IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY
Year:2007 | Volume:19 | Issue:2 (48)|Papers Count:12

Introduction: Allergic rhinitis is the most common allergic disorder and its prevalence appears to be increasing. For writing prescription we have to consider some points: efficacy, safety and affordability of drugs and compliance of patient. According to the direct costs of allergic rhinitis, we selected two treatment protocols for comparison.Materials and Methods: 15 to 65 years-old patients suffered from clinical allergic rhinitis at least from one year ago (with annual not seasonal signs and symptoms) referred to Emam Reza hospital arranged in two treatment groups sequentially. After recording the first part of the questionnaire (about their symptoms) treatment started with two protocols. The first was less expensive one included first-generation antihistamine (Chlorpheniramin) and systemic decongestant (Pseudoephedrine) and the second more expensive one consisted of secondgeneration antihistamine (Loratadine) with inhaled corticosteroid (Beclomethasone). After 45 days the second part of the questionnaire was completed. The patients who changed their jobs during this period were omitted from study. The two protocols were compared with each others by statistics software. Results: Two protocols had similar efficacy on improvement of symptoms such as rhinorrhea, nasal or pharyngeal dryness and itching nasal congestion, PND and sneezing.Conclusion: According to the high price of second protocol and same efficacy of two protocols in some situations such as lack of drug affordability and patients’ preference if there are no contraindications the first protocol could be a good alternative for second one.

Introduction: In this study we try to determine the effects of sub periosteal tunneling before intranasal lateral osteotomies during rhinoplastic operation on periorbital edema and ecchymosis.Materials and Methods: In 50 patients we carried out 100 lateral osteotomies which 50 without subperiosteal tunneling and 50 after subperosteal tunneling in a fashion that in each patient in one side we did sub perosteal tunneling and in the other side not.Then an other surgeon compared periorbital edema, ecchymosis and subcojunctival ecchymosis in each patient separately on 3rd postoperative day.Results: There was significant increment in perorbital edema, ecchymosis and subcojunctival ecchymosis in the side of patient whom subperiosteal tunneling carried out before itranasal lateral osteotomy.Conclusion: we sugest performing lateral osteotomies without subperiosteal tunneling during a rhinoplastic operation.

Introduction: To Perform FESS along with septorhinoplasty together and compare the Surgical complication.Materials and Methods: This is a retrospective study of 51 patients treated at the time of septorhinoplasty for sinusitis by FESS and we report the complication rate for combined and isolated surgeries.Results: Patients’ ages ranged 19-47 years (average 26 years) in my 51 cases, there were no major complication and 3 (5.8%) minor complication. (One case (1.16%) of postoperative orbital ecchymosis, and 2 cases (3.92%) postoperative epistaxis).Conclusion: Performing septorhinoplasty and FEES at the same time had successful results without higher rate of complication.

Introduction: From the most important laryngeal and hypopharyngeal cancer risk factors are smoking, alcohol and anemia. But reflux is one of the suggested etiologies. Pregnancy, Nonstroidal anti inflammation drugs and drugs decreasing the lower esophageal sphincter pressure will increase the reflux. Helicobacter pylories role in reflux formation is different due to the involved region and can also have a decreasing role and decline the rate of a series of esophageal and upper aero digestive system disease.Materials and Methods: This cross – sectional and case – control study was done in Qaem medical hospital, Mashhad during the years 1384 and 1385, for serum level detection of anti – H.pylori IgG and IgA antibodies in blood samples of both control and case groups. The variables were age, sex and serum test results.Results: 45 patients (39 male and 6 female) and 42 controls (33 male and 9 female) were evaluated. 2 groups were matched for age and sex. Positive IgG and IgA results in patients in order was 3 person (6.6 percent) and 3 person (6.6 person) and in control group 26 person (61.9%) and 12 person (28.5%). Result (P>0.001) was for healthy group showing the protective effect of H. Pylori against laryngeal cancer.Conclusion: In our study, control group with a meaningful difference was affected by H.Pylori infection. This can be due to a protective effect for H. Pylori against the laryngeal and hypopharyngeal malignancies. Prospective studies and simultaneously evaluation of reflux, H. Pylori infection and the regain of gastric location are suggested. 

Introduction: Because of the density of deep critical structures in neck and special anatomy, the choice of treatment and evaluation for penetrating neck trauma still remains controversial. Materials and Methods: This is a retrospective and descriptive study carried out in Imam Khomeini hospital over 5 years period on 65 patients with penetrating neck trauma. Demographic data of patients were investigated by using descriptive method.Results: According to this study, penetrating neck trauma is more seen among young males injured with stab wounds in zone II of the neck. All negative surgical cases are due to injuries from stab wounds. On the basis of information gathered, damage to major neck vessels is the most usual injury and the only cause of death. In all patients who had evidence of damage in diagnostic evaluation, the problem also found during operation. Patients who didn't have any evidence of injury in diagnostic evaluations and didn't undergo surgery, discharged without any complication. Conclusion: While evaluating and treating patients with penetrating neck trauma in situations without critical conditions and available diagnostic instruments, using them because of their accuracy specially for areas with complicated anatomy for surgery (zone I, III) and also using continuous clinical examination in vulnerable neck areas (zone II) is safe and practical.

Introduction: Nasopharyngeal colonization of Haemophilus influenza in young children may be important so in this study the nasopharyngeal carriage and antimicrobial susceptibility of Haemophilus influenza among children was surveyed in Mashhad.Materials and Methods: The study included 1161 healthy children less than 6 years of age. Nasopharyngeal swabs from these patients were cultured, and Haemophilus influenza were isolated. Antibiotic susceptibility of the strains was determined using disk diffusion.Results: The carriage rate of Haemophilus influenza was 10.76% (125/1161). High antibiotic resistance was observed against commonly administered antibiotics like Penicillin (82.4%), ampicillin (70.4%), Amoxicillin (79.2%) and trimethoprim sulfamethoxazole (71.2%). It was found that 68.8% and 42.4% of isolates were susceptible against erythromycin and cefexim, respectively.Conclusion: H. influenza isolates from healthy Children in Mashhad had high resistance rates against ampicillin, Sulphamethoxazole/ trimethoprim and some other antibiotics. So antibiotic susceptibility investigations are important for choice of therapy in every acute respiratory tract infection. And further monitoring of antibiotic resistance among nasopharyngeal H. influenza as a surrogate for invasive H. influenza seems an attractive option.

Introduction: intracranial meningiomas, with extension into the orbit through bone, the superior orbital fissure, or the optic canal, and optic nerve sheath meningiomas can lead to proptosis and visual loss. In this study we evaluated meningiomas’s cases presented with proptosis in Ghaem Hospital from 1374 to 1384 with respect to etiological factors, clinical findings, imaging studies, histopathological and prognostication.Materials and Methods: we reviewed medical records of fifty patients that because of orbital mass and proptosis underwent cranio-orbital surgery, then cases of meningiomas (a with respect to pathology) selected. The chi-square test was used for the statistical analysis. Results: Of fifty cases with proptosis, 6 cases (12%) were meningiomas with orbital involvement. In 6 meningioma’s cases, 5 (83%) were intracranial sphenoid wing meningiomas with orbital extension and 1 (17%) was optic nerve sheath meningiomas. Of six patients with meningiomas’s diagnosis, there were women (67%) and men. Mean age of patients in secondary meningiomas was 54.4 years (43-70 years) and in one primary meningiomas age was 21 years. In all cases there was decreased vision in addition to proptosis.Conclusion: The most common orbital meningiomas were secondary that arise intracranial. Visual loss is frequent; the most common cause of proptosis in neurosurgery ward is sphenoid wing meningiomas.

Introduction: Aspiration of foreign body into the tracheobronchial tree occurs most often in children. In this patient aspiration of a solid foreign body may be manifested as acute obstruction of the upper airway. In other patients however, the condition is more insidious manifested by recurrent pneumonia and bronchiectasis. Treatment of trachcobronchial foreign body usually requires only their complete removal by bronchoscopy rather than open lung surgery. Case report: This report is a rare case of bronchial foreign body has occurred after thoracotomy due to gunshot injury in 16 years ago.

Introduction: Malignant fibrous histiocytoma is rare in the head and neck and it accounts for 1-3% of all cases. Case report: We report a case of malignant fibrous histiocytoma of the nasal cavity in a 64-yearold woman. The patient referred with nasal obstruction and underwent wide surgical resection with negative margin. He is well with no evidence of disease for 36 month after surgery. The epidemiological aspects, histological diagnosis, treatment and outcome of this tumor are discussed.

Introduction: Kikuchi's disease is a necrotizing lymphadenitis that is prevalent in Japan and is being increasingly recognized in other areas of the world. It usually occurs in women in their late 20s or early 30s and manifests as a posterior cervical adenopathy. It resolves spontaneously, usually over a period of several weeks to 6 months. Its initial clinical appearance is commonly similar to that of a lymphoma, and it can be pathologically misdiagnosed as such.Case report: We report a case of Kikuchi's disease that occurred in a 51-year-old Iranian woman. We discuss the clinical features, differential diagnosis, and pathology of this case in an effort to assist otolaryngologists in diagnosing this benign and uncommon entity.