IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY
Year:2007 | Volume:19 | Issue:3 (49)|Papers Count:11

Introduction: Evaluations of voice disorders include clinical assessment (subjective) and Voice Laboratory Measurements (VLM) which use objective criteria to evaluate the severity of voice disorders. The purpose of this 2 years prospective team work study (during 2004 - 2006) was to determine the efficacy of voice laboratory analysis in evaluation of treatment in dysphonic patients, in comparison with clinical (subjective) evaluation.Materials and Methods: This study was done on 50 patients (42 males and 8 females) with voice disorders. All of the patients underwent complete ENT and neurological examinations and also complete voice lab evaluation with Visi pitch instrument and computer speech lab (CSL), both before and after appropriate treatment. Then the results of objective and subjective evaluations compared statically with the last version of SPSS software. We performed at least 5 voice parameters including fundamental frequency, phonation quotient, pitch range, percentage voiced and perturbation.Results: Only 8 patients (16%) had statistically significant improvement in data base of voice lab parameters and the rest patients (84%) although showed some improvement but without statistically significance. Overall, the sensitivity of voice lab was 80%. Some degree of changes was observed in all of the parameters before and after treatment. In the case of perturbation (t = 3.53 and P<0.01) and jitter (t =2.43 and P<0.05) there was significant differences with good statistical correlations.

Introduction: Esophageal carcinoma rarely metastasizes to the bone. The objective of the current study was to report five cases of esophageal carcinoma whieh first presented with bone metastases.Material and Methods: From January 1987 to June 2001, 550 patients with esophageal cancer were admitted to the Department Radiology of Ghaem Hospital for barium swallow, CT scan, sonography and plain radiographs. In five patients (three men, two women) first symptoms were bone pain and swelling due to metastasis. Radiographs and CT scan of specific bones were taken for diagnosis. Biopsy confirmed the diagnosis of squamous cell carcinoma metastases to bone. The primary site of malignancy was unknown at the time of presentation. Further evaluation including barium swallow, proved squamous cell carcinoma of esophagus that metatastasized to the bones.Results: Five patients with esophageal carcinoma (age range, 24-60 years; mean age, 45 years). Two patients showed solitary metastasis, and three patients had multiple metastases. Pelvis, cervical vertebrae, ribs, tibia and femur were involved. Patterns of bony destruction were lytic and in one patient were mixed (osteolytic-osteosclerotic). Two patients had cortical metastases simulating a primary bone tumor. The mean interval between skeletal metastasis and the appearance of dysphagia was two months.Conclusion: Bone metastases are very uncommon at initial presentation in patients with esophageal carcinoma, but Patterns of bony destruction in esophageal carcinoma were predominatly lytic and rarely sclerotic.

Introduction: Takayasu's arteritis (TA), often referred to as a pulseless disease, is a chronic inflammatory disorder affecting the aorta and its main branches. First reported in 1908 from Japan, it occurs worldwide, but is more prevalent in young oriental females from China and Southeast Asia.The main complications of the disease are due to occlusion of major branches of the aorta. We report a case of an Iranian female who developed left-sided leg intermitent claudication, left arm weakness and left-sided neck and jaw pain.

Introduction: Tuberculosis is a common infectious disease. Nasopharyngeal involvement is a rare finding.History: We present a case (33-year old female) of known chronic renal failure with primary nasopharyngeal tuberculosis. The only manifestation of disease was bilateral cervical lymphadenopathy.There were no tuberculosis lesions in other organs. Diagnosis was made based on result of pathological examination of biopsy. Improvement was obtained by anti tuberculosis therapy.Conclusion: Tuberculosis must be considered in differential diagnosis of nasopharyngeal mass.

Introduction: Thyroid nodule is a common disease and although usually benign, malignancy should always be ruled out. Fine needle aspiration (FNA) is the diagnostic modality of choice in approach to thyroid nodules. The main aim of this study is assessment of characteristics of thyroid nodules, risk of malignancy and accuracy rate of FNA in patients in Mashhad.Materials and Methods: We studied 450 patients with thyroid nodules during 2003 through 2007 with physical examination, radioisotope scan and FNA. Thyroid surgery performed in 64 patients and histopathology results compared with FNA cytological results. The patients were 383 women (85.1%) and 67 women (14.9%) with mean age of 39.8±12.7 years.Results: The mean length of largest diameter of nodules was 3.97±1.8 and the smallest one was 3.26±1.7 (cm). 59% of nodules were located on right lobe, 36% of them on left lobe and 5% on isthmus of thyroid. 24.4% of nodules were cystic. 30.3% of thyroid nodules were functional or hot and 69.7% of them were cold in thyroid radioisotope scan. In evaluation of cytological findings of nodules aspirate, 288 (68.6%) were benign, 22 (5.2%) were malignant, 92 (21.9%) were follicular lesions, 13 (3%) were suspicious and 5(%1.2) were non diagnostic.Comparison of cytopathologic results before and after surgery showed that FNA in operated patients yielded a sensitivity of 82.3%, specificity of 78.9%, a positive predictive value of 77.7%, negative predictive value of 83.3% and accuracy of 80.5%.

Introduction: Multiple Sclerosis (MS) is a neurological disorder that involves CNS.Researches indicated that Auditory Brainstem Response (ABR) and Auditory Middle Latency Response (AMLR) in MS disorder show some changes and can be used as diagnostic tests. So, the purpose of this study is to measure and compare the latency and Amplitude of ABR and AMLR waves in MS patients aged between 20-50 years.Materials and Methods: This cross sectional descriptive-analytic and non-intervention study were conducted on 31 MS patients and 34 normal cases aged 20-50 years. ABR and AMLR were performed on each case. Then amplitude and latency of waves were studied.Results: The mean latency of waves III, V (ABR), Na (AMLR) and Amplitude Ratio of V/I showed significant difference in both groups but comparing I (ABR) and Pa, Nb (AMLR) and amplitude of Na, Pa and Nb waves in two groups didn't show any significant difference. 70% of MS Patients in ABR test and 50% in AMLR test showed some kind of disorders in one or more waves.Conclusion: Using ABR test can help more in diagnosis process of MS in comparison with AMLR test.

Introduction: Odontogenic cysts and tumors are associated with some lesions that impacted teeth are one of them. Impacted teeth are those cease to erupt before emergence.Varying incidences have been reported in different literature about this condition. The aim of this retrospective study was to achieve the sexual, location and age related distribution of odontogenic cysts and tumors and frequency of each one in relationship with an impacted tooth in order to prompt of clinician knowledge and easy selection of treatment plan.Materials and Methods: In this retrospective study, we used registration books and paraffinized blocks and slides of pathology archives of Mashhad dental school which had belonged to the patients involving with impacted teeth pathology, were evaluated from 1996- 2006.0ver all of these lesions were 304 cases in this period and relation between impaction of tooth and type of lesion was done by exact test.Results: This study included 160 lesions consisting of 140 cysts (87.5%) and 20 tumors (12.5%). Dentigerous cyst was the most common cyst (58.7%), and Odontoma was demonstrated to be the most commontumor (5%). These lesions affected males (59.8%) more than females (41.2%) and they occurred with a pick in the second decade. The left-sided posterior mandible was more commonly involved by far.Conclusion: The findings of this study for Dentigerous cyst and Odontogenic keratocyst were similar to the findings of the other studies; nevertheless, Mandible and males predilection of Calcifying odontogenic cyst, one decade later involvement of Odontoma (3rd decade), one decade sooner involvement of Ameloblastoma (3rd decade), male predilection of Adenomatoid odontogenic tumor were not identical to the other studies, findings. However, more studies are recommended to achieve this purpose.

Introduction: Although most pituitary neoplasms are benign, but some of them spread to extrasellar structures. Definition of this giant pituitary adenoma is not clear. In order to clarify this question, we studied all pituitary adenomas with diameter of 30 mm or more and attempting to identify their typical and clinical features, complications and their prognosis.Material and Methods: In our prospective study since 1996to 2006, 235 patients had been admitted and operated in neurosurgical centers, were determind. We evaluated the clinical and paraclinical signs and symptoms and surgical results of these tumors and Rate of recurrence, morbidity and mortality was determined. Then we compared these results with other studies. The processing of the results was achieved by SPSS (11.5) and statistical analysis with descriptive methods.Results: From 235 patients with pituitary adenoma in our study, 131 patients were male and 104 cases were female. The age of patients was 18 to 75 years with the average of 50.5%. 22 patients from 234 cases had giant pituitary adenoma. The diameters of their tumors were equal or more than 30 mm. The most common clinical findings in our patients with giant pituitary adenoma were visual impairment (95.4%), headache (81.8%), gait disturbance (13.6%), decreasing of libido (18.1%) and papilledema (27.2%). In our study, the most common giant pituitary adenomas were non-functional adenomas and prolactinomas respectively. A mortality and post operative complication of giant pituitary adenomas is more than other adenomas.Conclusions: The giant pituitary adenoma is about 10.6% of total pituitary adenomas. Although these lesions are not special and typical tumors but in order to more invading and more spreading to adjacent structures, they are different of other adenomas. They are characterized by a higher clinical signs and symptoms, higher frequency of neuro-ophthalmological symptoms and hormonal deficits and poorer response to surgical treatments. The rate of recurrence, morbidity and mortality is more than other adenomas too.

Introduction: Carcinoid Tumor in trachea is rare, and in 25% is asymptomatic. Cough is the most common symptom and some times have similar symptoms such as chronic obstructive pulmonary disease. The best method of treatment is surgical resection and recurrency after resection is rare. In this study we report a 47 year's old man with chronic cough and dyspnea that treated with bronchodilator as COPD but without recovery. In evaluation with chest X. Ray, CT scan and bronchoscopy carcinoid tumor was diagnosed and surgical resection performed. There was no recurrency or complication in 5 years follow-up.

Introduction: Lipoma is the most common benign tumor which composed 25-50% of soft tissue tumors. This tumor can undergo a variety of changes, one of which is ossification.Osteolipoma is a rare benign tumor which is especially uncommon in the oral cavity.Case report: This is a case report of an osteolipoma of the oral cavity in a 68-year-oldmale who was referred for a painless mass on the mandibular alveolar mucosa since about four years ago. Histopathologically, the lesion was composed of trabeculae of bone and mature adipose tissue confirming to be an osteolipoma. The patient recovered after resection.Discussion: Osteolipoma can originate from osseous metaplasia within a long-standing lipoma following permanent stress, repeated microtrauma and prolonged ischaemia. Osteolipoma has the same prognosis as simple lipoma. The treatment of choice is excision. There have been no reports of recurrence.