Iranian Journal of Otorhinolaryngology
Volume:33 Issue: 4, Jul-Aug 2021

Nasopharyngeal carcinoma (NPC) is a rare and aggressive head and neck squamous cell carcinoma worldwide.Tumor-infiltrating lymphocytes (TILs) have been studied and reported to be effective targets of drugs on cancer and were related to the prognostic value.The aim of the study was to look systematically into the current literature and carefully analyze the results to explore the relationship of TILs and NPC.  

Three independent reviewers conducted the literature search, searching for articles published in January 2000-January 2020 and fulfilling inclusion and exclusion criteria. The lead author independently assessed the risk of bias of each of the included studies and discussed their assessments with the other two authors to achieve consensus. Of the 1233 articles identified in database searching, 12 articles met the criteria for this review.  

The majority of the study designs were cohort (9 of 12 studies). Most of the studies discussed the prognostic significance of TILs in NPC (nine studies), two studies reported the expanded TILs for the treatment of NPC, and one study reported TILs based on one gene expression.  

TILs in NPC are related to the prognostic factor and development of the immunotherapy. High TILs were associated with better outcome and survival rate; and TILs have been claimed to reflect an effective anti-tumor immune response, immune response inducer, delayed tumor progression, and improving the cancer-immune microenvironment. The understanding of TILs in NPC based on gene expression becomes important information to learn more about the relationship of TILs and NPC.

There is no consensus on which imaging modality is better for the detection of metastatic cervical lymph nodes in orofacial malignancies. This study evaluates the efficacy of computed tomography (CT) and ultrasonography (US) in diagnosis of metastatic lymph nodes in orofacial cancer.   Sixty patients with various histologically diagnosed orofacial malignant lesions and clinical evidence of cervical lymph node metastasis were examined using US and CT. Further, the affected lymph nodes were biopsied and examined histologically. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the techniques were calculated. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 19 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2010 (Microsoft, Redmond, WA, USA). Test of statistical significance was set at 0.05.   US recorded a sensitivity, specificity, PPV, NPV, and accuracy of 80.0%, 57.1%, 77.5%, 60.0%, and 71.7%, respectively (p = 0.004), while CT recorded a sensitivity, specificity, PPV, NPV, and accuracy of 87.1%, 71.4%, 85.0%, 75.0%, and 81.7%, respectively (p <0.0001). Lymph node size was the commonest criterion in the diagnoses of metastases in cases with cervical lymph nodes.   Although we obtained great results using US, our results indicated CT to be a better imaging modality for detecting metastatic cervical lymph nodes in orofacial malignancies.

The best initial investigation for thyroid nodule is fine needle aspiration (FNA). Bethesda System is an international standardized system of reporting thyroid nodules and recommends subsequent management. Every institution should assess the risk of malignancy in each category to avoid unnecessary thyroid surgeries, with this aim we conducted a review at our center to calculate risk of malignancy in each category.  

Retrospective 9-year (2009–2018) review of thyroid FNAs done at a tertiary care Centre. The FNA was stratified according to The Bethesda System. Histopathology reports of the operated cases were used to evaluate the cytology for diagnostic accuracy.  

There were 495 patients who underwent thyroidectomy. The mean age of the cohort was 42.51 +/- 13.2 years and 387 (78.2%) were females. The frequency of Bethesda categories I, II, III, IV, V, and VI were 9.1%, 55.6%, 16.4%, 6.5%, 9.3%, and 3.2% respectively. Malignancy rate in operated thyroid nodules were 37.8%, 8.4%, 33.3%, 50.0%, 89.1%, and 100% for Bethesda categories I to VI, respectively. The sensitivity, specificity, negative predictive value and positive predictive value and their 95% CIs were calculated as 81.30 (73.28 – 87.76%), 77.06 (72.12 – 81.51%), 91.64 (88.3 – 94.1%) and 57.14 (51.79 – 62.33%). The overall diagnostic accuracy was 78.22 (74.12 – 81.95%).  

All the Bethesda categories showed greater malignancy risks than other reported studies. Knowledge of local rates of malignancy is important to accurately predict the risk of malignancy even when reported with internationally accepted nomenclature like the Bethesda System.

The management of thyroid nodules has been proposed based on US features and information obtained from Fine-Needle Aspiration Cytology (FNAC). In this study, we checked the diagnostic value of ultrasound in comparison with FNAC in probably benign nodules of thyroid. Patients with thyroid nodules referred to the Radiology department from 2015 to 2020, were classified into five types based on the American College of Radiology/thyroid imaging reporting and data system (TI-RADS) standards. The patients with TI-RADS III-V were examined by FNA biopsy. Subsequently, the collected data of 535 patients having thyroid nodules with TI-RADS III were statistically analyzed. The mean age of the patients was estimated at 46.57. The analysis of TI-RADS III cases examined by the FNA biopsy revealed that 99.1% of the cases were diagnosed with benign lesions. The mean size of benign and malignant nodules was 27mm and 41mm, respectively. There was no significant correlation between the size of the nodules or patients age, and thyroid malignancy (P-values > 0.05). There was a very low chance of malignancy (0.9%) in thyroid nodules with thyroid imaging classification of TI-RADS III. Furthermore, no meaningful correlation was observed between the size of the nodules and their malignancy. Therefore, the use of FNAC, based on the current guidelines, on thyroids for nodules larger than 2.5 cm might need to be revised.

To analyze the clinical features, diagnosis, management and clinical outcomes in the patients with ectopic thyroid in a tertiary care hospital.   This was a retrospective study which included eight cases of ectopic thyroid presented in the outpatient clinic. Their medical records were reviewed for clinical presentation, imaging modalities used, biochemical tests and outcomes of the management was analyzed.   Total eight patients were included in the study, of which five were females and three were males, within the age range of 6 - 44 years. Painless neck swelling was the predominant complaint, which was observed in the seven (87.50%) patients. Total 6 (75%) patients had normal thyroid function test and 2 (25%) patients had features of hypothyroidism. Three patients underwent surgery and three patients needed hormonal replacement. Follow-up was advised for three patients. Post-treatment follow-up of all the patients was conducted for 24 months and no significant progression/recurrence/malignant transformation of the disease was seen in any of the patients.   Being a rare disorder, timely diagnosis and management is important to avoid complications and for better clinical outcomes.

Otomycosis, as a common superficial fungal infection, is the term to infection of external auditory canal. Despite numerous studies on diverse antifungal agents, there is no common consent on effective agent for treatment of otomycosis.  Therefore, the purpose of this study is compared therapy of otomycosis using two therapeutic agents; clotrimazole and iodine tincture.   This research is a clinical trial study included 160 patients who were presented otomycosis. All patients were randomly assigned into two therapeutic groups of clotrimazole and Iodine Tincture (80 cases in each group). The results of response to thrapy were evaluated on 4, 10, and 20 days. Statistical analyses were performed using Independent-Samples t-test, Chi-Square, and Fishers҆ Exact tests in SPSS software v.18, in 0.05 significant level.   Fungal species were isolated including Aspergillus (72.5%) and Candida albicans (22.5%). After 4thday of treatment, 7.5% of the tincture group and 11.2% of the clotrimazole group revealed a good response to treatment (P=0.30). A good response to treatment was observed in35.0 and 41.2% of the patients on 10th day of treatment (P=0.44); and in 67.5 and 62.5% of the patients on 20th day of treatment (P= 0.20). There was no significant relationship between the two therapeutic arms.   In this study, both clotrimazole and tincture showed the identical therapeutic efficacy on otomycosis. Our findings suggested that tincture can be used as a supplementary antifungal option for treatment of otomycosis.

Sphenoid sinus can be considered a key element in advanced sinus and skull base surgery. Due to its importance, many researchers tried to document its characteristics and evaluate possible differences among different races and populations. This study was conducted between March 2017 and December 2018 on 60 fresh adult cadavers in Tehran Forensic Medicine Center, Tehran, Iran. The evaluated variables were distances between nasal spines, posterior wall of the sphenoid, pituitary gland, and the distance between the anterior and posterior ethmoid artery and optic nerve, which were calculated using a flexible ruler through the direct length in millimeter. Another important variable was dehiscence, which was evaluated in optic and carotid artery canals. After dissecting 120 sphenoid sinuses, the carotid artery was dehiscent in 24 (20%) cases, and optic nerve dehiscence was observed in 15 (12.5%) cadavers. The mean distance between the anterior wall of the sphenoid sinus and the anterior nasal spine was determined at 73.3±1.3 mm (rang: 58.3-87 mm), and the mean distance between the anterior part of the middle of the pituitary gland and the anterior nasal spine was estimated at 81.1±1.6 mm. According to our finding, the dehiscence of the key structural organs may be more prevalent in the Persian sphenoid sinus, which should be considered carefully in the management of related pathologies.

Melanotic oncocytic metaplasia of the nasopharynx is an uncommon disease, usually asymptomatic, that could be misdiagnosed for melanoma, because of its macroscopic features. For this reason, is necessary to know it thoroughly and to take it into account in the differential diagnosis.  

A 69-year-old Italian woman presented to our Otorhinolaryngology Clinic with a 1-month history of sore throat. She has been a smoker for several years. During the nasopharyngoscopic examination, grey-brown, irregular and slightly elevated lesions, measuring few millimetres, were found near the right Eustachian tube opening. The preliminary diagnostic hypothesis was malignant disease. After biopsy and histopathological assessment, the lesion was diagnosed as melanotic oncocytic metaplasia of the nasopharynx that is a benign and rare disease. So, given the multiple lesions and their benign nature, they were controlled with regular nasoscopic examinations.  

Melanotic oncocytic metaplasia is a benign lesion of the nasopharynx and it is necessary to emphasize the importance of its clinical awareness for differential diagnosis with malignant lesions.

Clicking larynx syndrome is a rare condition that may be intriguing to the attending clinician. Patients typically present with clicking sensations in the neck, often obvious during head movement or swallowing. Due to the scarce presentation of such cases, clicking larynx syndrome harbors a high propensity to be an overlooked diagnosis, resulting in a clinical stalemate.  

Herein, we present a case of clicking larynx in a young girl followed by an overview of the latest literature on the aetiology and treatment options. This case aims to reinforce the presence of this entity further and subsequently increase its awareness among clinicians.

Expeditious diagnosis is imperative not just for the eventual treatment but also for timely relief to the anxious patients who would have been perplexed by the strange clicking in the throat.

Hemangiomas are benign tumors that are very common in the head and neck region. However, intravascular hemangiomas are very rare. Hemangiomas are classified as capillary, cavernous or mixed tumors according to the proliferating cells. Ultrasound, computed tomography, MR imaging and angiography are useful diagnostic tools and are generally required when planning surgical treatment. Definitive diagnosis is established by histopathological examination, differentiating hemangiomas from other vascular tumors or malignancies.  

We present a rare case of capillary hemangioma protruding from the external jugular vein. In our patient, the tumor was totally removed under local anesthesia. No complications and no recurrence were observed in the following two years.  

Intravascular tumors can present as neck masses and a definitive diagnosis is made by histopathological examination. Imaging tools provide important information about anatomy, the extent of the tumor, and for surgical planning.