters were compared to validate the BM2000A.All parameters, measured with BM2000A, had a good correlation (r ≥ 0.6, p < 0.0001) with PSG-derived indexes, except for sleep time (r = 0.19, p = 0.061) and hypopnea index (r = 0.4, p < 0.0001). AHI had the strongest correlation (r = 0.87, p < 0.0001). The mean difference between AHI values calculated with PSG and wrist-worn pulse oximeter (WPO) was -17.66 events/h (95% CI: -50.39 to 15.06). In AHI ≥ 5, BM2000A had 90.7% sensitivity, 100% specificity, 91.2% accuracy, and 0.994 area under the curve. Using AHI ≥ 5, ≥ 15, and ≥30 as the screening criteria, optimal WPO-AHI cutoffs to improve the screening accuracy were 3.10, 8.92, and 13.05.BM2000A-derived results properly correlate with PSG and can provide OSA screening with good sensitivity and specificity.

The present study aimed to compare the effects of paracetamol and ibuprofen on pain, bleeding, nausea, and vomiting following adenotonsillectomy in children.This was a prospective, double-blinded, randomized clinical trial. Block randomization was used to assign 50 patients to two groups of paracetamol and ibuprofen. In the paracetamol group, subjects received 15 mg/kg oral paracetamol 30 min before the induction of anesthesia, followed by the same dosage every 6 h postoperatively. Meanwhile, the ibuprofen-treated group took 10 mg/kg oral ibuprofen 30 min before and every 6 h after the operation. The subjects in both groups received the medication for three postoperative days. The postoperative pain score was assessed 6 h after the surgery and during the second and the third postoperative days. Nausea and vomiting episodes were recorded in the first postoperative day and first postoperative week. Based on the results, intraoperative and postoperative bleeding in both groups was not significantly different. The mean score of pain in the first postoperative day (6 h after the surgery) and the second and the third postoperative days did not show any statistical difference. The ibuprofen group experienced fewer vomiting episodes, compared to the paracetamol group during the first postoperative day (P=0.011). Vomiting episodes in the first postoperative week did not illustrate any significant difference. As evidenced by the results of the current study, Ibuprofen had the same effect on the alleviation of postoperative pain, caused fewer vomiting episodes, and did not cause excessive bleeding as an NSAID. Therefore, Therefore, oral administration of ibuprofen is suggested for pain relief and management of other complications following adenotonsillectomy in children.

Otosclerosis is a bone deforming disease of the otic capsule. The objective of our study was to evaluate the effect of stapedotomy on tinnitus in patients with otosclerosis.

Nineteen patients with otosclerosis who suffered from tinnitus and conductive hearing loss and scheduled to undergo stapedotomy were enrolled in the study. The incidence and severity of tinnitus were recorded using a visual analog scale (VAS) questionnaire before and after surgery. Tinnitus scores were compared according to the VAS.

Mean age of patients was 37.3±10.8. Tinnitus disappeared in 47.4% of the cases, improved in 36.8%, and was unchanged in 15.8% of the patients. Mean tinnitus scores before and after the surgery were 6.4±1.9 and 3.1±2.4 respectively. Comparison of the tinnitus score revealed statistically significant improvement in the tinnitus perception of the patients who underwent stapedotomy (P<0.001).

In otosclerotic patients who will undergo stapedotomy for hearing improvement, stapes surgery may improve tinnitus, also.

 Invasive aspergillosis (IA) is the most prevalent invasive infection with high mortality among patients with leukemia. Early diagnosis of IA has been a challenging topic in this group of patients.

 In this study, we evaluated the galactomannan levels of nasal lavage fluid (NALF) as a possible auxiliary method for IA diagnosis in patients with leukemia.

 In a prospective study, 32 adult patients with leukemia who were taking induction and/or consolidation chemotherapy with fever and neutropenia were included. In all patients, galactomannan (GM) levels of serum and NALF, and mycological examinations were evaluated before the first dose of antifungal therapy.

 Fourteen (43.7%) patients had NALF GM ≥ 0.5; however, in 16 (50%) patients the level of serum GM was ≥ 0.5. The elevated level of NALF GM had a significant association with the proven IA cases (P = 0.048). The GM level of NALF with a cut-off value of 0.45 (by receiver operating characteristic curve analysis) had 78% sensitivity and 64% specificity for the diagnosis of invasive aspergillosis (P = 0.033).

 Due to its non-invasive nature, GM level of NALF may be contributory to be used as part of the diagnostic work‐up of IA particularly in leukemic patients with thrombocytopenia which prohibits acquiring bronchoalveolar lavage.
 

This study aimed to assess the long-term effects of postoperative debridement on the 4th and 8th postoperative weeks versus no debridement in terms of subjective and objective outcomes.  

The statistical population of this study (n=80) consisted of 40 patients having chronic rhinosinusitis with nasal polyposis (CRSwNP) and 40 patients having chronic rhinosinusitis without nasal polyposis (CRSsNP). These samples were randomly divided into two groups of debridement and control.  

According to the results, 8 weeks after endoscopic sinus surgery (ESS), the 22-item Sino-Nasal Outcome Test questionnaire score (P =0.03), Lund-Kennedy score (p <0.001), nasal blockage (P=0.02), and loss/decrease in sense of smell (P=0.02) in CRSwNP were significantly lower in the debridement group than in the control group. Moreover, 6 months after ESS, in both CRSwNP and CRSsNP, no significant difference was observed between the two groups considering the outcomes (P>0.05).  

This study showed that debridement could lead to short-term improvements in CRSwNP patients; however, no long-term benefit was observed.

During functional neck dissection, the surgeon tries to preserve the internal jugular vein (IJV); however, the incidence of its narrowing or obstruction following modified radical neck dissection (MRND) or selective neck dissection (SND) varies between 0% and 29.6%. The most distressing complication of IJV thrombosis (IJVT) is pulmonary embolism. This study aimed to evaluate the incidence of IJVT following selective or modified radical neck dissection.   

In this study, 109 neck dissections were performed with the preservation of the IJV on 89 patients from March 2011 to December 2012 in the Cancer Institute of Imam Khomeini Hospital Complex, Tehran, Iran. Ultrasound evaluation of the IJV was performed in the early postoperative period and three months after the surgery.  

The study population consisted of 62 male and 27 female patients with a mean age of 57+17.57 years. Ultrasound evaluation of the IJV among the participants (109 veins) indicated thrombosis in nine veins (8.25%) in the early postoperative period, four of which remained thrombotic and without flow three months after the surgery. Moreover, 96.33% of the IJVs were patent with a normal blood flow three months after the neck dissection. Among the evaluated IJVs, the only factor that showed a significant association with IJVT was the incidence of postoperative complications, including hematoma and seroma (P=0.01).
 

It seems that the most important factor for the prevention of the IJVT is a meticulous surgery and surgical complication avoidance during neck dissection.

 The aim of this study was to assess the quality of the surgical field, amount of blood loss, and duration of surgery following induced hypotension with labetalol, nitroglycerin, and high dose propofol in patients undergoing FESS under general anesthesia.

One hundred and eight patients scheduled for FESS under general anesthesia were recruited in this randomized trial and were allocated to one of the three study groups: 1) Nitroglycerine (NTG) group: nitroglycerine with a dose of 2-5 μg/kg/min was administered; 2) Labetalol (LAB) group: an IV bolus dose of labetalol (20 mg) was injected at first and then IV infusion of labetalol at a rate of 1-2 mg/min; 3) High dose propofol plus normal saline (0.5-1 ml/min) group. Hemodynamic variables and the amount of bleeding were recorded intraoperatively and the surgeons' satisfaction was asked following each surgery considering the surgical field quality using a 5-item Likert scale.

The average blood loss (ml) in patients in the LAB group was significantly less than patients in NTG and high dose propofol groups (127 ml vs 198 and 145 ml, respectively) (p- value=0.001) and the surgeons expressed greater satisfaction with the surgical field quality in the LAB group (p- value=0.001).

Labetalol infusion may be a safe and effective method for induction of controlled hypotension to provide a comparatively bloodless field. High dose propofol may be a second choice if labetalol is not available.

Polysomnography (PSG) is the gold standard for diagnosis of sleep disorders. Several software programs are available to analyze sleep tests according to available guidelines and decrease the time and cost of PSG analysis. This study aimed to compare the parameters of automated analyzer software with analysis of trained technician (manual analysis). Twenty patients who underwent full-night PSG were randomly selected. A sleep technologist who was blind to the study, scored sleep stages and respiratory events according to recommended criteria of American Academy of Sleep Medicine (AASM) 2013, then an auto analysis was done using N-7000 amplifier. Results of auto analysis and manual analysis were compared. Descriptive statistics and paired t-test were used for data analysis. Total sleep time (TST) and sleep efficiency (SE) calculated by auto analysis was significantly more than manual analysis (511.82 ± 35.34 vs. 396.85 ± 75.97 for TST and 95.47 ± 3.74 vs. 74.14 ± 35.34 for SE, respectively). Furthermore, there was no concordance for sum of apneas and hypopneas during TST. However, calculated number of hypopneas in non-rapid eye movement (NREM) stage in auto analysis and manual analysis was quite similar. The least precision was observed in scoring of stages 3 and REM for auto analysis scoring and the most similarity for scoring of stage N2. Detecting hypopneas in NREM stage by auto analysis maybe the reliable parameter that could help the technicians during analysis of sleep test. There is a need for more advanced automated algorithms. Furthermore, manual analysis is superior to automated one in PSG analysis according to the current results.

To assess the rate of cervical lymph node involvement in patients with supraglottic squamous cell carcinoma (SCC) with no lymph node in clinical assessments and radiological studies.
Fifty-six patients who underwent elective dissection of the cervical lymph node of the second through fourth level were enrolled, and pathologic evaluation of the dissected lymph nodes was performed. Lymph node involvement and association between tumor grade, smoking and gender with lymph node involvement were assessed.
The rate of the occult neck metastasis in this series was 37.5%. There was no statistically significant association between lymph node involvement and tumor grade, smoking, or gender.
Based on the results of our study, we recommend elective bilateral neck dissection in all stages of N0 supraglottic SCC patients.

Numerous anatomical abnormalities or pathological conditions can cause upper airway obstruction in obstructive sleep apnea syndrome (OSAS). Muller’s maneuver (MM) is one of diagnostic modalities investigating the obstruction site in patients with OSAS. This study aimed to investigate the obstruction sites of patients with OSAS based on MM.
This was a case-series study. A total of 145 patients were enrolled in this study. The awake MM (a flexible fiberoptic endoscopy of the upper airway while patients perform forced inspiration against a closed oral and nasal airway) was performed by a single surgeon with the patient in a supine position. Endoscopic findings were classified using the modified velum, oropharyngeal lateral walls, tongue base, and epiglottis (VOTE) classification criteria.
Mean ± standard deviation age of patients was 41.5 ± 10.1 years old. Mean respiratory disturbance index was 29.7 ± 24.3/hours. The most common site of obstruction in all patients was velum. About 72% of the patients had more than 75% obstruction in the velum area while most patients had Simple awake diagnostic test before surgery would help physicians to identify obstruction sites of OSAS patients.

Cigarette smoking and alcohol consumption have a well-known effect on the development of upper aerodigestive tract carcinomas, but such a role for opium is questionable. This study was designed to assess the correlation between opium inhalation and cancer of the larynx and upper esophagus.
Fifty eight patients with laryngeal cancer, ninety eight patients with upper esophageal cancer and twenty seven healthy individuals with no evidence of head and neck or esophageal malignancies were selected from Otolaryngology and Radiation Oncology Department of Mashhad University of Medical Sciences. Duration and amount of cigarette smoking and opium consumption were recorded through comprehensive interviews.
The crude odds ratio for laryngeal cancer was 5.58 (95% CI 2.05-15.15, P=0.000) in cigarette smokers relative to non-smokers and 9.09 (95% CI 3.21-25.64, P=0.000) in opium users relative to non-users. The crude odds ratio for esophageal cancer was 0.44 (95% CI 0.18-1.09, P=0.07) in cigarette smokers relative to non-smokers and 1.44 (95% CI 0.57-3.62, P=0.43) in opium users relative to non-users. After adjusting for smoking, the odds ratio for laryngeal cancer in opium users relative to non-users was 6.06 (95% CI 1.10-33.23, P=0.05). Laryngeal cancer was detected at a significantly lower age in opium users (54.54±10.93 vs 62.92±10.10 years, P=0.02) than in smokers. This effect was not observed in esophageal cancer. Although the duration (year 17.50±14.84 vs 21.91±14.03; P=0.34) and amount (pack/day 0.625 vs 0.978; P=0.06) of smoking were higher among those who were opium dependent, these differences were not statistically significant (P=0.34 and P=0.06, respectively).
Opium addiction by snuffing is an independent risk factor for the development laryngeal cancer but not esophageal cancer. Cigarette smoking increases this risk. Opium dependency increases the likelihood of developing laryngeal cancer at a younger age.

The surgical management of chronic frontal sinus disorders remains a challenge for rhinologists. The aim of this study was to evaluate the result of Draf III in a series of patients who underwent this procedure.
Twenty patients were included in this study. Demographic data, history of prior surgery, asthma, aspirin sensitivity and Lund–Mackay score were recorded. A visual analog scale was used for frontal-related symptoms. Patients were followed for a mean duration of 17.5 months and the patency of the frontal sinus ostium was closely monitored.
Fifteen patients with chronic frontal sinusitis, two patients with mucoceles, two with malignancy, and one with osteoma underwent Draf III. The mean symptoms score significantly decreased from 5.9 to 3. No ostial closure was seen in the follow-up period. Among 15 patients with chronic frontal sinusitis, 12 had patent ostia of whom three had significant stenosis. All patients with mucocele and osteoma had patent ostia in the follow-up period but patients with sinonasal malignancy showed significant stenosis.
Draf III frontal sinusotomy is successful in alleviating patient symptoms and the frontal sinus neo-ostium will remain patent in long-term follow-up of most patients. Revision surgery will be required in some cases, which seems to be related to the nature of the underlying chronic sinus diseases.

The hallmark of vitiligo is the disappearance of melanocytes from the skin. As a result, of melanocytes presence in the auditory and vestibular apparatus, the involvement of these systems in vitiligo which targets the melanocytes of the whole body is possible; suggesting that vitiligo is a systemic disease rather than a purely cutaneous problem. A total of 21 patients with vitiligo were enrolled in this study. A group of 20 healthy subjects served as a control group. Pure tone audiometry (PTA), auditory brainstem responses (ABR) and vestibular evoked myogenic potentials (VEMP) were carried out in all participants. High frequency sensory neural hearing loss was seen in 8 (38.09%) patients. ABR analysis revealed 10 (47.61%) had an abnormal increase in latency of wave III, and 6 (28.57%) had an abnormal prolongation of IPL I-III, however, regarding our VEMP findings, there were no recorded responses on left ear of 1 (4.76%) patient and latency of p13 was prolonged in 5(23.80%) patients. There was no correlation between ages, duration of disease, and any of the recorded parameters (P>0.05). In the present survey, we highlighted the auditory and vestibular involvement in vitiligo patients.

High prevalence of asthma and bronchospasm was observed during induction of anesthesia in patients with chronic suppurative otitis mMedia (CSOM) who underwent tympanomastoidectomy. Although several studies have proposed association of allergic diseases with CSOM but no consensus about it has been established. Current study was designed to determine the coincidence of asthma in CSOM patients. In a cross-sectional study, authors investigated medical records of 106 CSOM patients underwent tympanomastoidectomy, aged 15 to 65 years, and 95 controls, which were matched by age and sex. Participants were admitted to Valiasr Hospital, Tehran, Iran, from April of 2011 to March of 2013. Required information, such as demographic characteristics and history of allergic rhinitis (AR) and asthma were obtained from patient's medical records. The prevalence of AR in the CSOM group was higher than controls’ group (19.8% and 15.8%, respectively) (P>0.05). Asthma prevalence was significantly higher in patients with CSOM (P=0.03) (OR=7.67, 95% CI: 0.9-62.5). No significant association was found between history of AR and chronic ear infections. However, asthma was significantly more common in CSOM patients. Current study indicates that asthma and risk of bronchospasm need particular attention in patients with CSOM underwent tympanomastoidectomy before and during anesthesia.

Tinnitus is a common otologic symptom that can seriously affect a patient’s quality of life. The purpose of the present study was to translate and validate the Iowa Tinnitus Handicap Questionnaire (THQ) into the Persian language, and to make it applicable as a tool for determining the effects of tinnitus on a patient’s life. The main version of the THQ was translated into the Persian language. The agreed Persian version was administered to 150 tinnitus patients. The validity of the Persian THQ was evaluated and internal reliability was confirmed using Cronbach’s α-coefficient. Finally, the effect of independent variables such as age, mean patient threshold, gender, and duration of tinnitus were considered in order to determine the psychometric properties of tinnitus. After an exact translation process, the Persian THQ was found to exhibit face validity. In terms of content validity, the Content Validity Ratio (CVR) reached 100% in all but two questions. Further, in structural validity measurements, intermediate correlation with annoyance from tinnitus (r= 0.49), low correlation with duration of tinnitus (r = 0.34) and high correlation with the Tinnitus Handicap Inventory (THI) questionnaire (r = 0.84) were demonstrated. Additionally, a negligible effect of gender and age was noted on degree of tinnitus handicap (P = 0.754 andP= 0.573, respectively). In the internal reliability assessment for Factors 1, 2, 3, and the whole questionnaire, Cronbach`s α-coefficient was 0.95, 0.92, 0.25 and 0.88, respectively. The Persian version of the Iowa THQ demonstrates high validity and reliability and can be used for the determination of tinnitus handicap and for following-up in the intervention process in Persian tinnitus patients.

Vestibular involvements have long been observed in otosclerotic patients. Among vestibular structures saccule has the closest anatomical proximity to the sclerotic foci, so it is the most prone vestibular structure to be affected during the otosclerosis process. The aim of this study was to investigate the saccular function in patients suffering from otosclerosis, by means of Vestibular Evoked Myogenic Potential (VEMP). The material consisted of 30 otosclerosis patients and 20 control subjects. All participants underwent audiometric and VEMP testing. Analysis of tests results revealed that the mean values of Air-Conducted Pure Tone Average (AC-PTA) and Bone-Conducted Pure Tone Average (BC-PTA) in patients were 45.28 ± 15.57 and 19.68 ± 10.91, respectively and calculated 4 frequencies Air Bone Gap (ABG) was 25.64 ± 9.95. The VEMP response was absent in 14 (28.57%) otosclerotic ears. A statistically significant increase in latency of the p13 was found in the affected ears (P=0.004), differences in n23 latency did not reach a statistically significant level (P=0.112). Disparities in amplitude of p13-n23 in between two study groups was statistically meaningful (P=0.009), indicating that the patients with otosclerosis had lower amplitudes. This study tends to suggest that due to the direct biotoxic effect of the materials released from the otosclerosis foci on saccular receptors, there might be a possibility of vestibular dysfunction in otosclerotic patients.

Tinnitus is a perception of sound without external source. The exact etiology of tinnitus is not fully understood, although some researchers believe that the condition usually starts in the cochlea. The aim of this study was to determine the potential contribution of outer hair cell dysfunction to chronic tinnitus, by application of Distortion-Product Evoked Otoacoustic Emission (DPOAE) and Transient Evoked Otoacoustic Emission (TEOAE) and also to determine the relationship between tinnitus loudness and the amplitude of these two potentials. This study was conducted on 20 tinnitus patients aged 20–45 years and 20 age- and gender-matched control subjects. DPOAE and TEOAE were performed on each subject. The difference in the amplitudes of TEOAE between the two groups was not significantly different (P=0.08), but the amplitude of DPOAE in patients with tinnitus was significantly lower than the corresponding value in the control subjects (P=0.01). There was no correlation between tinnitus loudness and the amplitudes of neither DPOAE nor TEOAE. Abnormal findings in the DPOAE of tinnitus sufferers suggest some form of cochlear dysfunction in these patients. As there was no correlation between the amplitude of the recorded potentials and tinnitus loudness, factors other than cochlear dysfunction may also influence the loudness of tinnitus.

Laryngopharyngeal reflux (LPR) is a variant of gastroesophageal reflux disease (GERD) in which the stomach contents go up into the pharynx and then down into the larynx. LPR causes a wide spectrum of manifestations mainly related to the upper and the lower respiratory system such as laryngitis, asthma, chronic obstructive pulmonary disease, cough, hoarseness, postnasal drip disease, sinusitis, otitis media, recurrent pneumonia, laryngeal cancer and etc. The object of this study was to examine the effect of N-acetyl Cysteine (NAC) with and without Omeprazole on laryngitis and LPR. Ninety patients with laryngitis or its symptoms were referred and randomly assigned into three groups. The first group was treated by Omeprazole and NAC. The second group was treated by Omeprazole and placebo and the last group was treated by NAC and placebo. Duration of treatment was 3 months and all patients were evaluated at the beginning of study, one month and three month after treatment of sign and symptoms, based on reflux symptom index (RSI) and reflex finding score (RFS). Based on the results of this study, despite therapeutic efficacy of all treatment protocols, the RSI before and after 3 months treatment had significant difference in (NAS+ Omeprazole) and (Omeprazole+ placebo) group (P<0.001 in the first group, P<0.001 in the second group and P=0.35 in the third group). Whereas RFS before and after 3 month treatment had significant difference in all groups. (P<0.001 in each group in comparison with itself) but this results had not significant difference after 1 month treatment. Our results showed that the combination therapy with Omeprazole and NAC treatment had the most effect on both subjective and objective questionnaire at least after 3 months treatment. Based on the results of the present study, it seems that the use objective tools are more accurate than subjective tools in evaluation of therapeutic effects in patients with GERD-related laryngitis.

Tinnitus is a perception of sound without external source. For complete assessment of tinnitus, central auditory processing abilities should be considered in addition to the routine psychological evaluation of tinnitus characteristics. Temporal processing is one of the important auditory skills that are necessary for complex higher level auditory processing. 20 tinnitus patients and 20 healthy volunteers without tinnitus, all with normal auditory thresholds (≤20 dBnHL), were enrolled in present study. Pure Tone Audiometry (PTA), Tinnitus evaluation, Gap in Noise (GIN) test and Duration Pattern Test (DPT) were applied to all participants. Analysis of GIN test revealed statistically significant increases in an approximate threshold value of gap detection in the patients group, both in right and left sides (P=0.007 and P= 0.011, respectively). Comparison of percentage of correct responses in between two groups was also statistically meaningful in right and left ears (P= 0.019 and P=0.026, respectively). The comparison of different parameters of DPT in two study groups revealed no significant differences in percentage of correct responses between two groups (P>0.05). GIN test results identified auditory temporal resolution difficulties in patients with tinnitus, meaning that in spite of normal auditory thresholds there may be some possibility of abnormality in central auditory processing functions.

Vestibular evoked myogenic potential (VEMP) has recently been broadly studied in vestibular disorders. As it is evoked by loud sound stimulation, even mild conductive hearing loss may affect VEMP results. Bone-conducted (BC) stimulus is an alternative stimulation for evoking this response. This study aims to assess the characteristics of BC-VEMP in different groups of patients. We performed a cross sectional analysis on 20 healthy volunteers with normal pure-tone audiometry as a control group; and on a group of patients consisted of 20 participants with conductive hearing loss, five with bilateral sensorineural hearing loss and four with vestibular schawannoma. AC and BC-VEMP were performed in all participants. In control group the VEMP responses to both kinds of stimuli had an acceptable morphology and consisted of p13 and n23 waves. Latency value of these main components in each type of stimulus was not significantly different (P>0.05). However, the mean amplitude was larger in BC modality than AC stimulation (P=0.025). In the group with conductive hearing loss, the VEMP response was absent in fifteen (46.87%) of the 32 ears using the AC method, whereas all (100%) displayed positive elicitability of VEMP by BC method. Normal VEMP responses in both stimuli were evoked in all patients with sensorineural hearing loss. In patients with unilateral vestibular schwannomas (VS), 2 (50.00%) had neither AC-VEMP nor BC-VEMP. Auditory stimuli delivered by bone conduction can evoke VEMP response. These responses are of vestibular origin and can be used in vestibular evaluation of patients with conductive hearing loss.

Otorrhea and granulation tissue in Canal Wall Down mastoidectomy (CWD) is the common problem in cholesteatoma removal and leads to many discomfort for both the patient and the physician. The main objective in CWD is creating the dry cavity, so the topical antibiotic and acetic acid in variable saturations are used for this purpose. In this study we evaluate the effectiveness of topical MMC and chemical cautery by acetic acid. Study population consists of 50 patients with cholesteatoma whom underwent CWD. All patient allocated randomly in two study groups, MMC and acetic acid. After 3 weeks, the first visit is planned, extension of granulation tissue and dryness of cavity are evaluated and topical drugs are used in blind fashion. MMC in 4% and acetic acid in 12.5% saturation are applied. Other visits are completed at next month and 3 months later. Both methods are effective in treatment of granulation tissue. In each group both treatment were effective too but MMC was more effective than acid acetic in the treatment of granulation tissue after 4 weeks. Based on our findings, it is clear that topical MMC is very effective in the treatment of granulation tissue and in CWD. It results in dry cavity much better than acetic acid without any complication.

Vitiligo is a systemic disease which leads to the destruction of melanocytes of the body. The hallmark of vitiligo is the formation of white patches in the affected skin but، because of the presence of melanocytes in the auditory and vestibular apparatuses، these systems may also be involved at some point in the course of the disease. 21 patients with vitiligo (12 females، 9 males) and 21 healthy controls (11 females، 10 males) were enrolled in this case-control study. Pure tone audiometry (PTA)، Auditory brainstem responses (ABR) and Vestibular evoked myogenic potential (VEMP) were carried out for all participants. High frequency sensory neural hearing loss was indicated in 8 (38. 09%) patients. ABR analysis revealed that 10 (47. 61%) patients had an abnormal increase in latency of the wave III، which was statistically meaningful in both right and left ears (P = 0. 024 and P = 0. 001، respectively) and that 6 subjects (28. 57%) had an abnormal prolongation of the IPL I-III. However، findings from the VEMP measurements showed no recorded responses in the left ear of 1 (4. 76%) patient and statistically significant prolongations in the latency of the p13 were shown in 5 (23. 80%) patients (P = 0. 001). Because of antioxidant، ion-recycling and protective roles of melanocytes in the auditory and vestibular systems، the involvements of these systems are possible in vitiligo vulgaris.

The hallmark of vitiligo is the disappearance of melanocytes from the skin due to an as yet unidentified mechanism. The presence of melanocytes in the auditory apparatus suggests that this system could possibly be affected by vitiligo, which targets the melanocytes of the whole body and not just the skin. The purpose of this study was to assess the incidence of auditory alterations in patients with vitiligo A total of 21 patients diagnosed with vitiligo were enrolled in this study. A group of 20 healthy subjects served as a control group. Pure tone audiometry (PTA) and measurements of auditory brain stem responses (ABR) were carried out in all participants. High frequency sensory neural hearing loss was detected in 8 patients (38.09%). Analysis of ABR revealed that 10 patients (47.61%) had an abnormal increase in the latency of Wave III and 6 (28.57%) had an abnormal prolongation of the inter peak latency between Wave I and III. There was no correlation between age, duration of disease, and any of the recorded parameters. This study highlights the involvement of the auditory system in patients with vitiligo, suggesting that vitiligo is a systemic disease rather than a purely cutaneous problem.

Although esophageal liposarcoma is an extremely rare tumor, liposarcoma is the most common soft tissue sarcoma in adults. Liposarcoma is currently classified into the types of well-differentiated, myxoid, round cell, pleomorphic and dedifferentiated liposarcoma. Up to now only a few cases of esophagus liposarcoma have been described in the world literature. We describe a myxoid type liposarcoma of the esophagus in a 68 year old man presented with hoarseness and intermittent dysphagea to solid food. He had a huge mass in his mouth which was mobile with gag reflex. A barium swallow, esophageal manometery and CT scan of the esophagus have not clearly revealed the mass. After endoscopic surgical resection of the tumor the histological examination revealed a myxoid liposarcoma. Both the presenting signs and symptoms and the histology type are rare for such tumor. This case demonstrate a rare differential diagnosis of intermittent dysphagia as early diagnosis is so important in those tumors and should kept in mind them, although they are quite rare.

Fewer than 15% of lipomas occur in the head and neck. Lipomas of the larynx are very rare benign laryngeal tumors (0.6%). To date less than 100 case of laryngeal lipoma have been reported in the literature.Clinical manifestation include progressive horseness, dyspnea, and even dysphagia. In the direct exam smooth or pedunculated mass is seen in the larynx and sometimes if tumor is large enough a mass palpated in the neck. In the computed tomography (CT) low attenuation mass is seen. Treatment of laryngeal lipoma consists of endoscopic removal or external surgical approach depending on tumor size. The authors present a case of laryngeal lipoma that involved the true vocal cord. The following is a report of a single case of laryngeal lipoma, Including esteroboscopy, radiologic and intraoperative finding as well as review of the literature.