فهرست مطالب farhad mokhtarinejad

Endolymphatic sac tumors (ELSTs) are uncommon low-grade, locally invasive epithelial tumor that originates from the endolymphatic sac of the inner ear and temporal bone. It is a rare event with less than 300 cases worldwide. In this article, we present a case of ELTS who presented with facial asymmetry and hearing loss.In this article, we present a case of ELTS who presented with facial asymmetry and hearing loss.

A 15-year-old female was admitted to our hospital with right-sided facial hemiplegia and hearing loss in her right ear which was started and progressed within two years. Except for facial hemiparalysis, other physical examinations were normal. In her audiological investigations, severe hearing loss of her right ear was evident. Imaging studies were indicative of ELSTs. This diagnosis was confirmed by histopathological investigations.

ELST is an aggressive papillary tumor that arises from the endolymphatic sac. In most cases, this tumor presents as a solitary growth. It usually presents with hearing loss but can be associated with other symptoms like tinnitus, vertigo and nerve VII paralysis. Imaging studies play a crucial role in the diagnosis of ELST, as it can reveal a characteristic soft-tissue mass involving the temporal bone, with bony erosion and extension into adjacent structures. Surgery is considered as the main form of treatment for ELSTs.

ELSTs are exceedingly rare events. Here we presented a case of ESLT with right facial hemiplegia and right ear deafness.

 Endoscopic endonasal transsphenoidal surgery is commonly used to remove pituitary adenomas. However, it can lead to cerebrospinal fluid (CSF) leakage, with an incidence of around 5% in sphenoid transnasal procedures and up to 20% in extended endonasal approaches. A retrospective study was conducted on 160 pituitary adenoma patients admitted to Loghman Hakim Hospital from 2016 to 2020 to evaluate the factors influencing CSF leak.

 The aim of this study was evaluating the occurrence of cerebrospinal fluid leakage and analyzing the factors involved.

 This is a retrospective analysis of patients diagnosed with pituitary adenoma at Loghman-Hakim hospital over a four-year period. Demographic information, tumor characteristics, surgical procedures, and complications were collected. All patients gave their consent, and the study was approved by the ethics committee. Surgical procedures were conducted using a direct endonasal trans-sphenoidal approach under general anesthesia, and antibiotics were given. Statistical analysis was conducted using SPSS to evaluate the relation between measured variables and the occurrence of CSF leak.

 The study found that 19.4% of the patients developed CSF leak during their hospital stay. Age and body mass index (BMI) of patients with CSF leak significantly differed from those without. The size of the tumor did not differ significantly between patients with and without CSF leak. The only variable associated with CSF leak was sphenoid sinus anatomy.

 The study concluded that older patients with a lower BMI and a larger defect size are more prone to CSF leak, but no significant difference was found in tumor size between the groups with and without CSF leak. Sphenoid sinus anatomy correlated with CSF leak, while other factors did not show any correlation with the incidence of CSF leak.

In the middle ear inflammation, otitis media with effusion (OME) leads to a sterile effusion. Although most OME resolves without any complications, long-lasting OME may cause conductive hearing loss (CHL).

In this article, we investigate the validity of the Rinne and Weber tests in different frequencies of tuning forks in predicting the conductive hearing loss secondary to OME as diagnosed by more modern audiometric tests.

A case series of 25 consecutive patients visited the Loqman Hakim Hospital clinic. Each patient was evaluated by tuning fork tests (256, 512, 1024, 2048 Hz), audiometry, tympanometry, and tympanocentesis.

In evaluation of the hearing status in OME patients, there was no significant association between the Webertest, audiometry, and tympanometry. The 256 Hz Rinne test correlated with the level of hearing loss in patients with OME. Results revealed no relationship between the presence of glue ear, audiometric, tympanometric, and tuning fork tests.

256 Hz Rinne test can predict the presence of CHL in cases suffering from OME. Adhesive otitis does not worsen thehearing condition of patients.

 In the middle ear inflammation, otitis media with effusion (OME) leads to a sterile effusion. Although most OME resolves without any complications, long-lasting OME may cause conductive hearing loss (CHL).

 In this article, we investigate the validity of the Rinne and Weber tests in different frequencies of tuning forks in predicting the conductive hearing loss secondary to OME as diagnosed by more modern audiometric tests.

 A case series of 25 consecutive patients visited the Loqman Hakim Hospital clinic. Each patient was evaluated by tuning fork tests (256, 512, 1024, 2048 Hz), audiometry, tympanometry, and tympanocentesis.

 In evaluation of the hearing status in OME patients, there was no significant association between the Weber test, audiometry, and tympanometry. The 256 Hz Rinne test correlated with the level of hearing loss in patients with OME. Results revealed no relationship between the presence of glue ear, audiometric, tympanometric, and tuning fork tests.

 256 Hz Rinne test can predict the presence of CHL in cases suffering from OME. Adhesive otitis does not worsen the hearing condition of patients.

Otosclerosis is a primary disease of the temporal bone and oticcapsule with autosomal dominant transmission and variable expression. The exact pathogenesisand factors affecting tinnitus in otosclerosis patients are unknown. This study aims to find the effect of stapes surgery on improving tinnitus in otosclerosispatients.

This study aims to find the effect of stapes surgery on improving tinnitus in otosclerosis patients.

Twenty-nine otosclerosis patients with preoperative tinnitus were enrolled in the study. Patients were divided into three groups; patients with high pitch tinnitus (>2 kHz), patients with medium pitch frequency (500-2000 Hz), and patients with low pitch frequency (<500 Hz). In addition, a visual analog scale was used to evaluate tinnitus severity.

In our study, 15 (51%) patients' tinnitus showed significant improvement, 5 (17%) patients' tinnitus converted to medium and low frequency, and nine (31%) patients' tinnitus remained unchanged. The majority of subjects (24, 83%) have decreased VAS scores (p= 0.001), and 5 (17%) patients remained unchanged. Results of pre and postoperative ABG showed that 82.3% of subjects (n=27) have postoperative ABG<10, and 18% (n=6) have ABG of 10 to 20. The patient's mean ABG was decreased from 35.9 ± 10.7 dB before surgery to 9.03 ± 7.9 dB after surgery (p= 0.001).

Patients high pitched tinnitus may be a better candidate for stapes surgery, although others can also benefit from surgical intervention.

 Due to the importance of time in diagnosis and treatment and, as a result, the prognosis of patients with neck malignancies, we decided to evaluate the causes of delay in diagnosis of neck masses and their associated factors.

 In this study, we have evaluated the delay in diagnosing neck masses and the related factors.

 This descriptive-analytical study was performed on 500 patients with a neck mass who were referred to Loghman Hakim Hospital in 2019. Demographic data were recorded. The time of the delay to visit a doctor and the time of the delay to diagnosis were recorded. Factors related to the delay in the patient and physician's diagnosis, including the patient's socioeconomic status, literacy and income level, associated symptoms, history of smoking, infections and underlying diseases, were evaluated.

 the mean age of patients was 46.04 years. 50.4% were female. The mean time interval between feeling neck mass and visiting a doctor was 34.72 days. This time interval between feeling neck mass and visiting a doctor in patients with higher education levels was less than in illiterate patients with low education levels (p = 0.046). This interval time in patients with higher income levels was less than in patients with lower income levels (p = 0.009). This interval was significantly increased with increasing age (p<0.001).

 Based on our findings, some factors such as age, income and education level significantly influence the process of diagnosis and treatment. On the other side, the presence of some signs and symptoms like dysphagia, sore throat, weight loss, etc., can remarkably reduce delay in that process. Ultimately it seems helpful to make an application which provides essential training for elderly, low-income or unlearned patients and facilitates consulting and referring to doctors for them.

The overdose of illicit drugs is not always fatal but can lead to various complications. One of the unusual medical complications is a sensorineural hearing loss (SNHL). There are multiple case reports about this subject. Considering the importance of hearing loss on quality of life, we investigated hearing status in patients with overdose of illicit drugs.

This cross-sectional study was performed in Loghman Hakim hospital in Shahid Beheshti University of Medical Sciences, Tehran, Iran, in 2016-2017. The hearing status of 95 patients with illicit drugs overdose and 44 healthy individuals were assessed using standard pure tone audiometry and distortion product otoacoustic emissions. The patient group was categorized based on hearing status and compared based on some variables. We applied 2 independent t tests, Mann-Whitney, Chi-square, and binary logistic regression tests. All analyses were conducted in Stata 12 (STATA Corp, USA) and significance level was set at less than 0.05.

We found higher percentage frequency of SNHL in the patient group than the control group (15.8% vs 2.3%; p=0.021). The frequency of hearing loss was 21.7% in opioid users, 5.3% in stimulant users, and 6.3% in concomitant use of both. There was a significant relationship between SNHL and overdose of illicit drugs (aOR = 14.48, 95% CI = 1.53-136.44; p=0.019) with adjusting age, sex, and smoking.

Illicit drugs overdose can potentially affect the hearing system. Opioid drugs, especially methadone and tramadol, have been found to affect the hearing system. Therefore, it is important to conduct longitudinal studies to demonstrate the role of opioid drugs on the hearing system.

 Cholesterol granuloma is a histological term used for the description of a tissue response to the presence of an irritant foreign body, i.e. a cholesterol crystal.  we report a cholesterol granuloma occupying the EAC of a17 year old teenage girl.

A 17 years old teenage girl presented with active otorrhea in the right ear. On physical examination the pink mass was visible in the right ear canal and the radiologist reported an expansile well-marginated lesion.

A cholesterol granuloma presenting as a mass. A CT scan, the following conditions were considered, and  do not routinely require surgery

Mastoidectomy is a common procedure in otolaryngology. It has numerous complications. Aesthetic issues following this surgery are not widely discussed.
To evaluate auriculocephalic angle and helix to mastoid distance between patients who underwent canal wall up and canal wall down mastoidectomy procedures.
In this cross sectional study, sixty patients who underwent canal wall down or canal wall up mastoidectomy, observed for auriculocephalic angle and helix to mastoid distance of both ears before and after surgery. We analyzed data with paired t-test and independent t-test. All tests were conducted at the 0.05 level of significance.
Patients, who underwent canal wall down mastoidectomy, had a significant reduction in auriculocephalic angle and helix to mastoid distance. In canal wall up group, these parameters increased, although the observed differences were not statistically significant.
Mastoidectomy can alter the aesthetical parameters of the auricle and may also lead to functional disorders due to these changes.

Incus is the most common damaged ossicle in the ear trauma and chronic infection (COM). Sculpted incus is one of the methods have been used for ossicular reconstruction and transition of sound from tympanic membrane to stapes.
To evaluate the success rate and risk factors of ossiculoplasty with sculpted incus.
A before- after clinical trial study of 25 patients with normal and mobile stapes who underwent ossiculoplasty using autologous or homologous sculpted incus was performed .Pre and post intervention audiometric results were compared. The utility of the middle ear risk index (MERI) in predicting hearing outcome in these cases were evaluated, also outcomes in patients with primary versus staged ossiculoplasty and incus interposition versus incus transposition were compared. P value The mean preoperative air-bone gap (ABG) was 33.9 dB and mean postoperative ABG was 19.4dB, with significant improvement (P value =0.001). The best results achieved in 2000 Hz with 13 dB improvement in mean ABG and worst results in 4000 Hz with 8.8dB improvement. Seventy six percent of patients had postoperative mean ABG less than 20dB and 88% less than 25dB. Hearing results were not significantly different in primary osiculoplasty when compared with staged procedure and in incus interposition osiculoplasty compared with incus transposition. There was no correlation between postoperative ABG and preoperative ABG or the middle ear risk index (MERI)
Osiculoplasty with sculpted incus has a good hearing outcome and recommended in the first stage tympanoplasty. This is independent of middle ear risk factors, if the stapes is normal and mobile.

Otosclerosis is a common cause of conductive hearing loss. It is surgically treated with stapedectomy or stapedotomy. Sensory-neural hearing loss is an uncommon but known complication of this surgery. A 25-year-old Iranian female with bilateral otosclerosis underwent right stapedotomy and developed bilateral sensorineural hearing loss a few days after the surgery, which recovered with appropriate treatment. The possible causes and their clinical courses are discussed in this study. Sensorineural hearing loss after stapedotomy has many different etiologies. Generally, the causes which are not directly related to the surgery should also be considered.

Cholesteatoma is traditionally diagnosed by otoscopic examination and treated by surgery. The necessity for imaging in an uncomplicated case is controversial. This study was planned to investigate the usefulness of a preoperative high-resolution computed tomography (HRCT) scan in depicting the status of middle ear structures in the presence of cholesteatoma and also to compare the correspondence between pre- and intraoperative CT findings in patients with cholesteatoma. This prospective descriptive study was performed from January 2009 to May 2011 in 36 patients with cholesteatoma who were referred to the Kashani and Al-Zahra Clinics of Otolaryngology. Preoperative high-resolution temporal bone CT scans (axial and coronal views) were carried out and compared with intraoperative findings. Evaluation of 36 patients and their CT scans revealed excellent correlation for sigmoid plate erosion, widening of aditus, and erosion of scutum; good correlation for erosion of malleus and tegmen; moderate correlation for lateral canal fistula (LCF) and erosion of mastoid air cells; and poor correlation for facial nerve dehiscence (FND), incus, and stapes erosion. A preoperative CT scan may be helpful in relation to diagnosis and decision making for surgery in cases of cholesteatoma and ossicular erosion. The CT scan can accurately predict the extent of disease and is helpful for detection of lateral canal fistula, erosions of dural plate, and ossicular erosions. However it is not able to distinguish between cholesteatoma and mucosal disease, facial nerve dehiscency, incus, and stapes erosion.

Bone conduction (BC) threshold depression is not always by means of sensory neural hearing loss and sometimes it is an artifact caused by middle ear pathologies and ossicular chain problems. In this research, the influences of ear surgeries on bone conduction were evaluated. This study was conducted as a clinical trial study. The ear surgery performed on 83 patients classified in four categories: Stapedectomy, tympanomastoid surgery and ossicular reconstruction partially or totally; Partial Ossicular Replacement Prosthesis (PORP) and Total Ossicular Replacement Prosthesis (TORP). Bone conduction thresholds assessed in frequencies of 250, 500, 1000, 2000 and 4000 Hz pre and post the surgery. In stapedectomy group, the average of BC threshold in all frequencies improved approximately 6 dB in frequency of 2000 Hz. In tympanomastoid group, BC threshold in the frequency of 500, 1000 and 2000 Hz changed 4 dB (P-value < 0.05). Moreover, In the PORP group, 5 dB enhancement was seen in 1000 and 2000 Hz. In TORP group, the results confirmed that BC threshold improved in all frequencies especially at 4000 Hz about 6.5 dB. In according to results of this study, BC threshold shift was seen after several ear surgeries such as stapedectomy, tympanoplasty, PORP and TORP. The average of BC improvement was approximately 5 dB. It must be considered that BC depression might happen because of ossicular chain problems. Therefore; by resolving middle ear pathologies, the better BC threshold was obtained, the less hearing problems would be faced.

One of the materials, which have been used to strengthen the graft in tympanoplasty, is cartilage. This clinical trial aimed to assess the anatomic and functional results of homograft cartilage tympanoplasty. This clinical trial study was conducted on 40 patients who underwent homograft cartilage tympanoplasty between 2008 and 2011 in Al-Zahra Hospital, Isfahan, Iran. All patients were followed up one month after surgery for recurrent retraction pocket cholesteatoma and re-perforation of the tympanic membrane. Periodic follow up visits were done every 3 months and all patients were followed up at least six months after the surgery. The results of the surgery were determined by otoscopic examinations and audiometric tests. One month after the surgery, there were no cases of retraction pocket, adhesive otitis, recurrent cholesteatoma, membrane re-perforation and cartilage atrophy. 6 months after surgery 20 patients (50%) had a normal tympanic membrane, 15 patients (37.5%) had some degrees of cartilage atrophy that was not associated with pathologic changes, and 5 patients (12.5%) had retraction pocket. Re-perforation, recurrent cholesteatoma and adhesive otitis were not observed in any of the cases. The findings of this study demonstrated that homograft cartilage tympanoplasty is an effective technique for tympanic membrane closure and prevention of retraction pocket cholesteatoma with acceptable hearing results.

Tympanoplasty is done to eradicate ear pathology and to restore the conductive hearing mechanism. The relapse of disease is seen after using Temporalis fascia, as graft, in this surgery. Cartilage is of the materials that can be used to enhance graft. This study was done to evaluate hearing after homograft cartilage tympanoplasty. This clinical trial study conducted in Alzahra hospital in Isfahan, Iran. 40 patients with recurrent perforation, retraction pocket and cholestatoma were operated by homograft cartilage tympanoplasty method. The audiometery was down for all of the patients before and after tympanoplasty. All patients were followed up for at least 6 months. The data was analyzed by SPSS software using Student’s t, paired t and ANOVA tests. After at least 6 months of surgery, there was not any case of perforation or cholestatoma recurrency. The change in range of 500, 1000, 2000 and 4000 frequency was 5.9 ± 1.9, 5.9 ± 1.6, 4.6 ± 1.6 and 3.8 ± 1.6 respectively and the difference between before and after surgery was statistically significant. In the other word, audiometry revealed improvement at all frequencies. Homograft cartilage tympanoplasty prevents perforation, cholestatoma and retraction paket recurancy after surgery. Hearing results were good.

Recurrence of nasal polyposis following surgical intervention is very common. Antifungal therapy has been an appealing alternative to reduce its recurrence and severity. Early studies showed definite positive response, but recent studies have raised doubts about its efficacy in treatment of polyposis. This prospective case-control clinical trial was conducted on 50 patients suffering from nasal polyposis in Isfahan university of medical sciences. All patients underwent functional endoscopic sinus surgery. CT scanning of paranasal sinuses was done preoperatively and 6 months postoperatively to stage the disease. Patients were assigned to two groups: amphotericine B group were instructed to irrigate the nasal cavity with a solution of amphotericine B, while the normal saline group used the physiologic normal saline for 6 months. 68% of patients in Normal saline and 84% of cases in amphotericine B group reported history of allergies. In amphotericine B group, stage of the disease improved in 84% of patients and remained unchanged in the rest. In normal saline group, imaging stage improved in 22 patients and remained unchanged in 3. The two cohorts were compared for reduction in imaging stage and no significant difference was found between them. This study showed no benefits for topical amphotericin B solution over normal saline. It might be better to retreat to the traditional normal saline nasal douching following functional endoscopic sinus surgery in the treatment of polyposis.

Vestibular evoked myogenic potential in response to click or short tone burst stimuli have been used as a clinical test for distinguish saccule and inferior vestibular nerve diseases. Different studies show that cochlear implant could have inverse effects on vestibular structures. We aimed to investigate vestibular evoked myogenic potential in unilateral cochlear implanted individuals in compare to normal individuals. Thirty-three unilateral cochlear implanted patients (mean age 19.96 years) and 30 normal hearing individuals (mean age 24-27 years) as control group were enrolled in this cross- sectional study. Absolute latencies and amplitudes of myogenic potential responses were measured and compared in both groups. Myogenic potential recorded in both ears of all controls were normal. No response could be recorded in 16 patients (48.48%) from both ears. In three patients, responses were recorded in both ears though the amplitude of waves was reduced in implanted ear. Unilateral response could be recorded in 14 patients only in their non-implanted ear. Vestibular evoked myogenic potential test is a useful tool for assessing saccular function in cochlear implant patients. Damages of osseous spiral lamina and basilar membrane after cochlear implantation could result in dysfunctions of vestibular organs specially saccule. It seems that saccule could be easily damaged after cochlear implantation. This would cause absence or reduced amplitudes in myogenic potential.