IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY
Year:2005 | Volume:17 | Issue:1 (39)|Papers Count:15

Background: Thyroidal hormones influence the inner ear development. Hearing is one of the most important senses in human. Normal hearing in early stage of life, especially in first six months, is essential for speech and education and communication. So diagnosis and treatment of hearing loss in young children is very critical and important. Therefore, high risk finding and hearing loss screening in these groups is essential. Method and Material: This study was performed upon 50 patients who referred to Imam Reza Hospital with congenital hypothyroidism, The patient was studied according their sex, age at diagnosis, familial history, etiology, clinical presentation, and other ENT abnormalities. Hearing threshold was evaluated by ABR. Result: 38% of patients were male and 62% were female. Mean of age at initial management was 10.96 months. 32% had positive familial history. Etiology was dysgenesy in 64%, dyshormonogenes in 26%, unknown in 24% and transient in 4%. The most common presentation was prolonged jaundice 18% had purulent PND and Rhinorrhea. Prevalence of hearing loss was 22% and speech abnormality 16% There was no relationship between hearing loss and sex, age at the time of diagnosis, and thyroidal hormone level. Conclusion: prevalence of hearing loss was 22% in this study, and it was fairly high. Most of our patients were detected before 6 months age. when it was most important for diagnosis and rehabilitation of hearing loss. We believe that it is essential to screen all congenital hypothyroid patients for hearing loss and treat them as soon as diagnosed.

Tuberculosis is a potentially lifelong chronic infection. It is almost always initiated by inhalation of infectious material. There was an increase in the number of cases of tuberculosis after 1985. Cervical Iympadenitis is the most common form of head and neck. Tuberculosis. The purpose of the this study is evaluation of type of presentation, sex and age groups, and location of tuberculosis involvment in head and neck region in our patients. This analysis report of head and neck mycobacterial infection diagnosed at Emam Khomini Hospital (Ahwaz) between 1996-2001. The inclusive criteria for the diagnosis were at least one of the following 1-Positive smear or culture for Acid fast Bacil. 2) Caseating granuloma consistent with tuberculosis. The study group consisted of 59 patients (35 female and 24 male) with head and neek mycobacterial infection. Their ages ranged from 7 to 73 years (mean age 27.3 yr). The most common decade was the third, 17 patients. The most common presenting complains were the following: Lump in the neck in 55 patients (93%), fistula of neck skin in the 19 cases(39%). Involvment of head and neck elements were the followng: 1) Lymph node (T.B lymphadenitis) in 53 cases; 2) Laryngeal in 2 patients;3) Parotid gland, (2 patients) ;4) Nasal and Lip 2 patients. In 33 patients (66%) neck involvment was in posterior triangle and remenant patients in anteriol triangel. There was simultaneously infection in lung and head and neck in 15(25%) of cases that consist of 2 patients with laryngeal involvment. Mycobacteial infection of the head and neck occurs in different forms and affects different populations in the different regions of the world In 1990 T.B killed more than 2.5 millons people. This reflects the delay in the diagnosis and ineffectiveness in manangement of the disease. Attention of head and neck surgeons to T.B in this area can lead to early diagnosis and rapid management of disease.

Among posterior fossa tumors, neurinoma arising from glossopharyngeal nerve are rare; only about 46 cases of glossopharyngel neurinoma have been reported. Though a typical jugular foramen syndrome has been described for tumors of this region, the clinical onset may often closely resemble that of acoustic neurinoma thus misleading the diagnosis. Although this tumor shares with the far more common acoustic norinoma the presenting symptom of hearing loss, it may be distinguished by an elicitable history of hoarseness, demonstration of abnormal palatal function and absence of expected findings upons standard radiographic examination of the petrous bones and internal auditory canal. This is the report of our experience with five such cases treated successfully and we have found that identification of this tumor may be accomplished with currently available diagnostic techniques, including computerized tomography and MRI. Because of its different surgical implication, such a rare condition must be clearly recongnised. Our aim is to emphasize the importance of particular focus on clinical symptoms, imaging findings and surgical management of this tumor.

Background: Currently, many patients are refered to our department because of continuous or inflammatory tearing; and the diagnosis is Dacriocystitis. Dacriocystitis is an infection of the lacrymal sac and is treated with External Dacriocystorhinostomy (Ext. D.C.R), an operative approach that has a failure rate ranging from 3% to 15%. Most of the failures are related to the incomplete inspection of the intranasal cavity during the operation. Endoscopic D.C.R. is another approach that has two advantages 1) avoid incision and prevent scar formation. 2) According to the perfect inspection of the intranasal cavity, the success rate is expected to increase. Object: The aim of this study is to compare the success rates of End. D.C.R and Ext. D.C.R. This study tries to complete the previous studies that introuduced End. D.C.R as a new approach to surgeons. In the previous studies, End. D.C.R was performed by using of YAG Laser that is expensive and unaccessable; whereas, we performed the procedure by using of suction cautery and punch forceps. For collecting the data, we designed a check list that was filled by one physician. Then the data was analized. Each of the groups included 43 patients. Results: According to the statistical analysis, overall "28 males and 58 females underwent one of the operational

Background: The aim of this study was to determine the value of the argyrophilic nucleolar organizer region (AgNOR) . as a proliferative marker in neoplastic and non-neoplastic lesions of the thyroid i-r Methods: AgNOR count were evaluated in paraffn. Embeded tissue of resection specimens of the thyroid from 100 patients was retrieved from files of the Pathology Department of the Ghaem Hospital Medical Center including: Normal thyroid gland (N=8) Nadular Goiter (N=19) Follicular Adenoma (N=34) Follicular carcinoma (N=10) Medullary carcinoma (N= 4) Papillary carcinoma (N=15) Anaplastic carcinoma (N= 4) Thyroiditis (N=6) The investigated parameters included the number, size, shape and localization of AgNOR dots in nucleoli of hundred cells and percentage of nucleoli with at least 3 and 5 or more AgNOR dots per cell (distribution score). Results: The mean AgNOR dots and 3 A dot per cell were statistically signifi tf cantly higher in malignant lesions in comparison to benign lesions. No clear separation statically between groups about parameter 5 or more dots per cells. Total discrimination between follicular adenoma and carcinoma was achieved by quantification of AgNOR dot tumor uncleolous cell (AgNOR distribution score) Conclusion: The AgNOR and AgNOR distribution score proved to be the most valuable diagnostic criterion for the differentiation between follicular adenoma and carcinoma of the thyroid.

Objective: One of the main questions in the design of Cochlear Implants is "How many channels of stimulation are needed to achieve a high level, of speech understanding? Recently, some investigations have been carried out in which experiments were conducted with adults to provide an answer to this question. To reach 90% accuracy in quit. 5 channels are necessary for more difficult sentences produced by multiple talkers (Loizou et aI.1999). and 8 or more channels are necessary for monosyllabic words (Dorman et aI., in press). Material and method: In our research we extend our observations on the number of channels necessary to reach high levels of word Recognition Scores (Without Lip-reading)to a group of 30 implanted patients using the Nucleus 22 and Med-el(Combi 40+) cochlear implant devices, who had at least six months of Auditory Verbal Training experience following implant surgery. Simulating various numbers of channels was performed by reducing the number of active electrodes while the overall spectral band width was preserved. Five levels of active electrodes were simulated for nucleus devices, including: 22, 16, 12.8 and 4 electrodes. Three levels of active electrodes were simulated for Med-El devices including: 12, 8, 4 electrodes. Word recognition score was measured on ten bisyllabic words after each level. Result: The results showed that word recognition scores decreased dramatically, as the number of electrodes was decreased from 12 to 8 and 4 electrodes (in nucleus devise) and from 8 to 4 electrodes (in med-el devices). There was no significant difference in word recognition score as the number of electrodes was increased from 12 to 16 and 22 electrodes (in nucleus devices), and from 8 to 12 electrodes (in Med El devices). Conclusion: Pesults indicate that if signal processors/electrode arrays could provide implanted patients with the equivalent of 8-12 functional channels of stimulation then the tasks of word recognition and language acquisition would be significantly facilitated.

Introduction: Benign paroxysmal positional vertigo is the most common cause of vertigo in adults. The main treatments for this disease are Epley"s and Semont"s maneuver. Effectiveness of both maneuvers is high but the Acceptability of them was not evaluated. In this study, effectivness and acceptability of two maneuvers are compared. Methods and materials: Between the Qct 2001 and Feb 2003 we identified 64 patient with typical form of BPPV in the clinic of otolaryngology head and neck surgery of Kermanshah University of medical science. They allocated randomly in two group of the Epley"s and Semont"s maneuver. Then evaluated objectively by Dix-hallpike maneuver and subjectively by using the history of patients. In addition the acceptability of two maneuver were assessed and all data analyzed by k-square and SPSS11.05. Results: The effectiveness of Epley"s and semont"s maneuver was 94.5%, 84% (respectively). Acceptability of epley"s maneuver was 93% and it was 45% for semont"s maneuver. Acceptability of Epley"s maneuver for patient in the group of more than 55 years old was statistically significant. Conclusion: Epley"s maneuver is effective treatment for BPPV. Although subjective results of two maneuvers were not significant but acceptability of Epley"s maneuver is higher in-group of old patients.

Difficulty in breathing through the nose after rhinoplasty is a serious problem. Patient dissatisfaction can be great even when cosmetic results are excellent. The etiology of nasal obstruction can be multifactorial, but is primarily the result of interplay between two factors. Unrecognized preexisting nasal conditions (such as deviated septum, turbinate hypertrophy and mucosal disease), in conjunction with decrease in nasal valve area after rhinoplasty. In order to prevent nasal obstruction after aesthetic rhinoplasty, the surgeon needs to recognize and correct the preexisiting nasal deformities; and, on the other hand, sugary at or near the nasal valve area must be preformed carefully and conservatively with the knowledge that narrowing in this area can cause significant air way obstruction and difficulty in breathing.

The purpose of this study is to determine the incidence and complications of skull base fx (such as CSF leakage and intracranial injuries) after head trauma. Retrospectively from Qct. 2000 to Sep 2003, 26133 patients were admitted with head trauma at the neurosurgical Department of Shahid Kamiab Hospital. 1072 cases of these patients had skull fx. Among them 93 cases were admitted with skull base fx. CSF leakage, pneumocephalus, and intracranial hematoma were the most common complications. Many of them needed medical and conservative treatment, while the others need surgery. The worse the preoperative medical management, the less likely the preoperative recovery. Early recognition, prompt and correct treatment are both essential for optimal management and reducing mortality and complications.

Introduction: Penetrating traumata"s to the skull is important cause of death special in industrial societies. The present study was done on twenty cases of penetrating traumas to base of skull; and patients were studied for Epidemiology, clinical symptoms, treatment procedures, evolution and prognosis. Study Methods: This research was done in a retrospective method on patients admitted to Mashhad Emdadi Hospital (Mashhad Emergency Hospital) from September 2003 to January 2004. Data concerning cause of incidence, clinical symptom, accompanying damage, procedures taken, and kind of treatment and prognosis were studied in all patients. Results: On this study all twenty patients were male ranging in age from 20 to 58 years. Causes for hospital admittance were; fighting 17 cases (80%) war injuries, 3 cases and suicide, 1 case (5%). (65%) received medical treatment and seven cases received surgery (35%) Surgery included extraction of hematoma from brain tissue or Subdural, brain debridement, repair of depressed skull fracture and orbit. Thirteen patients were treated concretively and seven patients had surgical operation and five died during treatment. Primary low GCS, shock and hypertension upon hospital admission abnormal pupil and high age of the person were all influential factors causing high-rate death level in patients. Conclusion: In addition to the result of this study, the literature show quick primary cure and accessibility to medical center are extremely important factors to decrease death rate and lessen damage due to penetrating trauma to the skull.

Objective: Evaluation of the causes of headache in patients referred to Neurological Emergency and Clinic of Ghaem Hospital. Materials & Methods: In this prescribing cross-sectional study, patients who came to the Clinic Department of Ghaem Hospital of Mashhad from 1980 to 1982, with chief complaint of headache, were studied. The clinical findings, laboratory findings, and imagings of the patients were reviewed. Results: Among 423 patients, 71 % were women. The female to male ratio was 2.44%. The average age was 35. Male patients with siniusitis and female patients with classic migraine had the lowest average age, respectively 17 years old and 19 years old. The maximum average age was in patients with cervical spondylosis. The most common type of headache was tension (48%) and migraine (24%). The most common associated symptoms were photophobia, phonophobia and nausea. The most common precipitated factor of headache was stress (71%). Conclusion: This study showed that stress was the most important factor of exacerabating headache, and rest was the best way to supress headache.

Aims: E-Cadherin is a cell-cell adhesion molecule involved in tumor progression and metastasis. We evaluated the E-Cadherin expression pattern in oral SCC and investigated its relationship to histopathological features. Methods: The expression of E-Cadherin was evaluated in 43 formalin-fixed, paraffin-embedded specimens of oral SCC by immunohistochemistry. Results: In normal squamous epithelium, E-Cadherin was expressed uniformly at the cell membrane. Abnormal E-Cadherin expression with loss of membranous localization was found in 62.8% cancer specimens. We used a scoring system for semiquantitative comparison of results. Altered E-Cadherin expression was found more often in higher grades than in lower grades (p=0.000) There was not any significant correlation between E-cadherin expression and muscular invasion (P>0.1). There was not significant correlation between sex and E-cadherin expression. Conclusions: Abnormal expression of E-Cadherin occurs frequently in oral squamous cell carcinoma and correlates with dedifferentiation of tUf!"lors. Moreover, E-Cadherin expression is not associated with muscular invasion. We concluded that loss of normal E-Cadherin expression might serve as a differentiation marker in oral squamous cell carcinoma. short running title: E-Cadherin Expression in Oral SCC.

Giant Calculi of tonsils is rare and more common in adults than children, This is the first case diagnosed in. ENT in Ahwaz University Imam Khomeini Hospital. Many possible cases for formatian of these calculi have been hypothesized but we believe that the most acceptable one is due to obstruction of crypt ostiums after inflammation and infection which leads to accumulation of debris and bacteria and inorganic salts to core formation that may result in giant caiculi. Occasionally the calculi can be seen or the lateral side on oropharynx examination this happens if cript ostia are dilated and tonsilla tiseus is ulcerated. Another possible hypothesis is obstruction of minor salivary gland ducts which result in stasis of saliva only few data support this clinical view. Diagnosis can be incidental be simple or somethimes difficult in a differential diagnosis of norulceration lymphoma.