IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY
Year:2005 | Volume:17 | Issue:2 (40)|Papers Count:17

Objective: To study throat culture and antibiogram results in treatment of acute pharyngitis. Methods: 105 patients with acute pharyngitis were included in this prospective study. From all of the patients throat culture and gram-stained smear were provided. Antibiogram was done in patients with posit throat culture.Results: 63 patients of 105 patients (59%) have negative throat culture and gram-stained smear from pharyngeal secretions. 20 patients (19%) have positive throat culture and gram - stained smear. 12 patients (12%) have positive throat culture and negative gram - stained smear. Therefore 32 patients (31%) of 105 patients have bacterial pharyngitis. Fever, pharyngeal and tonsillar purulent exudates and adenopathy in patients with positive throat (31%) was more common than patients with negative throat cultures (69%). The most common cause of bacterial pharyngitis was group A betahemolytic streptococcus.Conclusion: Antibiogram findings revealed that bacterial pharyngitis such as streptococcal, staphylococcal and pneumococcal were completely resistant to Penicillin, Amoxicillin and Ampicillin that are used routinely in out patient clinics, and on the other hand were sensitive to unusual antibiotics in treatment of acute bacterial pharyngitis. Including Doxycicline, Vancomycin and Erythromycin and they are better alternatives.

Introduction: To determine the Cephalometric criteria of preadolescent boys with Down's syndrome and compare- the results with Cephalometric criteria of preadolescent children with normal occlusion in Mashhad to be used in diagnosis and treatment planning of the above-mentioned patients. Materials and Methods: The investigation was done on 30 boys with Down's syndrome with the mean age 11.9 years selected randomly (one boy omitted because of inadequate documents). Medical and dental histories, study casts, lateral Cephalograms in NHP and photographs were prepared. Cephalograms were traced, statistical analyses were done and after comparing the data with Cephalometric criteria of children with normal occlusion, results were extracted.Results: The result of this investigation showed that in boys with Down's syndrome the cranial-base length is shorter, basal angle is flatter, height and length of the middle-third of the face as well as the size of the mandible are significantly smaller than of children with normal occlusion.Conclusion: With regard to the findings of this investigation it was found that there are significant differences between Cephalometric criteria of preadolescent boys with Down's syndrome compared to the children with normal occlusion and attention should be paid to these differences when diagnosing and treatment planning of the above-mentioned patients.

Introduction: The value of Silver Staining of nucleolar organizer regions (AgNOR) counts as a diagnostic aid has been reported for several neoplastic entities. The aim of this was study to determine the evaluation of the expression of AgNOR as a marker of proliferation in squamous cell carcinoma grade I, verrucous carcinoma and oral normal mucosa.Methods: Silver-Stain nucleolar organizer regions AgNORs were counted in sections from formalin - fixed paraffin embedded blocks of 20 cases of well differentiated squamous cell carcinoma, 20 cases of verrucous carcinoma and 10 cases of normal oral mucosa. Two methods of AgNORs counting were used. The mean number of AgNOR nucleus (M AgNORs) and determination cells containing 3 or more AgNORs/ nucleus (P AgNOR) as indicator of the proliferative activity of the cells. Results: Statistical differences were found between normal oral mucosa, verrucous carcinoma and WD squamous cell carcinoma in AgNOR related parameters.Conclusion: AgNOR would be a quantitative, discriminative aid, easy to monitor in a pathology laboratory in detection incipient cellular alterations and contribute to the issue of early diagnosis and to the knowledge of tumoral growth.

Introduction: of a person's ability to perceive speech is considered to be an essential component of auditory assessment before administering of medical treatment and rehabilitative management. Previous studies have shown that audiometric information yield by pure tones cannot estimate this ability. The first purpose of the study was to prepare a Persian auditory perception test on the basis of vocabulary for 6 to 7 year old Iranian children.Materials and Method: The frequency of monosyllabic bisyllabic, and multisyllabic Persian words in 873 children books were considered in preparation of the Persian version of the GASP/Modarres auditory speech perception test in Persian. The test was conducted while using hearing aids to a group of sitty six to seven years old children with moderate to profound hearing loss (ANSI, 1969). Results: There was no significant difference between test and retest scores (P>05). This indicates high test - retest reliability of the auditory speech perception test. ANOVA indicated significant difference in speech perception ability in three hearing loss groups (P<0.001).This indicates high construct validity of the Persian auditory speech perception test for 6 to 7 year old hearing- impaired Iranian children. Conclusion: It is inferred from the results that the Modarres test can be conducted as a valid and reliable test for speech auditory perception ability in 6 to 7 year old Iranian children before administering medical treatment and rehabilitative management.

Object: This study was designed to provide the relationship among labeling indices of ki-67, Helsinki grading, and tumor histopathology of meningiomas. Method: ki-67 staining by polyclonal was performed on twenty-nine formalin-fixed/ paraffin embedded tissues obtained from 29 meningiomas resected from 29 patients. The Helsinki grading and histopathology (classification of Russel and Rubistein) of tumour were reviewed by a pathologist.Results: There were 21 women and 8 men. The mean age of patients was 49.1 with range between 21 and 70 year. The most common presenting symptom was headache (16 patients, 55.1%). The most common presenting sign was papilledema (8 patients, 27.5%).The tumor was located most commonly on convexity (7 patients, 24.1%). There were 22 benign meningiomas (grade I Helsinki) and 7 atypical meningiomas (grade 11 Helsinki).Ki-67 was stained in 12 specimens; (71.14%) benign meningiomas and 5 atypical meningiomas. There were no differences between the two groups (p=0.192). The ki-67 labeling index was significantly lower in benign meningiomas than in atypical meningiomas (mean ki-67: 9.5 ±17.9 versus 31.8±28.4, p=0.02).The ki-67 labeling index was lower in meningothelial than transitional and fibroblastic meningiomas but it was not significant (the mean ki-67: 8.2±14.6 versus 18.6±26.7and 24± 28.8, p=0.27 and p=0.14). The log (ki-67) was higher than 1.2 in atypical meningiomas but was distributed evenly between 1.6 and 2.Conclusion: The ki-67 labeling index was significantly higher in atypical meningiomas. It may be a predictive value of aggressiveness in meningiomas and also shows the tendency of the tumor to recurrence.

Object: Electrode arrays are inserted only partially into the cochlea, typically 22-30 mm depending on the state of the cochlea and prosthesis type. This study aimed to investigate the effect of electrode insertion depth on word recognition in a group of 10 implanted patients using the MED-EL (COMBI 40+) multichannel cochlear implant devices, who had at least six months of "Auditory-verbal Training" experiences following implant surgery.Material and Method: To determine the effect of electrode insertion depth on word recognition score three different depth levels were simulated, including: full insertion depth (3/3), (2/3) insertion depth and 1/3 insertion depth. While the overall spectral band width was preserved, word recognition score was measured on ten bisyllabic words immediately after each levels. Result: The results showed that word recognition scores decreased dramatically by turning off the apical third of electrode array. We believe that these results indicate that: Conclusion1: Most speech recognition could be providing by the last (Apical) third of the cochlea.1-There are useful neurostructures for speech recognition beyond the second turn of the Cochlea.

Cholesteatoma of the temporal bone extending into the Intracranial region is an unusual occurrence. Acquired aural cholesteatoma can extend into either the middle or posterior cranial fosses. Epidural abscess and dural sinus thrombosis are complications of chronic otitis media with cholesteatoma, although potentially fatal, they are treatable. Epidural abscess and dural sinus thrombosis must be recognized and treated aggressively.Epidural abscess and dural sinus thrombosis is relatively more common (14). And treatment of the underlying cause is essential.In this study cholesteatoma extended into the posterior fosse, associated with epidural abscess and, lateral sinus thrombosis.While computed tomography and magnetic resonance imaging are both required to differentiate temporal bone cholesteatoma from other lesions of the temporal bone (14), computed tomography of the temporal bone is usually sufficient to diagnosis and defines intracranial extension of acquired aural cholesteatoma. The present study is presented to analyze the clinical presentation, imaging findings, and surgical treatment of patients with acquired aural cholesteatoma extending into the intracranial region associated with epidural abscess and lateral sinus thrombosis.

The twisted nose represents a complex deformity that involves multiple anatomic components. A deviated nose often produces a cosmetic and functional deformity. Experienced surgeons uniformly regard the twisted nose as the most challenging of all septorhinoplasty procedures, and sometimes complete straightening of such a Nose may not be possible. The septum is the key point of deformities in most twisted noses. A well done septoplasty with any correction of significant Septal deviations and deformities is important to attain satisfactory aesthetic and functional results. An open rhinoplastic approach with better visual field for using different sutures and grafts is essential for successful treatment.

Hydatid disease is common in endemic regions especially our country. As Khorassan is an animal husbandry century hydatic disease is very common in this area. Because the human is an intermediate host prevention of this disease is a primary principal.Surgery is the cardinal management of these cases. Liver and pulmonary involvement is very comm. but primary mediastinal involvement is very rare; and only two primary publications and articles confirm this idea.We aimed to study the early diagnosis and management of effects on vital mediastinal organs or involvement of these organs in the rupture of hydatic cyst.

Introduction: Cogan syndrome is a rare autoimmune disease that is characterized by acute IK with Audiovestibular dysfunction. Bilateral and progressive profound sensorineural hearing loss is the most important sign of the disease. Delay in diagnosis leads to deafness or death and atypical form has not complete response to therapy. The purpose of this case report is presenting the sign and symptom of syndrome and advancing knowledge for early diagnosis and reporting an exceptional case. Case Report: The patient was a 51-y male with chief complaints of eye redness and then hearing loss and typical vertigo. Clinical and Para clinical data rule out is the main differential diagnosis of syndrome (sarcoidosis, syphilis) and finally the Cogan syndrome was the diagnosis.Treatment with early high dose corticostroid was used and fortunately good response was observed.Comment: The diagnosis of Cogan syndrome is based on classic findings and rule out of differential. The main differential diagnosis of Cogan syndrome includes syphilis, sarcoidosis, (PAN) all causes of peripheral vertigo. Clinical and Para clinical findings lead to diagnosis of Cogan syndrome.Exceptional items in this case:1- Cogan syndrome is the disease of young adults, but this case was 51 year old.2-Atypical form of Cogan has not good response to drugs. But our patient completely recovered by using high dose prednisolone.At the end we have to say that complete knowledge about the symptom of inner ear autoimmune disease and early treatment led to better response even in the case of atypical form.

Despite the prevalence of hearing disorders in human, contemporary therapeutic measures are limited to rehabilitation with amplification or implantable electronic prosthesis. Without a period of learning and adaptation, available therapeutics for hearing-impaired patients do not provide perfect and sufficient hearing. In other words, hearing aids and cochlear implants which are considered as the best solutions are not a panacea. Recently, gene transfer as a form of therapeutic procedure has received significant attention as it offers a hope of reversing or curing deafness of genetic and non-genetic origin. In contrast to conventional treatment, the gene therapy approach offers the advantage to restore hearing by normal physiology of hearing system and it has a wide range of therapeutic benefits in curing hearing disorders. This article describes a summary of the first experiments developing gene therapy to cure hearing loss and some of the obstacles that must be overcome if this approach is succeed full.

Background: As tonsillectomy is one of the most common surgical interventions in medicine, this study is designed to compare between two methods of tonsillectomy, radio surgical dissection tonsillectomy and Guillotine technique. Material and Method: Subjects were 30 patients (13 male-17 female) who underwent tonsillectomy in Phalli Hospital during one year (1381-1382). Patients were between 9-31 years old. In each case extra capsular radio surgery dissection was performed on one side and on the other side, conventional dissection-Guillotine technique was done. Time of surgery, healing process and bleeding compared in each individualized case.Results: Radio surgical dissection tonsillectomy in comparison with conventional dissection-Guillotine technique takes longer time, leads to further bleeding, and needs longer period for healing process. Conclusion: there was not any significant advantage for extra capsular radio surgery tonsillectomy in comparison with conventional dissection- Guillotine technique. Indeed it takes more time, and leads to further complications.

Background: Epinephrine usage in septoplasty and Septorhinoplasty has less hemorrhage during operation and blood loss field as a rule. But under general anesthesia with halothane usage of solutions, epinephrine will be with some risk. The question is which concentrations of epinephrine will be more efficacious and have less complication.Methods: This study was arranged as a clinical trial on 80 patients equally divided in four groups. In group 1 we used solution of epinephrine 1/10000 with Lidocaine 1%. 100000 In group 2, solution of epinephrine 1/100000 with normal saline was used. In group 3 we used solution of epinephrine 1/200000 with Lidocaine 1% and at last, solution of 200000 epinephrine 1/200000 with normal saline was used in the 4th group. Each of the groups included 20 patients who underwent septoplasty or Septorhinoplasty under general anesthesia with halothane. We monitored changes of systolic and diastolic blood pressures, pulse rates, volume of blood loss and any finding about dangerous dysrrhythmias such as ventricular arrhythmia. Results: The mean percent of changes for systolic blood pressure was measured 8.46±4.59, this percent for diastolic blood pressure was measured as 10.55±5.89, and for pulse rates the mean percent of changes evaluated 7.85±4.61. In all of the groups, these percents were evaluated as less than 15% that were clinically acceptable. The mean volume of blood loss was evaluated as 73.13±30.02 milliliters. The differences were not statistically significant among the four groups. In the group 1, one case experienced an episode of ventricular tachycardia and in the second group one patient had ventricular tachycardia. Another patient showed an episode of ventricular fibrillation. Conclusion: Despite no statistically significant differences between groups using solutions of epinephrine 1/100000 and solutions of epinephrine 1/200000 about mean percents of changes in systolic and diastolic blood pressures, pulse rates and volume of blood losses, the higher concentrations of epinephrine 1/100000 raised the risk of dangerous ventricular arrhythmias, so this concentration is not recommended.