Iranian Journal of Otorhinolaryngology
Volume:33 Issue: 1, Jan-Feb 2021

Introduction There are many fibrin-derived sealants used as topical haemostatic agents in many surgical procedures. Fibrin sealants are usually non-autologous derivatives or animal derivatives, with the exception of Vivostat®, an autologous fibrin sealant derived from patients own blood.   Materials and Methods We present our experience on the use of Vivostat® in skull base closures in 20 patients operated at the Otorhinolaryngology Unit of the Hospital Ospedali Riuniti Villa Sofia - Cervello of Palermo. All postoperative patients were placed in an anti-trendeleburg position for 48 hours. After removal of the nasal swabs we did not find any rhinorrhea and we checked the tightness of the skull base defect with computed tomography.   Results On a total of the 20 patients (10 post-traumatic and 10 with iatrogenic leaks), 9 out of 10 post-traumatic cases had a leak in the border area between the anterior and posterior portion of the ethmoid, while 1 patient out of 10 post-traumatic cases had a leak at the level of the sella. In all 20 patients, we repaired skull base defects by fixing grafting materials with Vivostat®. We have not had any complications. Vivostat® is a useful product in skull base repair and safe for the patients.   Conclusion Vivostat® has been used as a sealant on body tissues with greater elasticity and more resistant allowing better and safer wound repair, especially in skull base surgery. In particular, its immediate polymerisation is very useful for an evaluation of the mechanical sealants in the closure of the skull base cerebrospinal fluid leak.

Oral prednisolone was suggested as the first step to treat idiopathic sudden sensorineural hearing loss (ISSHL). This study aimed to investigate the effect of pulse therapy with methylprednisolone and intratympanic methylprednisolone, compared to traditional oral prednisolone therapy on patients with ISSHL.  

This randomized control trial included an experimental group receiving 500 mg intravenous methylprednisolone for three sequential days, followed by 1 mg/kg oral prednisolone for 11 days, and intratympanic Depo-Medrol four times twice a week. On the other hand, the control group received 1 mg/kg oral prednisolone for 14 days. Hearing change was assessed through pure tone audiometry. Subsequently, hearing recovery was investigated and analyzed in this study.  

This study was conducted on 51 patients who were divided into two groups of experimental (n=26) and control (n=25). The result revealed no significant difference between the two groups in terms of hearing improvement (P=0.28).  

This revealed no added benefit in pulse steroids combined with intratympanic injections in cases with sudden hearing loss.

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.

Submandibular gland resection is a controversial issue in patients with oral tongue squamous cell carcinomas (SCC). This study aimed to determine the frequency of submandibular gland involvement in patients who had undergone elective submandibular gland resection following oral tongue SCC.   This cross-sectional retrospective study was performed between 2001 and 2017 on patients with oral tongue SCC who had undergone glossectomy in a referral center for otorhinolaryngology surgery, Shiraz, Iran.   In this study, 131 patients were included. Their mean age was 59.84 years (range: 19-86). The mean tumor size was 2.83 cm (range 0.3-7). The vast majority (92%) of the patients were at stage III-IVa and had well (55%) to moderate (31%) differentiated tumor. The mean diameter of the submandibular gland was 3.87 cm (range: 1.5-6 cm). There was only one (0.76%) patient with submandibular involvement. She was an 80-year-old woman with a T2 well differentiated tumor without cervical lymph node involvement in the neck node dissection.   In patients with oral tongue SCC, submandibular gland involvement is rare and its elective resection in not recommended.

The aim was to investigate the link between tinnitus and serum levels of total cholesterol (TC), triglyceride (TRG), low-density (LDL) and high-density lipoprotein (HDL) in the central anatolian Turkish population.   The retrospective and case-control study included a total of 91 patients with subjective tinnitus and a control group of age- and sex-matched 65 healthy volunteers. A detailed otolaryngologic examination followed by pure tone audiometry, serum lipid values, and magnetic resonance imaging of the temporal bone was performed. The clinical characteristics of tinnitus were registered for all patients. The serum levels of TC, TRG, LDL and HDL were compared between the two groups.   Mean TC level was 200.57±41.06 mg/dL in the patient group and 179.0±39.03 mg/dL in the control group (P=0.001). Mean TRG level was 177.76±86.94 mg/dL in the patient group and 124.43±61.44 mg/dL in the control group (P=0.000). Mean LDL level was 115.88±32.56 mg/dL in the patient group and 101.31±34.42 mg/dL in the control group (P=0.008). Mean HDL level was 50.25±13.60 mg/dL in the patient group and 53.46±12.66 mg/dL in the control group (P=0.137). Among all the serum lipids, TC, TRG and LDL established a significant difference between the two groups.   The results indicated that TC, TRG and LDL levels were significantly higher in tinnitus group and this increase implicates the potential role of hyperlipidemia associated with altered lipid metabolism in the etiology of tinnitus. We suggest that serum lipid levels could be useful and conducive in the diagnosis and prognosis of tinnitus.

The first successful attempt at tracheal intubation with minimal complications is crucial for emergency physicians. The aim of this study was to compare endotracheal intubation using video laryngoscopy versus direct laryngoscopy in the emergency department by emergency medicine residents.  

In this randomized clinical trial, 70 patients requiring laryngeal intubation were randomly enrolled in direct and video laryngoscopy groups. The first attempt success rate, frequency of attempts, complications, and hemodynamic changes after laryngoscopy were assessed. The data were analyzed using the Chi-square, independent t-test, and Fisher's exact test.  

The results showed a significant increase in heart rate, as well as systolic and diastolic blood pressure after both direct and video laryngoscopy (p <0.001). However, this increase was more severe in the video laryngoscopy group (p <0.001).  

Although the use of both devices had similar success rate, if orotracheal intubation is performed by a novice emergency medicine residents, direct laryngoscopy causes fewer hemodynamic effects on patients, compared to video laryngoscopy.

The relationship between autoimmune disease and   sensorineural loss is well documented in literature. Immune mediated sudden hearing loss is asymmetric, bilateral and rapidly progressive but responds well to steroid therapy. However association of cranial nerve neuropathies with sudden hearing loss is rare.  

Case Report: 

A 41 year old female presented with sudden mixed hearing loss and developed multiple cranial nerve palsies within a month. Blood and Cerebrospinal fluid analysis revealed an undiagnosed rheumatoid arthritis. She responded well to definitive therapy with cyclophosphamide and azathioprine.  

If sudden hearing loss is associated with cranial neuropathy, an autoimmune work-up is highly recommended.

Warthin's tumor (WT) is the second most common neoplasm of the parotid gland and consists of two components, including lymphoid stroma and glandular epithelium. The malignant transformation of this tumor occurs most often in the lymphoid component; however, the carcinomatous transformation of the epithelial component is rare.  

Case Report: 

We present a patient who had a mass in the right mandibular angle two years before referral. A cystic mass was reported on sonography, and the patient underwent superficial parotidectomy with a pre-operative impression of lymphangiomatouse-like lesions. In the microscopic view, the sections revealed salivary gland neoplastic lesion with the diagnosis of WT. On the periphery of the neoplasm, another neoplastic lesion was observed along with infiltrative borders and diagnosis of mucoepidermoid carcinoma.  

The WT is one of the most common tumors of the salivary glands. Malignancy transformation of the WT is a rare event. However, due to the importance of the treatment type, the surgeon should consider this issue in cystic lesions suspected of WT.

Verruciform xanthoma (VX) is an uncommon benign lesion with the subepithelial accumulation of foamy histiocytes and superficial papillary proliferations with a bright orange hue. This lesion exhibits an oral region predilection.Its clinical differential diagnosis includes verrucous leukoplakia, verrucous carcinoma, squamous papilloma, verruca vulgaris, condyloma accuminatum, squamous cell carcinoma, and fibroepithelial polyp.

  Case Report: 

This report presents a case of VX of the ventral surface of the tongue afflicting a 33-year-old otherwise healthy male.

This case report can be valuable as a consequence of VX rarity and the similarity of its clinical features to papillary lesions. A biopsy is required for its definite diagnosis particularly when it occurs at sites with a high-risk of squamous cell carcinoma development, such as the lateral border and ventral surface of the tongue.

Carotid sinus syndrome (CSS) is a hypersensitivity of the carotid sinus manifested by atrioventricular sinus bradycardia or decreased arterial pressure of at least 50 mmHg. Triggering factors can be neck movements, shaving of the beard or too-tight collars. CSS can be rarely caused by the presence of malignant or benign masses in the head and neck area.

Case Report: 

A 49 years-old white woman with a laterocervical mass presented recurrent episodes of sinus bradycardia related to head’s rotation. Neck CT scan revealed a right piolaryngocele and internal left laryngocele. Episodes of bradycardia were disappeared after endolaryngeal carbon dioxide laser assisted marsupialization.

Laryngocele should be sought in the differential diagnosis of patients with bradycardia episodes due to carotid sinus compression. Surgical treatment of laryngoceles can lead to the termination of such episodes.