فهرست مطالب

Iranian Journal of Otorhinolaryngology
Volume:32 Issue: 3, May-Jun 2020

  • تاریخ انتشار: 1399/02/10
  • تعداد عناوین: 10
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  • Sasan Dabiri, Mohammadtaghi Khorsandi Ashtiani, Melorina Moharreri, Zahra Mahvi Khomami, Ali Kouhi, Nasrin Yazdani, Pedram Borghei, Kayvan Aghazadeh * Pages 133-138
    Introduction
    The primary aim of facial reanimation surgery is to restore tone, symmetry, and movement to the paralyzed face. Hypoglossal-facial end-to-side anastomosis provides satisfactory facial reanimation in the irreversible proximal injury of the facial nerve. This study discussed the facial function results of end-to-side anastomosing of hypoglossal nerve to facial nerve when the injury occurred during skull base surgery.
    Materials and Methods
    The present study enrolled a total of 10 patients who underwent end-to-side hypoglossal-facial nerve anastomosis after facial nerve paralysis due to skull base surgery. The data of the patients were gathered from hospital records, pictures, and movies during the 18 months of follow-up.
    Results
    At the 18 months of follow-up, seven (70%) and three (30%) patients were reported with grades III and IV of the House-Brackmann scoring system, respectively. In total, out of the seven grade III patients, six subjects underwent early anastomosis (within the first year of the paralysis). On the other hand, among patients with grade IV, two subjects had late anastomosis.
    Conclusion
    It seems that early end-to-side hypoglossal-facial anastomosis can be a favorable surgical option with good facial function results for reanimating the facial function of patients with facial paralysis following skull base surgery.
    Keywords: Facial nerve paralysis, Hypoglossal-facial nerve anastomosis, Rehabilitation
  • Neha Chauhan_Satyawati Mohindra_Sourabha K Patro *_Preethy J Mathew_Joseph Mathew Pages 139-145
    Introduction
    Evidence for factors determining paediatric tracheostomy decannulation vary extensively; therefore, this prospective observational study aimed to investigate these factors.
     
    Materials and Methods
    In total, 67 consecutive paediatric patients (<12 years old) who referred to the Department of Otolaryngology, (Postgraduate Institute Medical Education and Research),(Chandigarh), India, for decannulation were included and evaluated for contributing factors in this study. Parental counselling was performed, and informed consents were obtained from them. The patients underwent detailed work up including X-rays of airway/soft tissue neck (STN) and endoscopic assessment under anaesthesia for evaluating airway patency. Decannulations were attempted post assessment and followed up one month to classify decannulation as success or failure regarding the removal of the tracheostomy tube.
     
    Results
    Totally, 61 patients out of 67 cases were successfully decannulated, whereas six children failed the decannulation. Moreover, the duration of tracheostomy (Pearson’s Chi-square 35.330, P=0.013), indication of tracheostomy (Pearson’s Chi-square 21.211, P=0.000), STN X-Ray (Chi-square 43.249, P=0.000), and bronchoscopic findings (Chi-square 67.000, P=0.000) were significantly associated with the outcome of decannulation. However, decannulation outcome had no significant correlation with various factors, such as the duration of intubation preceding tracheostomy, duration of ventilation, tracheal swabs, and antibiotic therapy.
     
    Conclusion
    The STN X-ray is an independent predictor, and it is recommended for paediatric tracheostomy decannulation. Moreover, bronchoscopic assessment should be performed in children having doubtful infra-stomal airway. Duration of tracheostomy significantly affects decannulation outcome. However, intubation duration preceding tracheostomy and duration of assistive ventilation have no direct effects on the outcome of decannulation. In children, gradual decannulation should be preferred and one month follow up is adequate for deciding decannulation outcome.
    Keywords: Decannulation, Factors Affecting Decannulation, Paediatric Tracheostomy, Prolonged Mechanical Ventilation
  • Mehdi Dehghan, Akram Ahmadi, Behnaz Yousefghahari, Keyvan Kiakojouri *, Hemmat Gholinia Pages 147-153
    Introduction
    The aim of the present study was to compare the videolaryngostroboscopic findings between patients with rheumatoid arthritis and vocally healthy controls.  
    Materials and Methods
    This case-control descriptive study was performed on 113 people, including 50 patients with rheumatoid arthritis and 63 controls. The participants were subjected to videolaryngostroboscopic examinations in order to evaluate fundamental frequency, different structural vocal lesions, patterns of glottal closure, subglottal changes, supraglottis appearance, and movement patterns of the arytenoid cartilage. The obtained results were compared between the two research groups. Data analysis was performed in the Statistical Package for the Social Sciences, version 24.0. A p-value less than 0.05 was considered statistically significant.  
    Results
    The results revealed a statistically significant difference between the two groups in terms of the complete pattern (P=0.00) and strained state of glottal closure (P=0.00), pattern of subglottal changes (χ2=25.98, df=2; P<0.001), and movement patterns of the arytenoid (χ2=21.16, df=1; P<0.001). Additionally, based on the obtained frequencies, the two groups showed significant differences regarding the normal state of the larynx (P=0.00), hypertrophy of vocal fold (P=0.007), epithelial change (P=0.007), and Reinke's edema (P=0.001). However, the videolaryngostroboscopic examination results revealed no significant difference between the two groups in terms of polyp (P=0.20), nodule (P=0.57), sulcus vocalis (P=0.08), cyst (P=0.45), and atrophy of vocal folds (P=0.45).  
    Conclusion
    It seems that rheumatoid arthritis affects the patterns of arytenoids movement, some kinds of glottal closure patterns, and subglottal changes. As the results indicated, the occurrence of some laryngeal structural changes was higher in patients with rheumatoid arthritis than in individuals without this disorder.
    Keywords: Larynx, Rheumatoid arthritis, Voice, Vocal cords
  • Negin Salehi, Mehdi Akbari *, Akram Pourbakht, Hamid Haghani, Mahyar Janahmadi Pages 155-161
    Introduction

    Cisplatin is one of the most commonly used antineoplastic drugs; nonetheless, its ototoxic dose-limiting side effects have remained a significant challenge in clinical practice. The recognition of the exact template of hearing loss induced by multiple low doses of cisplatin could be of great help in managing the treatment process. The present study aimed to investigate the effects of multiple doses of this drug on the auditory system.

    Material and Methods

    The present study was performed using an experimental guinea pig model in four groups as follows: 1- 0.9% sodium chloride solution, 2- total dose of 7.5 mg/kg Cisplatin, 3- total dose of 10 mg/kg Cisplatin, and 4- total dose of 12.5 mg/kg cisplatin. The drugs were injected as 2.5 mg/kg/daily IP access in all groups. The auditory brainstem response (ABR) test was performed before the treatment and after every injection on a daily basis up to 72 h after the last injection.

    Results

    There was dose-dependent significant hearing loss in all evaluated frequencies in three cisplatin groups. The general template of induced hearing loss during experimental days was almost the same in groups Cis7.5 and Cis10. In Cis 12.5 group, there was a jump in the threshold shift on the 5th day of the experiment and an upward trend in the function.  

    Conclusion

    As evidenced by the obtained results, the monitoring of hearing loss after every injection in patients who receive the drug and detecting the exact dose-dependent pattern of the induced hearing loss is of great help in controlling its undesirable destructive side effects on the auditory system.

    Keywords: Auditory Brainstem response (ABR), Cisplatin, Guinea pigs, Hearing Loss, Ototoxicity
  • Mustafa Çelik *, Yakup Yegin, Burak Olgun, Ahmet Altıntaş, Fatma Tülin Kayhan Pages 163-168
    Introduction

    The aim was to explore the developmental relationships between the angles of septal deviations and the degree of the mastoid pneumatization.

    Materials and Methods

    In total, 143 patients with a diagnosis of septal deviation who underwent septoplasty were included. The patients were divided into three groups in terms of the angles of the septal deviation. The angle of the septal deviations was defined as mild (<9 degrees), moderate (between 9 and 15 degrees) and severe (15 degrees and above). The degree of the mastoid pneumatization of each groups were compared.

    Results

    In right-sided septal deviation subjects, the right mastoid air cell volumes of group mild, moderate and severe were 6,31±2,33 cm3, 5,20± 1,51 cm3, and 5,31±1,57 cm3, respectively. The mean right mastoid volumes of each groups did not differ in right-sided deviations subjects (P>0.05). The mean left mastoid volumes of each groups did not differ in right-sided deviations subjects (P>0.05). In right-sided septal deviation subjects, the mean volume of the right and left-sided mastoid air cells of each groups did not differ (P>0.05). In left-sided septal deviation subjects, the mean volume of the right and left-sided mastoid air cells of each groups did not differ (P>0.05).

    Conclusions

    No developmental relationships between the angles of septal deviations and the degree of the mastoid pneumatization was observed in the study.

    Keywords: Mastoid, Nasal septum, Nasal Surgical Procedures, Temporal bone
  • Maryam Moradi, Bahare Dalili * Pages 169-173
    Introduction

    This study aimed to investigate the distribution of ethmoid roof variation and symmetry according to Keros classification.  

    Materials and Methods

    This cross-sectional study assessed the paranasal CT scans of 600 patients over 18 years of age with no history of surgery, trauma, or localized fracture in the ethmoid, nose, and anterior skull base. The lateral lamella of the cribriform plate (LLCP) sizes were measured and classified as Keros type I (1-3 mm), II (4-7mm), and III (8-16mm). Moreover, the symmetry was surveyed in accordance with the LLCP measurements on both sides of the ethmoid roof. These variations were analyzed regarding gender and age.  

    Results

    In total, 600 patients participated in this study out of whom 311 cases were male. According to the results, the mean age of the participants was 37.50±16.63 years. Furthermore, the mean values of the LLCP height for the right and left sides were 4.17±1.69 and 4.93±1.97 mm, respectively. Moreover, the asymmetry was observed in 38.3% of the cases, and they were classified as 36.7% Keros type I, 50.5% Keros type II, and 12.8% Keros type III.  

    Conclusion

    Keros type II and symmetry were the most common variations in this study. In addition, these variations were independent of age and gender.

    Keywords: Anatomy, classification, Ethmoid sinus
  • Paolo Farneti *, Andrea Bellusci, Alfredo Parmeggiani, Ernesto Pasquini Pages 175-179
    Introduction

    Bilateral silent sinus syndrome (SSS) is a very rare pathology reported only in few papers in literature. Most of the described cases are simultaneous, and only one had a metachronous presentation. The evolutionary phases of the disease have yet to be well demonstrated and a complete radiological evaluation is needed to demonstrate the pathogenetic mechanisms that cause the disease.

    Case Report:

    A 45-year-old male presented with a left SSS and a bilateral concha bullosa. He developed a contralateral SSS two years after an endoscopic uncinectomy and re-ventilation of the diseased maxillary sinus. This case is the second reported in literature with a metachronous presentation. A pure endoscopic approach has led to the resolution of symptomatology and the full restoration of the ventilation of the maxillary sinuses. The key role of the uncinate process in the genesis of the pathology has been well demonstrated by the onset of a contralateral SSS in a normally developed maxillary sinus thanks to a complete radiological follow-up.  

    Conclusion

    Bilateral presentation is a rare entity; however, it should be considered in patients with SSS. A minimal endoscopic uncinectomy could also prevent the onset of the disease on the healthy side.

    Keywords: Diplopia, Enophthalmos, Endoscopy, Maxillary Sinus, Orbit, Paranasal Sinuses
  • Remo Accorona, Giovanni Colombo, Marco Ferrari, Enrico Fazio *, Andrea Bolzoni Villaret Pages 181-186
    Introduction

    Supernumerary teeth are frequently reported in dental clinical practice; however, eruption in nasal cavities and paranasal sinuses is an extremely rare clinical entity.   

    Case Report:

     We report two cases with a history of recurrent nasal discharge and obstruction. In both cases, clinical and radiological findings confirmed the presence of an inverted supernumerary tooth erupted in the sinonasal cavities (i.e., the right nasal fossa and left maxillary sinus, respectively). We managed the cases with transnasal endoscopic approach. A survey of the English literature identified 69 documented cases with intranasal supernumerary teeth within January 1st, 1886 to December 31st, 2017.  

    Conclusion

    Inverted supernumerary teeth should be considered among the potential causes of unilateral nasal obstruction and rhinosinusitis and included in differential diagnoses among the fibro-osseous lesions of the sinonasal cavities.

    Keywords: endoscopic sinonasal surgery, Inverted supernumerary tooth, Rhinosinusitis
  • Giorgos Sideris *, Marilia Sapountzi, Pavlos Maragoudakis, Alexander Delides Pages 187-191
    Introduction

    Acute epiglottitis or supraglottitis is a rapidly progressing upper respiratory tract infection that can often threaten the airway patency. Epiglottic abscess that expands to the paraglottic (PGS) or preepiglottic (PES) space and acute airway obstruction constitute rare complications, exclusively presented in adults. 

     Case Report:

    We report two cases. In the first case flexible fiberoptic Rhino-Pharyngo-Laryngoscopy showed epiglottitis that was obstructing the airway and abscesses on the lingual surface of the epiglottis. Abscesses were opened using laser CO2. In the following days flexible fiberoptic endoscopy revealed persisting protrusion of the left hemilarynx. A CT scan was performed showing an abscess in the paraglottic space. Under direct laryngoscopy the abscess was drained. In the second case endoscopic examination revealed epiglottitis that did not cause airway obstruction. The patient was admitted for follow-up and treated with intravenous antibiotics. On the 5th day showed an exacerbation of her symptoms. A CT scan was performed that showed the existence of an abscess in the preepiglottic space. She was taken to surgery and the abscesses were drained through a cervical- U shaped- incission.  

    Conclusion

    Existance of an abscess means, by default, an adequate surgical treatment to ensure the airway, and immediate drainage under direct laryngoscopy or through an external approach.  Diagnosis is based exclusively on medical history and clinical examination.  CT scan is necessary to reveal “secret” abscesses and “silent” extension of the infection inside pre-epiglottic and paraglottic space even if epiglottitis is mild. Postoperative management includes proper care of the surgical wound and antibiotics.

    Keywords: Abscess, Airway obstruction, Epiglottitis, Supraglottitis, Tra187cheostomy
  • Swagatika Samal, Pradeep Pradhan *, Chappity Preetam Pages 193-196
    Introduction

    The primary involvement of the parotid duct in rhinosporidiosis is very rare in clinical practice. Here, we present a case of rhinosporidiosis primarily involving the parotid duct, which was successfully excised through transparotid and transoral approaches.

      Case Report: 

    A 51-year-old male presented with a painless progressive swelling over the left cheek for nine months. It was diagnosed as a parotid cyst or a mucous retention cyst based upon the radiological and cytological features. The cyst was completely excised with transparotid and transoral approaches, and the final diagnosis was confirmed to be rhinosporidiosis.

    Conclusion

    Although the nose and the paranasal sinus are the common sites to be involved in rhinosporidiosis, the affection of the parotid duct is very unusual in clinical practice.

    Keywords: Parotid duct, Primary rhinosporidiosis, Surgical excision