IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY
Year:2006 | Volume:17 | Issue:4 (42)|Papers Count:16

Objective: To determine the correlation between vitiligo and hearing loss.Materials and Methods: Fifty patients with active vitiligo and forty healthy subjects were included in this case control study. Pure tone thresholds were determined at frequencies between 250 and 8000Hz. We compared the results in control and patients group by use of chi-square test.Results: M/F ratio was 10:40 in the patients group and 10:30 in the control group. Mean age in patients and control groups was 22 and 22.6 years old respectively. The mean hearing threshold in patients was 19.5±5.7 and 10±5.7 in control groups. High frequency sensor neural hearing loss was seen in 19 out of 50 patients (38%), whereas no hearing loss was observed in the control group (X2=19.26, P<0.001). Bilateral, right ear and left ear involvement were 63.1%, 26.3% and 10.6% respectively. Statistical difference between bilateral and unilateral involvement was significant (P<0.05). No conductive hearing loss was seen in the control and patients groups.Conclusion: Vitiligo, Which is a type of pigmentary disorder, seems to be an effective factor in hearing loss. The mechanism for this condition might be the absence of the preventive function of melanin – containing cells in the inner ear.

Introduction: Coronal CT is the imaging modality of choice in patients with sinus diseases. CT provides and initial screening of these patients and can display anatomic cuases of recurrent sinusitis when they exist, CT is essential for planning surgery, and it provides an operative road map for subsequent FESS.Materials and Methods: Coronal sinus CT scan of 200 candiates of FESS reviewed for the major inflammatory patterns and anatomic variations which may attribute to inflammatory disease.Results: Five recurring patterns of inflammation, including infundibular 6%, ostiomeatal unit (OMU) 34%, sphenoethmoidal recess (SER) 24%, polyposies 16%, and sporadic 32% were seen. Some cases have more than one pattern. Anatomic variations included septal deviation (40%), Chonca bullosa (24%), paradoxical middle turbinate (4%), atelectatic uncinate process (6%), Haller cell (12%), giant ethmoid bulla (8%), agger nasi cell (8%), onodi cells (2%).Conclusion: Higher incidence of more severe patterns and anatomic variations in our study may be due to socioeconomic states of patients, study on surgical cases, and that our center is a referral center.

Background:Morphology and movements of vocal cords should be checked during bronchoscopy. In past literature, unilateral vocal paralysis is considered as benign.Objective: Evaluation of major underlying disease in patients with unilateral vocal cord paralysis diagnosed during bronchoscopy.Materials and Methods: A cross sectional case control study design was used to evaluate all patients who underwent bronchoscopy during the year 2003 for various causes. Sample size was 194 patients (0.01 error and 80% potency). Data including patient’s respiratory complaints and radiological findings were gathered in a questionnaire. Bronchoscopy was performed in standard condition using local anesthesia. During procedure, vocal cord movement was examined with appropriate maneuver, and complete study of trachobronchial tree with bronchial lavage was done. Appropriate biopsy was performed when indicated. Specimens were sent for evaluation of AFB, cytology, histopathology and culture for mycobacterium tuberculosis.Results: Unilateral vocal cord paralysis was observed in 10% ( 19 of total 189 patients who underwent bronchoscopy), Male to female ratio was 3:2 and average age of patients was 65 years (range= 37-76). Cough was the main complaint in 94%, dyspnea in 100% and hemoptysis in 32%. Smoking was present in 9 patients (47%). Vocal cord paralysis in left side was predominant and it was seen in 68% (13/19). Twelve patients (63%) with unilateral vocal cord paralysis had significant lung disease, eight had pulmonary tuberculosis, and four had lung cancer (one SCC, one SmCC, and two undifferentiated carcinoma). Confirmed lung disorders in case group was significantly more than control group (chi square=4.92; p=0.026; Odd ratio= 2.93, 95% Cl=1.01-8.76)). In the remaining patients with vocal cord paralysis (7), one had old healed tuberculosis and 5 had chest roentgenogram strongly suggestive of malignancy who were referred for further evaluation.Conclusion: The bronchoscopist should pay special attention to unilateral vocal cord paralysis observed during routine bronchoscopy. We observed significant lung disorders present in 63% of these patients.

Interaction: Nasal chondromesenchymal hamartoma (NCMH) is an extremely uncommon primary benign cartilaginous growth of the nasal and paranasal sinuses. It has been reported almost exclusively in infancy. We report a NCMH in a 23-year-old patient who presented with anosmia, right gaze diplopia and proptosis. CT scan of paranasal sinuses revealed frontal sinus mass extending to the right orbit, ethmoid cells and nose. After an initial inconclusive incisional biopsy, the patient underwent a complete radical resection; and the defect was reconstructed with osteoplastic flap of frontal sinus. Histopathological examination confirmed NCMH, which, we believe, probably had been present and undetected for many years. This report greatly extends the age of NCMH, as part of the differential diagnosis of cartilaginous lesions of the nose and paranasal sinuses.

Introduction: Otosclerosis is common disease of the ear and surgery on stapes is very fine operation. There are two techniques for surgical treatment of otosclerosis: stapedectomy (partial, Total) and stapedotomy.Materials and Methods: This is a retrospective clinical study that performed in referral center (university hospital) on four hundred and eight patients with otosclerosis treated by surgery. Surgery on 285 patients were stapedotomy and 89 were stapedectomy. Preoperative and postoperative hearing thresholds were compared.Results: In this study hearing results after stapedectomy were better in comparison with small fenestration stapedotomy.Conclusions: skill and experience of the surgeon has a significant role in stapes surgery. As stapes surgery is a very fine operation it is recommended not to be done by unexperienced surgeon.

Introduction: Epiphora is one of the most common complaints of patients that refer to ophthalmology clinics and primary nasolacrimal duct obstruction is the main cause of this problem in adults. Dacryocystorhinostomy (D.C.R) is the surgical treatment of epiphora that can be done by two basic methods: external and endonasal (Microscopic or Endoscopic). The aim of this study was comparison between results and complication of these two methods in treatment of patients with primary nasolacrimal duct obstruction.Materials and methods: This prospective randomized double blind clinical trial study was done in Emam Khomeini Hospital of Hamedan University of medical sciences during 1380-1381. According to patients' history, physical examination findings and results of regurgitation and dacryoscintigraphy tests, we divide 50 cases in two groups, randomly. External group was operated by classic DCR skin incision and creation of two lacrimal sac flap, and endoscopic group was operated by intranasal drilling of lacrimal bone, finding of lacrimal sac by lacrimal probe and complete removal of medial wall of lacrimal sac. After surgery all patients were fallowed up in two 4 and 6 month periods and results and complications were studied in each group.Results: In 92% of both groups epiphora was resolved clinically but nasalacrimal duct obstruction in irrigation test were seen in 16% of external group and 8% of endoscopic group (P>0.05). Pain in second week of surgery, hematoma and bleeding was equal in both groups but only 76% of external group were pain free in first week after surgery. In contrast, nasal discharge in endoscopic group was significantly higher than external group.Conclusion: On the basis of our findings, results of endoscopic DCR is similar to external method and because of lack of scar and lower complication rate, this minimal invasive method can substitute classic external method successfully.

Introduction: Allergic rhinitis is one of the most important diseases that occurs commonly in east IRAN specially northeast, Khorasan. Approximately 10-15% of general population suffers from it. One of the best methods of treatment of allergic rhinitis, that is the most usual, is the usage of classic antihistaminic drugs (such as Chlorpheniramine), but their side effects, specially somnolence and malaise, made a few patients to discontinue such treatment. More than a decade has showed that the Non Sedating Anti Histaminic Drugs (Terfenadin, Astemizole and Loratadine) are free from these side effects and do not show the CNS and anticholinergic disorders. The evaluation of their efficacy in the epidemiology of IRAN, beside the comparison of generic products with the registrated ones, is the main goal of this research.Material and Method: In this clinical study, the efficacy and adverse reactions of the Loratadine and its registrated product called Claritin are compared with Chlorpheniramine on 90 patients. It has been performed in northeast IRAN and the study is a kind of double blind, prospective studies. 30 patients have received Chlorpheniramine, as the same for Loratadine and Claritin. Then the results are compared with each other by Chi- square test.Results: According to results and the P. value for each controlled sign and symptoms, it seems that all the three drugs act effectively in this setting. On the other hand, there is a suitable growth in their efficacy from Chlorpheniramine toward Loratadine and then Claritin. Also for the side effects, there is a meaningful difference in somenolence, headache, giddiness and xerostomia between Chlorpheniramine with the others and also a decline in these side effects from Loratadine toward Claritin.Conclusion: The results suggest that in the geographic condition of IRAN, Loratadine and specially Claritin can be use as the powerful and effective nonsedating antihistamines that do not cross the blood brain barrier to show adverse disorders and will be a successful treatment of Allergic rhinitis in the first line, specially in patients who are sensitive to other antihistaminic drugs. Claritin due to acceptable clinical efficacy and lower side effects is preferred to Loratadine and makes the drug managers to pay more attention to quality improvement of the generic products.

Introduction: In recent years, the number of patients suffering from temporomandibular disorders (TMD) is increasing. Considering the increasing number of dental students with TMD, this study was conducted to evaluate the prevalence of TMD and its signs and symptoms among the students of Mashhad dental school.Methods and Materials: In this descriptive cross-sectional study, 37 male and 30 female students with ages between 21 to 34 who were in grade 4 to 6 of study in Mashhad dental school were randomly selected and examined for TMD and its signs and symptoms. The data were analyzed using Chi square test.Results: The prevalence of TMD was 51.5% totally, among which 34.8% had disc displacement, 3% had masticatory muscle disorder and 13.6% had both of them. Joint clicking was the most frequent symptom (32.4%) followed by muscle pain and tenderness (26.5%). There was no statistical difference between males and females in TMD frequency. (P-value=0.307)Conclusion: Among the dental students, TMD frequency was rather high and disc displacement was more frequent than masticatory muscle disorder. The most common signs and symptoms were joint clicking followed by tenderness and muscle pain.

Introduction: Intrathoracic tumors in children often occur in anterior mediastinum where the rate of malignancy is high. Flexible airway with small diameter in children may lead to acute respiratory emergency. In this study we evaluated (age, sex, clinical and radiological signs, site of tumor in mediastinum, way of diagnosis, type of pathology, treatment and 6 months survival), and also we assessed the effective factors that led to acute respiratory emergency in children.Materials and Methods: This is a retrospective study of the patients who were under 15 years old with mediastinal tumor and treated with a net pathologic diagnosis and followed for at least 6 months in Mashhad Ghaem and Omid hospital from 1994 to 2004, then we compared 2 groups (with and without acute respiratory emergency), and we assessed the effective factors.Results: 22 patients consisted of 55% male and the most common age group was 5-10 years (45.5%). 13% of patients were asymptomatic and 16% of them had minor respiratory symptoms such as cough and dyspnea and 27% of them had acute respiratory emergencies. The most common sign was fever (45%) and 45% of these tumors were in anterior mediastinum, 37% in posterior mediastinum and 18% in middle mediastinum. The most common method of diagnosis was anterior mediastinotomy (41.5%). 72% of these tumors were malignant, the most common malignancy was lymphoma (41%). Effective factors for acute respiratory emergencies included, being of tumor in anterior mediastinum, persisting of signs of pressure on airway and great vessels (superior venacava syndrome) and pleural effusion. In this study, mortality rate was 9% during 6 months after diagnosis which all of these patients were in the group with acute respiratory emergencies.Conclusion: According to high rate of malignancy in children with mediastinal tumor and probable acute respiratory emergency with high mortality rate in them, we recommend accurate investigation in these patients before any kind of diagnosis and treatment decision by a team of specialists (pediatrician, ENT, thoracic surgeon, oncologist and anesthesiologist) to ind the best method of diagnosis and treatment for these patients and decrease the complications and mortality rate.

ntroduction: Determining of epidemiologic and angiographic findings in 100 patients with brain AVM.Materials and Methods: 100 patients with clinical and neurological symptoms and CT and MRI findings which had brain AVM after four vessel angiography, was selected.Results: The peak incidence of clinical symptoms presentation was second decade and there was mild predominancy of male sex (59%). Clinical findings in order of prevalence were brain hemorrhage, headache, seizure and motor deficit. In brain CT scan the most common finding was heterogeneous density mass and mass with intracranial hemorrhage. In angiography, most AVMs were grade IV that most of them had one feeding artery and two draining veins. In 10% of cases there was only superficial draining vein. In 6%, AVMs was coexistent with aneurysm. In most cases, there were patent anterior and posterior communicating arteries. Location of AVMs in eloquent and non – eloquent area of brain was equal. The most common location was parietal lobe.Conclusion: ICH is more than IVH or SAH. Parietal lobe is the most common site for these AVMs in our study. Most of them are in grade IV Spetzler and Martin.

Introduction: The aim of this descriptive study was to determine the frequency of pleomorphic adenoma of oral minor salivary glands according to sex, and age and different site of tumor, in patients referring to Mashhad Dental School.Materials and Methods: Among the total number of 8115 biopsies taken during years 1349 to1384 at oromaxillofacial pathology department of Mashhad Dental School, 120 cases of oral minor salivary glands tumors were detected and selected for the study. Two time intervals of A (1349-1375) and B (1375-1384) were considered in which the frequency of pleomorphic adenoma was compared according to age, sex and site of the lesion. The frequency of benign and malignant tumors of oral minor salivary gland tumors was also determined.Results: Pleomorphic adenoma with the frequency percentage of 29.16 was the most benign tumor in oral minor salivary glands. The most frequent age of pleomorphic adenoma involvement was different between the two time intervals. The percentage of benign to malignant tumors was higher in the first interval.Conclusion: pleomorphic adenoma was the most frequent oral minor salivary glands neoplasm especially in the palate. The onset age of involvement had decreased but female/ male ratio increased. Malignancy was more frequent in Interval B compared to A.  

Introduction: Sublingual dermoid cysts are rare and constitute a little percent of alln dermoid cysts. Typically, these cysts present as a non-painful slow growing mass on floor of the mouth or submental region. They can cause problems in deglution, speech and respiration. These lesions can be diagnosed by ultrasonography, CT or MRI. Surgical excision is the treatment of choice, which can be done through extra- or intra- oral approach. We report a case of a large sublingual dermoid cyst in a 17 years old girl, who was referred to our hospital because of sublingual mass, submental swelling and fibrovascular lesions of lower face.