Iranian Journal of Otorhinolaryngology
Volume:33 Issue: 2, Mar- Apr 2021

The ossicles of the middle ear are affected by the erosive effect of pathology in chronic otitis media. Ossicular reparation can be done via autologous incus or with alloplastic materials. Glass ionomer cement (GIC) is simple to use and saves considerable operative time and expenses especially in developing countries where costly ossicular prosthesis are not affordable for the majority of the patients.   Twenty-five chronic otitis media patients who underwent surgery were included in this study. The reconstruction material used in this study was glass ionomer cement. All patients had erosion of the long process of incus and a normal stapes.      Pure tone average in pre-operative and post-operative period of study patients were 50.09 & 29.92 dB respectively (P=0.01) and the air-bone gap was 24.85 dB preoperatively and 14.05 dB postoperatively. The closure of the air-bone gap was statistically significant (P= 0.01).   The study showed that the use of GIC ossiculoplasty is an efficient method for the reparation of the long process of the incus. The results are encouraging and indicate that it is worthwhile to conduct more trials using this method.

 The caloric test is a well-known valuable clinical instrument that can evaluate and quantify the functional status of both lateral semicircular canals. The American National Standard Institute (ANSI) does not include air as a standard method for caloric stimulation due the lack of published data to determine response variability comparable to water. Due the controversy about air irrigators, it is worthwhile to evaluate the presence of differences between the two irrigation methods in caloric response. The goal is to compare, by age group, the post caloric responses with water and air according gender and age.  

Individuals without otoneurologic complaints were selected and divided in groups. All were submitted to caloric bithermal stimulation with water at temperatures of 44°C and 30°C (Micromedical Technologies, Inc., USA) and air at temperatures of 50°C and 24°C (Micromedical Technologies, Inc., USA).  

91 subjects were evaluated (46 men and 45 women) with a mean age of 43 years old. The caloric response was similar between genders (P=0,958) and no statistical difference was observed comparing both stimulus (P=0,93). It was identified that the Slow-Phase Velocity (SPV) was lower for the group older than 60 years comparing to the other groups.  

For the caloric test, the stimulus with air was confirmed as similar as stimulation with water, including absolute values. Lower values for SPV were found for elderly population.

Hearing loss (HL), with more than 100 gene loci, is the most common sensorineural defects in humans. The mutations in two GJB2 and GJB6 (Gap Junction Protein Beta 2, 6) genes are responsible for nearly 50% of autosomal recessive nonsyndromic hearing loss. The aim of the present study was to evaluate polymorphisms of 111C>T (rs7329857) and 337G>T (rs7333214) in GJB2 (encoding connexin 26) and GJB6 (encoding connexin 32) genes, respectively.   In this study, 32 blood samples were obtained from Iranian patients with HL defect and 32 normal blood samples were prepared. After genomic deoxyribonucleic acid extraction, genotyping in rs7333214 and rs7329857 polymorphisms was conducted using tetra-amplification refractory mutation system-polymerase chain reaction and the obtained data were analyzed.   In this study, the prevalence rates of CC, CT, and TT genotypes in GJB2 gene were reported as 84.4%, 68.7%, and 0% in the affected subjects and 0%, 15.6%, and 31.3% in the control samples, respectively, which were statistically significant (P=0.004). In relation to GJB6 gene, the prevalence rates of GG, GT, and TT genotypes were 65.2%, 78.1%, and 25% in the control subjects and 21.9%, 9.4%, and 0% in the affected samples, respectively, which were not statistically significant (P>0.05).   The results of this study revealed that 111C>T polymorphism in GJB2 gene was involved in the incidence of HL in the studied population and could be suggested as a prognostic factor in genetic counseling before marriage and pregnancy.

The aim of this study is to analyse different surgery (radio frequency and cold instrumentation) of oral benign papillomatous lesions.   A retrospective study was carried out in our section of Otorhinolaryngology from 2014 to 2018. 112 patients with oral benign papillomatous lesions were enrolled and divided into 2 groups. Group A of 62 patients treated with excision of lesions using radio frequency using a bipolar coagulation electrode (CelonLabENT). Group B of 50 patients treated with excision of the lesion using traditional cold instruments (scalpel and surgical forceps). All patients were evaluated for intraoperative bleeding, discomfort and recurrence rate.   112 patients (of which 37 males and 75 females) with mean age 32.9 ranged from 10 to 61 years. The HPV types associated with oral benign papillomatous lesions were HPV 6 (17%), 11 (23,3%), 13 (10,7%), 32 (34%), 2 (10%) and 57 (5%). There are no statistically significant differents among patients operated with radio frequency (Group A) and cold instrumentation (Group B) regarding intraoperative bleeding (P= 0.08), recurrence rate after 1 year from surgery (P=1), intraoperative discomfort (P=0.7) and postoperative discomfort (P=0.6).   Radiofrequencies and surgery with scalpel and surgical forceps are equal valid methods for the treatment of benign papillomatous.

Introduction :

The facial nerve is an important structure related to parotid gland surgery. Its identification at the time of surgery is critical. Multiple anatomical landmarks have been described to aid in its identification. The objective of this study is to assess whether the tympanomastoid suture is a better surgical landmark than the tragal pointer for identifying the facial nerve while performing parotidectomy.  

Sixty patients presenting over a period of 3 years from 2016 to 2018 with a parotid swelling without pre-operative facial weakness were included in the study. The average distances between the facial nerve (FN) and the tragal pointer (TP), and the facial nerve (FN) and tympanomastoid suture (TMS) were calculated intra-operatively and compared.  

Out of the 60 patients operated, 54 underwent superficial parotidectomy and 6 underwent total conservative parotidectomy. The mean distance between the FN (main trunk) and TP was found to be 18.38 ± 6.85 mm and that between FN and TMS was found to be 2.92 ± 0.6 mm (p <0.0001).  

Tympanomastoid suture is a fairly constant and consistent bony landmark to locate the facial nerve during parotid surgeries as compared to the more commonly used cartilaginous tragal pointer. The results of this study can guide surgeons during parotidectomy, to correctly and promptly identify the facial nerve thereby reducing the risk of injury.

Laryngeal tuberculosis (LTB) is the most frequent granulomatous disease of the larynx. The aim of the present work was to study the laryngostroboscopic features and voice quality of patients with laryngeal TB secondary to pulmonary TB.   Participants were 35 patients diagnosed as having pulmonary TB and dysphonia. All patients had a complete history, clinical and laboratory workup. Patients were assessed using a protocol of voice assessment which included Auditory-perceptual analysis of voice, voice analysis using the Multidimensional Voice Profile (MDVP), and laryngostroboscopy.   The participants were 24 males and 11 females and their mean age was 43.7 years. The voice acoustic analysis revealed a significant difference from normal in jitter percent, shimmer percent, and harmonic to noise (H/N) ratio. Laryngeal gross lesions were found in 11 patients while the other 24 patients had normal laryngoscopic findings with nonspecific stroboscopic changes as reduced mucosal waves and mild glottic gap. Diffuse lesion of the whole vocal folds was found in 5 patients and anterior predilection in 4 patients. The type of lesions were granulomatous lesions in 7 patients and non-specific inflammatory mild exophytic lesions in 4 patients.       Voice disorders in pulmonary TB include disturbance in the mechanism of voice production with or without detectable laryngeal lesion. Videostroboscopy has the advantage of showing the extension of laryngeal involvement, vocal folds vibrations, and mucosal waves.

Very late presentation of cerebrospinal fluid rhinorrhea is quite rare with some factors like brain shrinkage with age and ethmoidal growth fracture that lead to leakage from fracture site.  

We present a 70 years old man diagnosing with CSF rhinorrhea, 45 years after head injury with metallic rod. Treatment of cerebrospinal fluid leakage was performed successfully  by endoscopic intranasal repair.  

The cerebrospinal leak can occur years after the traumatic head injury even though patient may not had cerebrospinal fluid leakage at the time of trauma. The physician should be aware of the possibility of very late presentation of the cerebrospinal leakage even after years of traumatic head injury.

Angiofibromas classically develop in the lateral wall of the nasopharynx from the sphenopalatine region. Extra-nasopharyngeal angiofibromas are rare entities, with the maxillary sinus being the most common site. Parapharyngeal angiofibroma is an extremely rare entity, being seldom reported in English literature.  

We present a case of parapharyngeal angiofibroma, which came as a diagnostic surprise in a young adult 25-year-old male. The radiological picture showed a highly vascular lesion, which did draw our attention for not going for a direct or guided FNAC, and upfront excision was planned through the transcervical route.  A firm 5 * 7 cm mass was excised and sent for histopathologic examination. The histopathology showed angiofibroma like features as a diagnostic surprise as angiofibroma of parapharyngeal space is a known but rare entity.  

   The knowledge of angiofibroma as a differential in parapharyngeal space will help the clinicians to properly deal with these disorders during preoperative evaluation and definitive surgery and thus prevent the chances of vascular injuries and complications associated with an FNAC.  A high level of suspicion regarding this differential as a possible lesion in the parapharynx is required for the entity's diagnosis.

Paraganglioma are infrequent neuroendocrine tumors that are most commonly found in the carotid body, ganglia of the vagus, jugular and tympanic nerve. Very rarely they can involve other cranial nerves outside the cranial cavity, we present one such case of hypoglossal nerve paraganglioma in neck.

A 48 years old male presented with 1-month history of right sided stroke and aphasia. Ultrasonography of neck revealed a highly vascular mass on the right side of the neck. CT angiogram confirmed a highly vascular mass arising above the carotid bifurcation. With the working diagnosis of Glomus tumor, he underwent right sided neck exploration, however, intra-operatively tumor was found to be arising from the hypoglossal nerve instead. Surgery was abandoned on basis of the available literature, with only 6 reported cases in the past 54 years. Patient had no immediate post op complications and was sent for cyber knife treatment. After completion of 5 cycles of cyber knife there was a total of 45% reduction in the size of the paraganglioma with the resolution of the patient’s symptoms after a follow up of 6 months.  

Hypoglossal nerve paraganglioma is an uncommon tumor of the neck and can be misdiagnosed with the other tumors in this region especially chemodectoma and glomus tumor. The diagnostic criteria and appropriate treatment modalities have not been established due to the rare presentation hence hypoglossal paraganliomas should be kept in mind when Highly vascular neck mass is encountered.

Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibro-inflammatory disorder.  Laryngotracheal manifestation is very rare; therefore, it is usually associated with complex diagnostic and therapeutic problems.  

Herein, we report the case of a 35-year-old woman with idiopathic subglottic stenosis (ISGS) treated with one-step laryngotracheal reconstruction surgery. Postoperatively, the lesion was found to be a part of the IgG4-RD spectrum. Objective and subjective phoniatric tests, spirometry, and Quality of Life Questionnaire were used for the evaluation of postoperative functional results. Slide laryngotracheoplasty as a one-step surgery without stenting and tracheostomy ensured a sufficiently wide subglottic space with no adverse effect on voice quality. During a follow-up period of 22 months, endoscopy and computed tomography scan revealed no significant restenosis. The patient was able to return to premorbid activities of daily living without any further medical treatment.

The laryngeal involvement of IgG4-RD is uncommon; however, it is a manifestation that should be included in the differential diagnosis of subglottic stenoses (SGS). Furthermore, subglottic IgG4-RD might be a potential etiological factor of ISGS and acquired airway stenosis after short-term intubation. Slide laryngotracheoplasty might be a favorable solution without stenting and tracheostomy even in special cases of SGS.