IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY
Year:2006 | Volume:18 | Issue:1 (43)|Papers Count:17

Introduction: Jet ventilation is one of the procedures that do not need intubation. Jet ventilation is used in difficult intubation, diagnostic laryngoscopy and micro laryngeal surgery, adult respiratory distress syndrome and bronchopleural fistulas. Jet ventilation has done by a thin cannula such as angiocath from oral or nasal route or cricothyroid membrane. Respiratory rate is 10–15/min in low frequency or 100–200/min in high frequency and tidal volume is 1–2 cc/kg to 5–10 cc/kg and O2 pressure is 15–50 psi with high flow. Major complication in this procedure is cannula kink, hyperinflation, pneumothorax and sub cutaneous emphysema.Case report: In this patient for good exposure of the larynx and immobility of the vocal cords, a nelaton cath was used from oral route into trachea & jet ventilation was done with 10–15/ min and 5cc/kg. Total IV anesthesia was done. Air-trapping and bilateral pneumothorax was caused due to pharyngeal obstruction and hemorrhage. Then the problem as resolved rapidly with bilateral chest tubes. The patient discharged after 3 days.Conclusions: Therefore when this procedure was used, we must be careful for expiration. Airway obstruction is treated rapidly and jet ventilation is stopped soon.

Introduction: Abroad epidemiologic studies have suggested human papillomavirus (HPV) to be an etiological agent in Squamous cell carcinoma (SCC) of larynx. In this study we investigated the frequency of HPV 16 infection in various neoplastic and non-neoplastic laryngeal tissue.Materials and Methods: The study was done on 55 cases of laryngeal SCC, 10 cases of dysplastic and 5 cases of normal tissues were analyzed by polymerase chain reaction (PCR) for the presence of HPV 16.Results: None of the five normal and ten dysplastic laryngeal tissues showed the presence of HPV. Seven of fifty-five Squamous cell carcinoma of larynx (12.7%) were positive for HPV type 16.Conclusions: The results suggested that HPV DNA has a major role in squamous cell carcinoma of larynx.

Introduction: sulfur mustard is a chemical warfare agent that was widely used against Iranian veterans. The most prevalent effect of this agent on the respiratory system was chronic obstructive pulmonary disease. The aim of this study was evaluation of bronchiectasis as a late complication of chemical gas injury.Materials and Methods: One hundred fifty two patients who had been exposed to chemical weapons were selected. Complete history, physical examination, chest x-ray, HRCT of chest, and spirometry were performed.Results: Among one hundred fifty two patients with pulmonary complications of chemical gas inhalation thirty four patients with bronchiectasis were diagnosed. Others were mostly asthma, chronic bronchitis and, rarely, large airway stenosis and interstitial fibrosis. Bronchiectatic lesions were mostly identified as bilateral 67.6%, and 33.4% of cases were unilateral. The most common sites were RLL, LLL, RML, Lingual and LUL in order. Abnormality of spirometric parameters were found in all of them. The most common finding was obstructive pattern (58%). No significant difference was seen between Spiro metric values and age in the patients with bronchiectasis and patients with asthma and chronic bronchitis.Conclusions: Bronchiectasis is a late pulmonary complication of sulfur mustard gas inhalation and should be considered in chemical gas victims with pulmonary problems.

Introduction: To determine the causes of upper airway obstruction leading to tracheostomy; endoscopic evaluation was done in Khalili Hospital, Iran.Materials and Methods: During a 2 year period, 47 patients who underwent tracheostomy,were evaluated endoscopically to determine the causes of airway obstruction leading to tracheostomy.Results: forty-seven cases were included in the study including 40 males and 7 females with mean age of 31.9 years. The most common cause of obstruction was subglottic stenosis (40.5%) and laryngeal carcinoma (38.3%). The cause of subglottic stenosis in the majority of the patients was prolonged endotracheal intubations (95%). Other less common causes were direct laryngeal trauma (4.5%), vocal cord paralysis (2.1%), supraglottitis (2.1%), tracheal foreign bodies (2.1%), severe trismus (2.1%), and status asthmaticus (2.1%).Conclusions: Subglottic stenosis secondary to prolonged intubations is the major cause of upper airway obstruction leading to tracheostomy. Converting endotracheal intubations to tracheostomy in patients who need prolonged ventilator support may prevent subglottic stenosis and decrease the rate of serious complications following prolonged endotracheal intubations.

Introduction: Endotracheal-Endobronchial Metastases (EEM) secondary to extrapulmonary neoplasm are rare. Since 1989 we have encountered 14 patients with EEM.Materials and Methods: EEM were defined as documented extra pulmonary neoplasm metastatic to subsegmental or more proximal central bronchi in a bronchoscopically visible range. The developmental modes were described on the basis of classifying categories of Kiryu.Results: The primary tumors included breast cancer (4 cases including 3 women,1 man), colorectal carcinoma 1, renal cell carcinoma 1, embryonal cell carcinoma of testis 1,uterine cervix carcinoma 2,melanoma 1,osteogenic sarcoma 2,papillary thyroid carcinoma 1and prostatic sarcoma 1. The chest roentgenographic findings were: collapse 5, parenchyma mass 5, multiple nodule 2 and hilar enlargement 2. Median interval from diagnosis of primary tumor was 39.5 months. Endobronchial lesions were detected by bronchoscopy and their metastatic nature was confirmed histopathologically in all patients. Six patients were treated with external radiotherapy, while 6 patients had chemotherapy and 2 patients underwent surgical resection of metastasis.Conclusions: The cases we have reported are similar to those found in the literature, regarding their clinical and roentgenographic presentation. Local treatment is effective for palliating symptoms. All patients with extra pulmonary malignant tumor who are suspected to have pulmonary metastasis should undergo bronchoscopy to diagnose end bronchial metastasis and to differentiate it from primary lung cancer.

Introduction: Cavitary lung lesion is caused by serious lung pathology. Among rare causes is Zygomycosis that should not be overlooked. High index of suspicion is necessary to avoid missed diagnosis especially in diabetic and immunosuppressed patients.Report of cases: We present two cases with lung mucormycosis diagnosis. Case 1: A 58 year old male with history of diabetes, presented with hemoptysis. Chest X ray (CXR) showed cavitation. Bronchial lavage revealed mucor hypha that was proved again with lobectomy. Case 2: A 39 year old female with history of chronic renal failure and lung cavitary lesion due to previous necrotizing pneumonia. She suffered from cough, dyspnea and hemoptysis. Comparison of old and new CT scan showed increasing of cavity thickness. Lobectomy was performed and mucor was proved in histopathology.Conclusions: We present two cases of pulmonary Zygomycosis (mucormycosis) who referred With hemoptysis and other respiratory tract symptoms and lung cavitations. Surgical resection and amphotericin was very successful in their management. We recommend investigation of fungus in BAL fluid or tissue material of patients with cavitary lesion.

Introduction: Thyroid node is one of common clinical symptoms. Fine needle aspiration, radioisotope scan and ultrasound are some imaging methods which help us in diagnosis and management of a thyroid node. Ultrasound is a noninvasive method with minimal side effects and we studied diagnostic value of ultrasound and color doppler in thyroid nodules.Materials and Methods: We studied 66 cases of palpable thyroid node who came to endocrine clinic of Emam-Reza hospital between August 2003-2004 and underwent FNA. These patients were evaluated by sonography and color doppler in radiology department of Ghaem hospital.Results: 8% of the nodules were malignant and 92% were benign. Homogeneous echo pattern suggests benign lesion rather than malignancy. The probability of malignancy is greater in solitary nodule than multiple nodules. In color doppler examination, 91% of benign nodules and 75% of malignant nodules had perilesional vascularity. 60% of malignant nodules and 12% of benign nodules had very high intranodular vascularity, so rich intralesional flow is an indicative of a malignant lesion. RI>0.75 is significantly higher in malignant lesions than benign lesions (P=0.045).

Introduction: Hearing loss diagnosis solely by using the classical clinical methods in neonatal and infants seems to be difficult. Any delay in diagnosis results in reverse effects on speech, language and social cognitive developments. TEOAE and ABR tests are highly recommended to be performed at birth. The aims of this study were early diagnosis, intervention and prevention of linguistic delay that were performed in the three hospitals in mashhad city.Materials and Methods: This was a descriptive study and neonates in the first 24 hours were screened using the TEOAE test. The cases who failed the first time test were have been rescreened 3 weeks later. If the results in both sessions (screen and re-screen) failed in one or both ears the child would be referred for a complete diagnosis ABR test before 3 month of age. Confirming the presence of mono aural or biaural hearing loss using by the ABR test. Long term follow up and medical/rehabilitative interventions were been programmed and performed before the age of 6 month.Results: From 10016 screened new born 9615 individuals (96%) passed the tests and 401 individual (4%) were referred to the next step. Of those who were referred, only 289 individuals showed up for the re-screening test. From these only 23(8%) newborns were referred to ABR test. In this population the presence of hearing loss was only confirmed in 13 individuals (56%). Eight of them had profound hearing loss in cochlear, 2 of them had moderate hearing loss in Cochlea, and 3 newborn had sever conductive deficit.Conclusions: Because of the high prevalence of congenital hearing loss, the reverse effects on children development, the availability of accurate tests for diagnosis of hearing loss, and being cost effective, hearing screening of all the neonates are highly recommended at the birth.

Introduction: Mediastinal tumors consist of wide spectrum of benign and malignant disease. Some of these tumors which locate in the thoracic apex can produce many problems in decision making due to developing to neck spaces. with thoracotomy approach most of these tumors cannot be resected totally because of close attachment of these tumors to great vessels and removal of these tumors accompanied with dangerous complications and massive hemorrhages during surgery. The goal of this study is to report the operated cases of these kinds of tumors with anterior trans cervical-thoracic approach.Materials and Methods: Depending on the tumor extension in neck spaces, first with on oblique incision near the SCM (Sternoclidomastoeid) muscle neck space dissection is done, In all patients the clavicle head is resected to see the subclavian vessels, then with continuing the incision, as in partial sternotomy, the mediastinal space is being assessed for complete removal of tumor. If needed, for complete removal of mediastinal tumor, the operation is completed with an anterior thoracotomy.Case reports: There were 3 patients in our study; all were females; with age between 10 to 21 years old. Pathology reports of them were: one case ganglioneuroblastoma, one case neurofibroma and the other, medullary carcinoma of thyroid. Tumor extension in neck spaces in 2 patients was at the left side and in one patient in right side. In all three patients tumors were completely removed by mentioned technique and only in one case an anterior thoracotomy was needed to remove the huge mediastinal tumor. Total resection of tumors were done in all 3 patients and there were no severe injuries to great vessels and all patients were discharged from hospital without any complications and are being observed for 6 months until now without tumor recurrence. The median time for hospitalization was 5.5 days.Conclusions: Due to good exposure of neck and mediastinal great vessels and succeed in removing these tumors, we advise using this technique for approaching them. Of course it is obvious that more studies are needed in future.

Introduction: Surgeons have been tried to reduce tonsillectomy associated pain by multiple techniques, such as covering exposed sensory nerves and surgical wounds with fibrin or sucralfae and infiltration local anesthetic agent.Materials and Methods: 60 patients (6-40 years) in study group were injected with 3-10 ml of 0.5% Bupivacaine and 1,200,000 epinephrine, at the end of tonsillectomy, and 60 patients (6-40 years) in control group with 3-10ml of normal saline. The intensity of pains were evaluated by visual analogue scale (VAS) in both groups at 6, 12, 18 hours after tonsillectomy and oral feeding.Results: The study group fared better and had less pain than the control group; also, in study group oral feeding time is shorter than control group. Post tonsillectomy pain is not related to sex, tonsilar enlargement and the indication of tonsillectomy.Conclusions: Pillars and tonsilar-fossa infiltration with 0.5% bupivacaine and 1,200,000 epinephrine, provides post-operative pain relief in pediatric and adult tonsillectomy.

Introduction: Adenoid hypertrophy is one of the main common causes of eustachian tube dysfunction and otitis media with effusion. A group of otolaryngologists and pediatrics believe that it is not possible to estimate adenoid size in order to do Adenoidectomy only with clinical evaluation and there is no any acceptable result to show how many patients with OME were satisfied after adenoidectomy. The aim of this study is to determine ratio between adenoid and nasopharynx in children with adenoid hypertrophy and OME then determine the number of children who will be satisfy after adenoidectomy.Materials and Methods: This descriptive study was performed on 50 patients who had OME and adenoid hypertrophy and came to ENT department of Imam Reza Hospital. The standard lateral neck view for the patients was done and sizes were calculated on lateral neck graphy. The A/N degree ratio which estimated was compared with the A/N degree ratio in normal children in the same ages from the other studies and the efficacy of adenoid size on obstructive manifestations was considered.Results: 6 of 50 patients were between 4-6, 37 of them between 6-8 and, 7 of them between 8-10 years old. A/N ratio on different age groups in OME patients in comparison with normal people has no significant differences (P=0.43). 16(%32) patients did not have any obstructive signs and 54(%44) had obstructive signs and mean ratio A/N was 0.44 and 0.49 respectively. This study shows in patients with OME, mean ratio A/N in a group with adenoid hypertrophy is higher than those in asymptomatic group (P<0.001).Conclusions: This study shows in patients with OME and obstructive signs, adenoidectomy can be effective for the treatment of obstructive signs, but in patients with adenoid hypertrophy without obstructive signs, adenoidectomy would not be beneficial.