maryam jalessi

The pituitary gland is located near the center of the cranium base, caudally surrounded by a bony basket structure of the sphenoid bone named “Sella Turcica." The adjacent structures, such as optic chiasma stated superiorly, are of clinical and surgical importance(1, 2). Surgery is the first-line treatment for the large nonfunctional pituitary adenomas with clinical signs and symptoms (e.g., optic chiasma compression) and most functional adenomas  (4). The very primary surgical access to pituitary adenomas was provided via trans-facial or trans-cranial approaches. The trans-sphenoidal approach was introduced later in the early 1900. However, this approach was abandoned due to serious complications and a higher mortality rate (5-8). With the advent of the microscope and later the endoscope and its application in the trans-sphenoidal approach, the endoscopic endonasal trans-sphenoidal approach (EETSA) has been rapidly accepted and well established for its advantages such as a better visualization, more complete tumor resection, and lower complications (8-10). However, as the access to a pituitary adenoma is provided through a bony defect in the sella turcica floor, postoperative cerebrospinal fluid (CSF) leak is a risk with the recently reported prevalence of 0/5-12% in endoscopic approach (11-16). To avoid it, various reconstruction strategies and materials have been introduced. In nonrigid reconstructions, materials such as fat, fascia, dural replacements, mucosal or muscular grafts, and pedicled mucosal flap of the nasal septum, middle or inferior turbinate are used. In rigid reconstructions, bone, cartilage, titanium mesh, ceramic implants, and bone cement are adopted (8,21). None of them being known superior to the other, heterogenous algorithms have been designed principally based on the grade or risk of CSF leak (22, 23). Rigid reconstruction is supposed to strengthen and protect the reconstructed area well. However,  donors cite morbidities in autografts (e.g., nasal bone or cartilage) (24), infection transmission in allografts (e.g., cadaveric iliac crest) (25), high costs, low biocompatibility, infection, and radiologic artifacts in synthetic grafts (e.g., Medpor) (26) are among the challenges both the patients and the surgeons encounter (19).Moreover, minimal data exist on the spontaneous sella turcica re-ossification following EETSA, which can debate the necessity of rigid reconstruction. This pilot study consequently aims to consider the possible self-repair of sella turcica without any rigid reconstruction in eight patients with pituitary adenoma.

In this retrospective pilot study, the pituitary adenoma data bank of Rasoul Akram hospital's skull base research center was reviewed for the patients who had undergone EETSA between March 2014 to February 2018.Those with available pre-operation paranasal sinuses CT scan, data bank documented measures of the intra-operation bony defect, evidence of the complete tumor resection according to the MRI three months after the surgery, and no evidence of tumor recurrence based on the last MRI ( 2018 or 2019) were included if no revision surgery or radiotherapy before or/and after the operation was conducted. They were accidentally called, and the first ten patients accessible by the documented phone number were invited to take a paranasal sinuses CT scan to evaluate sella turcica spontaneous re-ossification after informed consent.The CT scans were evaluated, and measurements, including the maximum diameters of bone defect in the coronal and sagittal planes on the CT scans - using the Picture Archiving and Communication Systems (PACS) - Osirix system-, were compared with the defect size created intraoperatively. The area of the defect was calculated using the equation for the area of an Ellipse (major radius multiplying by minor radius Multiplying by pi.) All procedures performed in this study were in accordance with the ethical standards of the Iran University of Medical Sciences research ethics committee (IR.IUMS.REC.1395.29082) and with the 1964 Helsinki Declaration and its later amendments.Median and interquartile ranges (IQ) were used for the descriptive analysis of quantitative variables. Mann-Whitney test was used to compare independent quantitative variables, and Wilcoxon Signed Ranked test was used for quantitative dependent variables. The Spearman test evaluated the correlations. The statistical software IBM SPSS Statistics for Windows version 22.0 (IBM Corp. Released 2013, Armonk, New York) was used for the statistical analysis. P values <0.05 were considered statistically significant.

Eight patients with no rigid reconstruction were included in the final analysis, with a median age of 40/5 years old (IQ=17), of whom six were female. After a median of 46 months (IQ=20.5, range 12-60), length, width, and the area of the bony defect were significantly reduced (21.5 to 9.3 mm, 15.6 to 9.4, and 297.90 to 77.5 mm2, respectively p values=0.01) leading to the median of 74.1% (IQ=11.2%, range 67.8-99.2%) self-repair of the primary bony defect.The area of the intraoperative bony defect was significantly correlated with the final bony regenerated area and with the area of defect remaining after follow-up. (r=0.929, p value=0.001, and r=0.976, p value≤0.001, respectively).  A negative correlation between age and the bony regeneration speed (the monthly percentage of the repaired area) was also detected. (r=-0.762, p value= 0.02)

In this study, spontaneous bony regeneration was shown to occur in all eight studied individuals (median of 74.1%, range of 67.8-99.2%) with various types of pituitary adenomas and primary defect areas (median of 297.9, range of 78.5 to 575.52 mm2) after a median of 46 months. The results align with the only previous study that reported spontaneous ossification in 94% of the 17 patients with pituitary adenomas in the median of 36 months (27). There are no more available data on sella turcica spontaneous bony regeneration. However, there is evidence of potential spontaneous re-ossification of the mandible, which is of the same bone type (irregular), showing even better healing without reconstruction strategies (29, 32-35). CSF leak risk, which is the most salient concern in EETSA, determines the reconstruction strategy in the skull base surgeries. Nonrigid reconstruction, whether intraoperative CSF leak is present or not, has led to permissible postoperative CSF leak (38,42,43). Moreover, the postoperative CSF leak rate was not significantly different with or without the use of Buttress in a recent meta-analysis (38). Putting all these findings together and considering the natural sphenoid spontaneous bony regeneration capability, the authors suggest that rigid reconstruction of sella turcica following EETSA may not be necessary.

The sense of smell, one of the five basic senses that humans have, helps us detect different types of odors. It also plays an important role in the detection of pollutants, toxic gases, or rotten and hazardous foods. Although olfaction is considered less important than the other senses, smell disorders could cause a variety of problems, including reduced taste detection due to the relationship between taste and smell, depression, and overall loss of quality of life. Olfactory dysfunction is one of the first clinical signs of neurological diseases such as Alzheimer's and Parkinson's disease. The olfactory disorder has many etiologies, some of which are more obvious. Most people with olfactory disorders have experienced a recent illness or trauma. Common causes of olfactory disorders include aging, rhinosinusitis, upper respiratory infections, and cerebral lesion; the rest of the cases are less relevant. Since there are limited evidence-based treatments for olfactory disorders, it is necessary to share information about the risks associated with these disorders. This information includes practical and useful screening measures for olfactory dysfunction, appropriate clinical evaluation, patient counseling to prevent injury, health and quality of life management, and the introduction of treatments with higher recovery rates. This review study focuses on the etiology, prevalence, and short-term and long-term consequences of olfactory disorders. Also, diagnostic strategies and new treatment options have been developed and discussed.

Psychophysical tests are typically used for clinical assessment of human smelling function. Given that olfactory identification is linked to the regional culture, the main aim of this study was to provide the comprehensive “sniffin’ sticks” olfactory test, culturally adapted on the Iranian population as well as to examine the discriminatory power of this test between normal people and patients with olfactory disorder.

This cross-sectional study consisted of 3 steps. A total of 200 healthy people were recruited to determine odor familiarity (using Likert- scale) for the first step. In the second step, based on the original sniffin’ sticks test and odor familiarity, 16 odor items were selected. Odor modification was performed and the identification part of the sniffin’ sticks test was created. Then, 99 patients with olfactory disorders and 214 healthy participants were tested using the Iranian sniffin’ sticks test (Ir-SST). After 2 to 4 weeks, participants were reexamined and test reliability was evaluated by using a Pearson correlation coefficient test. 

The Ir-SST showed that scores of patients with smell loss were significantly lower than normosmic participants (13.6 ± 5.24 vs 34.3 ± 3.41, P < 0.001). The sensitivity (95.2%) and specificity (93.5%) of the test were also found to be high. Test-retest reliability was as follows: composite score: r = 0.8; odor identification: r = 0.83; odor threshold: r = 0.77; and odor discrimination test: r = 0.56; P < 0.001.

The results suggest that the Ir-SST can be effectively adapted to the Iranian population. The current study validates that the sniffinchr('39') sticks olfactory test is applicable as a useful screening tool for comprehensive assessment of olfactory function in an Iranian population.

Smell Identification Tests (SIT) are routinely utilized for the clinical evaluation of olfactory function. Since Iran consists of various ethnic subgroups, the reliability and validity of this test as a national SIT are required to be evaluated across the country.   This cross-sectional study evaluated the cultural adaptation of SIT administered to 420 healthy volunteers from 6 various ethnic subgroups (i.e., Fars, Turk, Kurd, Lor, Baluch, and Arab) living in 7 cities (one city for each subgroup, and Tehran [capital of Iran] with mixed ethnicities). The SIT consists of pens pre-filled with 24 odorants. The correct identification response rate was evaluated in all and each subgroup. The test was performed twice on 60 participants with a 2-week interval to assess its reliability. The SIT was further administered to 150 cases with documented abnormal olfactory function to evaluate its validity.   The correct identification response rate was estimated at 70% for all odorants in all and each subgroup. The mean odor identification score was 21.41±1.37 (score range: 17- 24) with no significant difference among various subgroups. Moreover, the test-retest correlation coefficient was obtained at 0.77. The mean odor identification score in patients with olfactory impairment was 10.69±3.76, which was significantly different from that in healthy participants (P<0.001). The best cut-point for the beginning of olfactory impairment was 17.5 (95% CI: 9-100, Sensitivity=99, Specificity=81). Females obtained higher scores of odor identification, compared to males (P=0.025).   The results indicated the reliability and validity of the SIT, which can be used nationally for the assessment of olfactory function in various ethnic subgroups across the country.

The occurrence of anosmia/hyposmia during novel Coronavirus disease 2019 (COVID-19) may indicate a relationship between coincidence of olfactory dysfunction and coronavirus disease 2019 (COVID-19). This study aimed to assess the frequency of self-reported anosmia/hyposmia during COVID-19 epidemic in Iran.

This population-based cross sectional study was performed through an online questionnaire from March 12 to 17, 2020. Cases from all provinces of Iran voluntarily participated in this study. Patients completed a 33-item patient-reported online questionnaire, including smell and taste dysfunction and their comorbidities, along with their basic characteristics and past medical histories. The inclusion criteria were self-reported anosmia/hyposmia during the past 4 weeks, from the start of COVID-19 epidemic in Iran.

A total of 10 069 participants aged 32.5±8.6 (7-78) years took part in this study, of them 71.13% women and 81.68% nonsmokers completed the online questionnaire. The correlation between the number of olfactory disorders and reported COVID-19 patients in all provinces up to March 17, 2020 was highly significant (Spearman correlation coefficient = 0.87, P< 0.001). A sudden onset of olfactory dysfunction was reported in 76.24% of the participations and persistent anosmia in 60.90% from the start of COVID-19 epidemic. In addition, 80.38% of participants reported concomitant olfactory and gustatory dysfunctions.

An outbreak of olfactory dysfunction occurred in Iran during the COVID-19 epidemic. The exact mechanisms by which anosmia/hyposmia occurred in patients with COVID-19 call for further investigations.

Treatment of parasagittal meningioma (PSM) is always a challenge, especially if the tumor is spread enough to invade critical structures like venous sinuses. This study aims to evaluate the outcomes of gamma knife radiosurgery in patients with parasagittal meningioma.

In this descriptive retrospective study, medical records of 61 patients with PSM who had undergone GKRS from 2003 to 2013 were reviewed. The demographic characteristics, medical history and radiotherapy history, tumor's volume and the characteristics of radiosurgery were assessed.  Radiological tumor control following treatment were evaluated during follow-up period.

In this study, 32 patients (52.5%) were men and 29 (47.5%) were women. Of 61 patients, 45 had a history of surgery or/and radiotherapy. The mean tumor volume was 11.35±9.20 ml (1-37.9 ml). The mean follow-up time was 30.28±27.48 months. Five patients died. Radiologic tumor control was achieved in 91.8% of the patients, in whom the tumor volume decreased to 30 (49.2%) and remained unchanged in 26 (42.6%) ones. The tumor volume increased in 5 patients (8.2%). Overall, the progression-free survival of the patients was 98.6% during 12 and 67.04±13.4% during 60 months. Edema occurrence rate was 18%. There was no significant difference in GKRS characteristics, tumor volume, and history of surgery and radiotherapy between patients whose tumors were controlled and patients who experienced an increase in the tumor volume.

Our study suggest that GKRS can be the first or second treatment to control PSM[NM1] . There was no association between the treatment outcome, tumor characteristics, and radiosurgery parameters AS radiosurgery management in PSMs encounter limitations , a long-term follow-up to diagnose life-threatening complications including brain edema is needed.




 [NM1]It is not a conclusion statement, but it can be suggest.

Processing odor information by the olfactory system depends greatly on the odor concentration. In order to use an odorant in a smell identification test (SIT), the minimum identification concentration (MIC) needs to be determined.
This study was conducted in 60 healthy native individuals aged 20 to 60 years, selected from patients’ companions in a tertiary hospital. In the first step, 25 odorants were presented to evaluate familiarity among the subjects. Then, the MICs for the eligible odorants were measured using the ascending method of limits.
Out of 25 odorants, only one (cacao) was distinguished by less than 70% of the subjects, and was therefore removed from the list. The MICs of the remaining 24 odorants ranged from 6.87±2.74% for menthol to 27.62±18.98% for cantaloupe. There was significant correlation between age and the MIC only for coffee (P=0.02, r=−0.300). There was a significant difference in MIC between men and women only for hazelnut (P=0.03).
We present the MICs of 24 culturally-familiar odorants in a sample of the Persian population in a SIT.

This study aimed to determine the prevalence of hearing impairment (HI) by age and gender in a population aged 5 yr and older residing in Tehran, Iran.
In this cross-sectional study, 140 clusters each including 10 households from Tehran, Iran were sampled between 2012 and 2013 using cluster random sampling. Trained audiologists examined the participants during face-to-face interviews. The hearing of the participants was evaluated before the removal of wax or other foreign bodies. In this study, HI was categorized as mild (grade 1, 26-40 db), moderate (grade 2, 41-60 db), severe (grade 3, 61-80 db), and deaf (grade 5, 81 db or more). All participants signed informed consent forms. The SATA software was used for data analysis.
Of 6521 individuals, 4370 (67%) were interviewed. The prevalence of HI (auditory threshold of 0.5, 1, 2, 4 KHz and more than 25 db in the better ear) was 14.27 (11.53-17.91) of whom 9.52 (7.07-11.98) had grade 1, 4.04 (3.02-5.06) had grade 2, 0.67 (0.33-1.02) had grade 3 HI and 0.48 (0.16-0.8) were deaf. About 5.19% of the participants had disabling hearing impairment. All HI grades increased significantly with age but no significant difference was observed between men and women.
The considerable prevalence of HI in Iran in comparison with other developing countries, with regards to the trend of aging in the population, seems concerning. The results of the study could be used as a treatment and research guideline for future works in the area of policymaking and plan to decrease these disorders.

The Questionnaire for Olfactory Dysfunction (QOD) is a self-reporting olfactory-related quality of life questionnaire. The aim of this study was to determine the reliability and validity of the Persian version of this questionnaire.
One hundred and thirteen patients with olfactory problems were enrolled in this study. The English version of the QOD was first translated into Persian. The reliability was then tested by determining the Cronbach alpha coefficient to assess internal consistency. The QOD was reviewed by a panel of experts, followed by calculating the content validity index to determine the content validity.
Based on the reliability analysis, the total Cronbach alpha was 0.88. The items in the “life quality” and “parosmia” domains had a good internal consistency in total, as well as in both genders and in different age subgroups. For the “sincerity” domain, however, low internal consistency was revealed (Cronbach alpha = 0.25). When questions related to the sincerity domain were omitted, the Cronbach alpha reached 0.89. The overall scale validity index for clarity and relevance were 0.88 and 0.87, respectively.
The Persian version of the QOD seems to be a reliable and valid tool for the assessment of quality of life in patients with olfactory dysfunction. The “sincerity” domain cannot be used separately or should be substantially modified in order to be applicable to the Iranian population. However, there is no need to change the whole format of the questionnaire.

Vitamin D has been suggested to play a considerable role in the function of the immune system in various infectious, inflammatory, and autoimmune conditions. Otitis media with effusion (OME), defined as the presence of non-purulent fluid within the middle ear without signs or symptoms of suppurative otitis media, has a number of inflammatory predisposing factors. This study was designed to explore the association between vitamin D deficiency and OME.
In this cross-sectional study, 74 children aged 2–7 years with an obstructive indication for adenotonsillectomy were included. Patients were divided into two groups based on the need for ventilation tube insertion for OME. Thirty-two children were enrolled in the OME group and 42 in the control group. The mean vitamin D level was compared between the two groups.
Mean vitamin D concentration in all patients was 11.96±5.85 ng/ml (9.79±4.36 ng/ml in the OME group and 13.61±6.33 ng/ml in the control group; P=0.003). There was also a significant difference in levels of vitamin D in patients referred in winter (9.0±2.94 ng/ml) compared with the summer (19.85±4.21 ng/ml; P=0.001). Data analyzed based on the season in which the patients were referred showed no significant difference between the OME and the control group.
Although our results showed lower serum levels of vitamin D in OME patients, the difference was not significant when seasons were taken into consideration. Therefore, the season is an important confounding factor in any research related to vitamin D due to the effect of sun-induced vitamin D.

Nose is used as a corridor in endoscopic endonasal transsphenoidal approach (EETSA) for pituitary adenoma. Thus, it may affect the nasal airway patency, function and sinonasal-related quality of life. The aim of this study is to objectively and subjectively evaluate these effects.
In this prospective study, 43 patients with pituitary adenoma who were candidates for EETSA from March 2012 to October 2013 were enrolled. The patients were evaluated preoperatively using acoustic rhinometry and rhinomanometry (with/without the use of decongestant drops) and asked to complete the 22-Item Sino-nasal Outcome Test (SNOT-22) questionnaire. The tests were repeated at one and three months postoperatively. The preoperative data were compared with the first and second postoperative ones using paired-sample t-test.
Without the use of decongestant drops, the total airway resistance increased significantly (p=0.016), and the nasal airflow decreased significantly (p=0.031) in the first postoperative evaluation. However, in the 3rd postoperative month, the difference was not significant. With the use of decongestant drops, the objective parameters showed no significant changes compared to preoperative data even at the first evaluation. The SNOT-22 scores also did not differ significantly in 1st and 3rd postoperative months. The first postoperative SNOT-22 showed a strong correlation with the second minimal cross-sectional area on simultaneous evaluation, and with the preoperative total airway resistance.
EETSA has a transient adverse effect on the nasal patency that quickly improves, making it a safe approach for the sinonasal system. Rhinomanometry is the most sensitive test for detecting these nasal functional changes objectively.

Using Nigella sativa L. (Black cumin), in traditional medicine, dates back to Tutankhamen, the pharaoh of Egypt. There are aboundant historical and religious evidence implying the importance of these curative seeds. Traditionally, they have been used for various therapeutic purposes. Zokam and Nazleh (ZaN) are two nasal diseases used to be treated by these medicinal seeds. Traditional Persian Medicine (TPM) classifies each of these diseases into warm and cold types. Comparing symptoms, Warm ZaN resembles Allergic rhinitis and cold ZaN is similar to Rhinosinusitis. Many documents have been found in TPM references that explain different ways for preparing Black cumin seeds for the treatment of cold ZaN, but there is no evidence for treating warm ZaN. In recent years, many original articles have been written to explain the therapeutic qualities of these curative seeds. They exhibit that Black cumin seeds, in addition to increasing the mucociliary clearance, histamine release inhibition and antihistaminic effects, have anti-inflammatory, antibacterial, antibacterial biofilm formation. Consequently, they confirm the application of Black cumin in the treatment of rhinosinusitis or cold ZaN.

Soft tissue profile can be widely different in various populations. Furthermore, this profile can be also continues to change throughout life. However, there are few studies that quantitatively evaluate the soft tissue profile in Iranian population. In order to determine normal reference values of facial parts in our populations, we aimed to measure standards for facial soft tissue parameters in Iranian young population. The study samples included 155 medical students at the Firouzgar hospital in winter 2011. The soft tissue facial profiles were digitally analyzed using linear measurements and angles made with standardized photographic records, taken in a natural head position, to determine the average soft tissue facial profile for males and females. There was a statistically significant difference between males and females in 21 of our 26 measurements. The most prominent differences between the genders were observed in the measurements taken from the face region. Minimum frontal breadth and supraorbital breadth were larger in males than in females. Except for middle face height measurement, other horizontal and vertical measurements for the face were larger in males than in females, indicating wider and higher faces in men than in women. Some measurements of facial angles are discrepant between the two genders. Due to the specific features of Iranian facial soft tissue values and also observable differences in facial measurements and angles between men and women, the Iranian standard values on facial measurements and angles should be given more attention, especially by plastic and cosmetic surgeons.

SCORE, OST and ORAI risk assessment tools could reduce the cost burden of BMD tests by selecting the high risk patients to osteoporosis. In this study we compared the ability of these risk assessment measures to assess probability of the osteoporosis among post-menopausal women. 211 post-menopausal women aged 45-88 years enrolled into the study. All of the patients underwent BMD test and divided into two groups according to T-Score level. 43 patients (20.4%) had T-Score ≤-2.5 (osteoporotic) (group-1) and 168 (70.6%) patients had T-Score of > -2.5 (non-osteoporotic). Among 168 nonosteoporotic cases, 88 had -2.5≤T-Score≤-2 in at least one bony area. These 88 cases in addition to the 43 cases with -2.5≤T-Score considered as high risk group to osteoporosis (group 2). Afterward, SCORE, OST and ORAI risk scores were calculated and sensitivity, specificity, likelihood ratio, accuracy index and area under the curve of each tool were determined in both groups and then compared with each other. SCORE had the highest sensitivity compared with others in both groups (95% and 88.2% respectively). Moreover, it had the highest diagnostic odds ratio and negative predictive value between the three methods. OST had the highest likelihood ratio and specificity in both groups (71.4% and 75.4%). There was significant difference between the sensitivity and specificity of the tests (p= 0.004 and 0.027). OST with the highest specificity and positive LR had a special role in determining the osteoporotic patients and SCORE with the highest sensitivity and negative predictive value had an exceptional role in exclusion of the non- osteoporotic individuals. However, considering the area under the curve, there was no significant difference among these three methods in determining osteoporosis.

University of Pennsylvania Smell Identification Test (UPSIT) is one of the most common smell identification tests to assess olfactory function.. The study was conducted to assess the accuracy of University of Pennsylvania Smell Identification Test (UPSIT) in Iranian population.. University of Pennsylvania Smell Identification Test was performed on 30 (50%) female and 30 (50%) male, who were healthy adult volunteers. The total mean score as well as mean scores according to the gender were assessed and compared to the UPSIT classification. Odors considered valid and accurate if its correct identification ability rate was more than 70% among study population.. The test score was 25.04 ± 4.92 in female and 23.29 ± 4.23 in male volunteers that all were considered as microsmia according to UPSIT. Sixteen odorants were correctly identified by about 70% of the volunteers and the remains 24 odorants were identified by less than 70%; 7, 5 and 12 odors was identified by60%-70%, 50%-60% and less than 50% of the volunteers, respectively.. According to the results of the study, documented that even less than half of the odors (16 out of 40) were identified correctly by the volunteers, which indicating that the UPSIT is not a suitable test to evaluate olfactory function in Iranian population due to the high amount of unfamiliar smells that should be replaced with more familiar ones..

A wide range of population, 4% to 30%, suffers from tinnitus that is defined as perception of sound without apparent acoustic stimulus. We conducted the present study to determine the prevalence of tinnitus in Iranian population; Tehran province. This cross-sectional study was conducted from January 2009 to December 2009, recruiting 3207 individuals (age range, 7-98) who were residing in Tehran province, Iran. Participants were asked to fill two questionnaires; the validated Persian version of Tinnitus Questionnaire (TQ) and another one that was specifically designed for this study. Prevalence of tinnitus and its association factors were evaluated. 3207 participants enrolled into our study comprising 1429 (44.7%) male and 1765 (55.3%) female with mean age of 55.01±17.85. Of total of 3207 participants, 146 (4.6%) had tinnitus consisting of 80 male (54.8%) and 66 (45.2%) female participants. It showed a rising trend with increasing age that was especially significant after the sixth decade of life (P=0.001). The analysis showed mean TQ global score of 35.96±25.52 that was significantly different between male and female participants (P=0.051) and had no significant correlation with increasing age (Spearman’s r=0.1, P=0.10). The tinnitus intensity was moderate to very severe in 95 (56.1%) of the participants. Its severity level was not significantly different between men and women (P=0.09). Tinnitus intensity had no significant association with increasing age (Spearman''s r=0.1, P=0.31). Patients with higher TQ global score had higher tinnitus intensities (P=0.001). The annoyance level was significantly different between men and women (P=0.04) and its impact on the participants daily routine functions were significantly higher in men (P=0.003). Given the results of the study, demonstrating that prevalence of tinnitus in Iranian population (Tehran province) was lower than the other countries and had a direct correlation with increasing age only after the sixth decade. TQ global score had significant correlation with tinnitus intensity, annoyance and impact on the participants'' daily routine functions. However, none of the above had correlation with increasing age. Tinnitus TQ global score and intensity were not different between men and women; however annoyance of tinnitus and its impact on participants'' daily routine functions were significantly higher in men.

Proposing a strategy for sellar reconstruction in endoscopic transsphenoidal transsellar approach for pituitary adenoma. 240 patients with pituitary adenoma underwent pure endoscopic endonasal transsphenoidal surgery. Intra-operative CSF leaks were classified as grade 0، no observable leak; grade 1، CSF dripping through an arachnoid membrane defect of less than 1 mm; and grade 2، CSF flowing through an arachnoid defect of more than 1 mm. Sellar reconstruction was performed according to our staging system; in stage I، the defect was covered with oxidized cellulose and sphenoid sinus filled up with Gelfoam. In stage II، a layer of fat was applied on the defect and fascia lata placed epidurally. In stage III، one or two layers of fascia were used with adding surgical glue and/or lumbar drainage. Mucosa of sphenoid sinuses was kept intact as much as possible and approximated at the end of procedure. intra-operative CSF leaks grade 0، 1 and 2 resulted in 133 (55. 4%)، 78 (32. 5%) and 29 (12. 1%) patients، respectively. Stage I of reconstruction was used in 126 patients (52. 5%) with no intra-operative CSF leak or sever prolapse of arachnoid membrane. Stage II was performed in 80 patients (33. 3%) with either leak grade 1 (73 patients) or grade 0 with severe prolapse of the suprasellar components induced in the sella (2 cases) or in whom extra-pseudocapsular dissection performed (5 cases). Stage III was performed in 34 cases (14. 2%) with either CSF leak grade 2 (29 patients) or grade 1 with simultaneous severe destruction or removal of sellar floor laterally، superiorly or inferiorly (5 patients) which made it impossible to place the fascia underlay to the bone. A minimum of 18 months follow-up showed development of 2 CSF leaks (0. 8%)، one pneumocephalus (0. 4%) and 2 meningitis (0. 8%) cases. Given the low postoperative CSF leak rate، we demonstrated that our adopted sellar reconstruction strategy focusing mostly on the adopted intra-operative CSF leak grading system is safe and useful for overcoming devastating complications like postoperative CSF leaks.

the quality of life (QOL) is an important indicator for disease-severity classification, obtaining treatment and outcome measurement in sinonasal diseases. The sinonasal outcome test 22 (SNOT 22) questionnaire has been introduced as the best specific one. The aim of this study was to prepare a valid and reliable Persian language version of SNOT 22 questionnaire as it is a as a self-reporting QOL questionnaire..Patients and After forward and backward translation of the original version of SNOT 22 questionnaire from English to Persian, a group of patients with nasal septal deviation need septal surgery and another group of healthy volunteers answered the Persian version of the questionnaire. The responsiveness rate, validity (Pearson correlations and differential validity) and reliability (internal consistency and test-retest reliability) of the 22 items of the questionnaire was calculated. P value < 0.05 was considered significant.. Thirty adults with nasal septal deviation need surgical correction and 30 healthy volunteers were included (mean age 30.4 ± 7.1 vs. 33 ± 6.7, P value = 0.148). The questionnaire was introduced to subjects two times with a two-week-period gap. Total responsiveness rate for 22 items was more than 97%. The total Cronbach''s Alfa coefficient was 0.898 (ranging 0.890-0.903). The Pearson correlations were 0.85 and 0.96 for patients and healthy volunteers, respectively. The mean total score was 47.6 ± 13.3 (range 28-74) and 29.6 ± 9.1 (range 22-67) in patients and healthy volunteers groups, respectively (P < 0.0001). The subscales scores were also significantly different between two groups.. The Persian version of SNOT 22 questionnaire is a valid and reliable instrument for accessing sinonasal diseases in Persian-speaking people..

The Ministry of Health and Medical Education of Iran, and similar institutions in many other countries, advises physicians to use current guidelines for the diagnosis and treatment of acute otitis media (AOM). However, there has been no evaluation of the effectiveness of such guidelines or whether physicians in Iran adhere to them. Thus, as laryngologists are the most important group of people who interact with patients with AOM, the aim of this study was to evaluate the attitude of laryngologists to the established guidelines. A total of 120 anonymous surveys were mailed to 120 otolaryngologists in Tehran, Iran, to evaluate the patterns of diagnosis and treatment of AOM used by these physicians. The survey included questions regarding the otolaryngologists’ age, gender, place of work, and attitude towards diagnosis and treatment of AOM. Sixty-two completed surveys were received, for a response rate of 51%. There was no significant difference between respondents to these surveys according to sex, age, practice setting, graduation year, or the number of patients with AOM seen each month. Our study adds new insights to the previous literature on the use of guidelines in the management of AOM. We can now assess the impact of guidelines on the usual practice of physicians in evidenced-based management of AOM.

Epidermoid tumors comprise 1% of intracranial tumors. Although reported, intraosseous epidermoid tumors are even more rare. Cystic lesions of the petrous apex are uncommon and surgically challenging; the most rare pathology is presumed to be epidermoid. This is a case of a 61-year-old woman with a large skull-base tumor extending inferiorly from the C1-C2 articulation and superiorly to the tuberculum sella. The lesion replaced the left-sided petrous apex, and the lateral extension of the tumor reached the styloid process. The tumor displayed intradural invasion medial to the internal auditory meatus, producing an intra-axial mass at the level of the upper pons. The patient presented with a 4-month history of headache and total unilateral deafness. Under image guidance, an endoscopic endonasal approach was used to totally resect the tumor. By following the tumor’s dural defect, the intra-axial part of the tumor was safely resected, and the dural defect was successfully repaired. Image-guided endoscopic endonasal surgery is a versatile approach that can safely and easily address a large epidermoid tumor in this challenging region, obviating the need for demanding and sophisticated transcranial surgery.

Tinnitus is a sense of sound perception in absence of an external source which can affect life quality. Different conditions may lead to tinnitus including metabolic disorders such as dyslipidemia. The aim of this study was to investigate the prevalence of dyslipidemia among Iranian patients with idiopathic tinnitus. This was a cross-sectional study in which prevalence of dyslipidemia in fasting state and its subclasses were assessed in 1043 tinnitus patients aged 12-90 years who referred to Rasool Akram Hospital, Tehran, Iran, 2006-2009. Data was summarized by SPSS software version 17 and one sample t-test and chi-Square test were applied to analyze the results. P less than 0.05 were considered significant. The most prevalent type of dyslipidemia was hypercholesterolemia with the frequency of 14.4% followed by low HDL-C with the frequency of 12.8%. Mean of total cholesterol, HDL-C, LDL-C and triglyceride levels in all patients were not greater than general population. Based on the results of the present study, there might be no need to check the serum lipid profile in tinnitus patients. We recommend further studies to assess both fasting and postprandial serum lipid profile in patients with idiopathic tinnitus. Simultaneous investigation of their dietary intake is also suggested.