IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY
Year:2008 | Volume:19 | Issue:4 (50)|Papers Count:12

Introduction: Migraine is characterized by unilateral and pulsatile headache with or without aura. There are various treatments of migraine attack. One of them is intravenous (IV) Corticosteroids which is used in status migrainous. The aim of this study is comparison of the efficacy of I.V Dexamethasone with intramuscular (I.M) Methadone in improvement of migraine attacks. Materials and Methods: This study was a controlled double-blind randomized clinical trial on all patients whom referred to emergency room with diagnosis of migraine attack. The patients were randomized in four groups. Groups I and II received intravenous 8 mg Dexamethasone, while groups III and IV received intramuscular 10 mg Methadone. Thereafter all of them were evaluated after 2, 4 and 6 hours. Results: One-hundred and eighty one patients were evaluated; 107 patients were treated with IV Dexamethasone and 74 patients with IM Methadone. One-hundred and three of 107 patients (96.2%) had complete or significant improvement whereas 63 of 74 patients (85%) whom received IM Methadone had similar improvement (P= 0.01).Conclusion: Our study showed that treatment of acute migraine headache by using intravenous Dexamethasone is more effective than Methadone.

Introduction: Type I thyroplasty for unilateral vocal fold paralysis restores voice. In medialization thyroplasty carved sailastic, prefabricated, dense hydroxyapatite and Gore-Tex implants are routinely used.Materials and Methods: In this prospectively study thyroplasty performed with simultaneously use of carved sailastic and Gore-Tex implants. Nine patients with true vocal fold paralysis due to complication of cardiac surgery, thyroidectomy and idiopatic, underwent medialization thyroplasty by this method. In six patients, just sailastic implant was used and results compared together.Results: Mean duration of follow was 9 months. 5 patients had excellent voice improvement. The voice improvement in four patients was good. In patients with only sailastic implant, just one patient had excellent voice improvement and 5 patients had dysphonia.Conclusion: In this method carved silastic is placed in thyroid cartilage window just one time and additional medialization is performed by insertion of Gore-Tex strips between cartilage and silastic implant. Resulting decreased manipulation of surgical field and surgical time, paralyzed true vocal fold edema is reduced and judgment of voice improvement was exact.

Introduction: Adenoids and tonsils, which are major components of secondary lymphoid organs, appear to function as the host's first line of defense against exogenous microorganisms. The purpose of this study was to investigate possible impacts of Adenotonsillectomy in serum levels of IgA, IgG, IgM as indicators of humoral immunity, but there is a controversy about immunologic effect of tonsillectomy and adenoidectomy.Materials and Methods: Pre and post operative serum samples were collected from 40 patients (7-11 years old) referred for adenotonsillectomy. Serum samples were analyzed, using Radial Immune Diffusion (RID) method to determine levels of IgA, IgG, IgM, before and 3 week after surgery. Results: The level of IgA and IgM were reduced in post operative period. But this was not statistically significant. However, it was found that the level of IgG was reduced in the post operative period and this reduction was statistically significant (P<0.01).Conclusion: The results of this study indicate that adenotonsillectomy had not a significant effect on two major parts of humoral immunity (IgA and IgM) but it reduced IgG levels.

Introduction: myasthenia gravis is an autoimmune disorder affecting postsynaptic acetylcholine receptors of voluntary muscles. Since Blalock et al. first demonstrated the beneficial effect of thymectomy in 1939. The procedure has become increasingly accepted in the treatment of myasthenia gravis. Materials and Methods: we studied clinical results of thymectomy in myasthenia gravis cases during 12 years retrospectively and antegradly. Our variables included: patient's age, sex, and signs at the time of admission, disease onset to operation interval, postoperative complications, and duration of hospitalization, thymus histology and clinical response to thymectomy. Data were analyzed appropriate analysis. Results:16 women and 11 men with median age of 29.8 (±12.7) years were operated on by median sternotomy approach. Thymectomy was done during less than 1 year after disease onset in 44%, 1-3 years later in 42% and later than 3 years in 14%. Most had mild to moderate generalized myasthenia. Thymic hyperplasia was reported to be the most common pathologic finding. Clinical response to thymectomy was good (70.4%). The best results were obtained in female less than 40 years old, with out thymoma, disease onset to operation interval less than 2 years and mild myasthenia. Conclusion: Because of its high beneficial rate thymectomy is an advantageous therapeutic option. The chance of benefit increases when the history of myasthenia gravis is short and the stage of the disease is early.

Introduction: The aim of this research was to determine the prevalence of hearing impairments and its associations with different ear problems among schoolboys in Mashhad, Iran. Materials and Methods: In this cross sectional research, a representative sample of 1047 schoolboys (between age group 7 to 11 years) was subjected to diapason tests, Otoscopic examination and questionnaire. Then in the next step, suspected cases were visited by an Ear, Nose and Throat (ENT) specialist and subjected to Pure Tone Audiometry (PTA).Conclusion: Data analysis identified 29 children with hearing impairment (72.1% mild, 20.9% moderate, and 2.3% severe and4.7% profound) making a prevalence of 2.76% (60.4% conductive, 27.9% sensorineural and 11.7% mixed hearing impairment).Data analysis revealed ear problems with the following prevalence’s: ear wax (13.7%), otalgia (11%), ear trauma (5.3%) and ear washing (3.6%). The prevalence of hearing impairment was comparable to that in developed countries, but was better than that in developing countries.

Introduction: It has been recognized that noise levels generated during ear surgery may cause sensorineural hearing loss. However, there is a controversy about the main factor that may cause such hearing threshold alternations: drilling, suction or both of them. The purpose of this investigation was to measure the air-conduction noise levels generated by common drills, burrs and suction irrigators in mastoid surgery.Materials and Methods: Our evaluations were carried out in two states: isolated temporal bones (cadavers) and intraoperative recordings. Preliminary drillings were made on 10 cadavers, and intensity and frequency analysis of common diamond and cutting burrs were performed. Then, the noise levels generated by drilling, suction irrigation and simultaneous drilling & suction irrigation were measured from 15 patients under radical modified mastoidectomy. Data were analyzed by SPSS 11 software and 0.05 value was regard as significant level.Results: The average noise levels of drilling ranged from 83 to 95 dB SPL, varying with burr used. Cutting burrs were found to be up to more intense than diamond burrs. Mean suction irrigation noise levels ranged from 77.45 to 78.65 dB SPL. The average of "intraoperative drilling" and "simultaneous drilling and suction irrigation" generated noise levels were 87.14 and 86.26 dB SPL, respectively. The comparison of resultant noise levels between cadaver and under operation situations was not statistically significant.Conclusion: Our results showed that the main factor contributing the highest noise level is drilling which is predominately apparent in cutting burrs. Exposure to these noise levels may account for shifts in the hearing thresholds.

Introduction: Many infections of the oral cavity and adjacent structures involve anaerobic bacteria. Most infections involve multiple anaerobes and in many instances facultative organisms. Present study was conducted regarding to clinical aspects and complications of anaerobic bacterial infections in oral cavity.Materials and Methods: 72 Specimens were taken from oral cavity infections. Routine culture techniques and strict anaerobic techniques were used for isolation and identification of aerobic, facultative and obligatory anaerobic bacteria respectively. Results: Cultures of all specimens were positive. Mono-bacterial and poly bacterial infections were repored in 1/3 and 2/3 of specimens, respectively. More than 65% of isolated organisms, were obligatory anaerobic belonging to the Peptostreptococcus, Prevotella, Fusobacterium, Porphyromonas and Bacteriodes as well as facultative and aerobic species include Streptococcus, Staphylococcus, interobacteriacea and Actinomcs Israelii are also obtained. Conclusion: Many infections of the oral cavity and adjacent structures involve obligatory anaerobic bacteria. Regarding to results of present study, under the anaerobic atmospheric system, obligatory anaerobic bacteria were isolated and identified from clinical specimens of oral cavity infections, especially abscesses.

Introduction: Petrositis, osteomyelitis of temporal bone, is a rare complication of middle ear infection or mastoiditis. Symptoms reported in patients with petrositis are otalgia, deep facial pain, headache, otorrhea, fever, coma and cranial nerve paralysis. Current diagnostic tests for this complication include high-resolution CT scan, brain MRI and bone scan with Technetium, Gallium and Indium 1-11.Case report: A 34 years old lady with left multiple cranial nerves palsies of VII, VIII, IX, X, XII is presented. She had a history of otitis media and then mastoiditis in left side 6 months ago which was underwent tympanomastoidectomy. In radiological studies there was involvement of parameninge tissue next to petrous bone. Gallium scan was highly suggestive for petrous osteomyelitis. She was treated with empiric parenteral antibiotics and her symptoms resolved completely.