IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY
Year:2006 | Volume:18 | Issue:2 (44)|Papers Count:18

Introduction: Tympanoplasty is accomplished under general anesthesia. One major drawback of general anesthesia is the increased bleeding encountered, which can interfere with optimal visualization of the microscopic surgical field. We performed a prospective study to compare the effect of combination of propofol and tranexamic acid as a protocol versus halothane on blood loss and the surgeon's subjective assessment of operating conditions during tympanoplasty.Materials and Methods: 40 patients undergoing tympanoplasty were randomly assigned to receive the mentioned protocol or halothane (n=20). One surgeon, who was blinded to the anesthetic agent, performed all the operations, and assessed surgical condition, using a grading system of score as follow: 1. minimal or no bleeding 2 Modest bleeding 3 Significant bleeding 4 severe bleedingResults were compared in the two anesthetic groups using appropriate statistical tests. Results: There was no difference between the duration of surgery or the intraoperative mean arterial pressure when comparing the two groups. Mean bleeding scores were less over time with above protocol. 80% of the patients had a satisfactory visualization of the surgical field in protocol group, while it was 45% in halothane group.Conclusions: General anesthesia, based on the combination of propofol and tranexamic acid may have the advantage of decreased bleeding compared with conventional inhalation agents, making tympanoplasty technically easier and safer by improving visualization of surgical field. This anesthetic technique may have other applications in otolaryngology, when bleeding within a confined space frequently can interfere with visibility.

Introduction: Due to our geographical area of living, esophageal cancer is one of the most common cancers in gastrointestinal system. Treatment of choice in these diseases is surgery. Because of various kinds of surgical techniques, in this study we tried to compare common techniques in these groups of patients.Materials and Methods: In a retrospective study between 1990 and 2005 all patients with esophageal cancer in middle and distal third of esophagus whom underwent transhiatal or transthoracic esophagectomy, have been studied about age, sex, pathology of tumor and tumor staging.Then in other study, with considering special parameters of two groups (transhiatal or transthoracic) are studied separately about factors such as intraoperative bleeding, operation time, post-operation morbidity, time of hospitalization, mortality 30 days after surgery, incidence of anastomosis leak and stenosis and survival have been evaluated.Results: 156 patients entered our study with M/F=110/46 ratio. 116 patients with S.C.C and 40 patients with adenocarcinoma The comparing study between transhiatal groups with Ivor Lewis groups (with similarization) showed intraoperate bleeding, cardiac and pulmonary complications after surgery, mean time of hospitalization, mortality in 30 days after surgery and incidence of late stenosis and survival are similar but the incidence of anastomosis leakage was higher in transhiatal group and mean operation time was longer in Ivor Lewis group. Since the leakage was more common in transhiatal group but mortality rates were the same, it indicates that leaking in neck has a better outcome.Conclusions: According to the results of this study, both of these techniques are similar and choosing one of them depends on surgeon’s choice and patient’s conditions.

Introduction: Benign paroxysmal positional vertigo is the most common peripheral vestibular disorder. Canalith repositioning manoeuvers are an established method for treatment of this disorder but efficacy of these maneuvers, including Epley canalith repositioning manoeuver are reported differently in various studies. In this study the efficacy of the Epley canalith repositioning maneuver has been evaluated in 43 patients.Materials and Methods: 43 patients with a history and physical examination consistent with posterior canal benign paroxysmal positional vertigo were studied. Patients were treated with a modified Epley canalith repositioning manoeuver. Patients were provided with a preprinted diary in which they had to circle the answers most relevant to their symptoms for 7 days after the manoeuver. Patients were reevaluated at one week after the manoeuver, The Hallpike manoeuver was performed at this time to corroborate the response to therapy.Results: The mean duration of the BPPV before treatment was 7 weeks. A resolution of vertigo as a result of the manoeuver was obtained during the first 24 hours in 59% of the patients after one canalith repositioning manoeuver. 20% of patients had a resolution of vertigo during the first week however it is not evidently possible to conclude that these patients definitely benefited from the canalith repositioning manoeuver. In 21% of the patients vertigo persisted after the first week. Residual symptoms of lightheadedness, imbalance or both, were frequent (55% of cases) but rarely required any intervention.Conclusions: Epley canalith repositioning manoeuver resulted in immediate resolution of vertigo in 59% of our cases after one treatment. This manoeuver is safe and requires no special equipment or investigations; and it should be regarded as the treatment of choice for BPPV.

Introduction: To review all cases of esthesioneuroblastoma in Qaem Hospital from 1990 to 2004 with respect to Clinical findings image studies, staging, grading, histopathological and prognostication.Materials and Methods: Possible cases of esthesioneuroblastoma were retrieved from Neurosurgery, Otorhinolaryngology and Pathology departments. Patients were included on the basis of review of their files or pathology reports. Thirteen possible cases were retrieved. One case was excluded because of no documented pathology. Esthesioneuroblastoma is a malignant neuroendocrine tumor originating in the olfactory mucosa. It is a small blue cell neoplasm with a characteristic lobular architecture. The tumours were staged according to Kadish staging system and Kaplan-Meier survival analysis was used to identify prognostic factors.Conclusions: The Kadish staging system was able to group the patients into prognostic ally relevant groups. Intracranial involvement and metastases at the time of diagnosis were found to be poor prognostic factors.

Introductions: Infections and among them extravascular infection may cause atherosclerosis and provoke their complication. Some evidence suggests that dental infections and periodontal disease are involved in pathogenesis of coronary artery disease.Materials and Methods: Patients were chosen from private cardiology clinic. In this double blind controlled cross-sectional study, patients were in two groups. Those who had CAD by given criteria and those in non-CAD group periodontal examinations were performed by periodontologist in a blind manner.Results: Of 250 subjects screened and examined by cardiologist, 39 agreed and presented for dental examinations, of whom 10 were edentulous, and 29 were dentate. Of dentate subjects 11 had CAD and 18 were free of CAD. For all periodontal parameters, greater values were recorded for CAD group, indicating a more severe periodontal disease among CAD subjects as compared to non-CAD group. CAD subjects showed a significantly greater level of dental plaque accumulation as compared to non-CAD group (P=0.004). Percentage of edentulous subjects was greater among CAD subjects than non-CAD subjects.Conclusions: All periodontal parameters were not significantly greater, among CAD patients than non-CAD control subjects, suggesting no association between poor periodontal status and coronary artery disease. Further studies are needed.

Introduction: Cavitary lung lesion is caused by serious lung pathology. Among rare causes is mucormycosis 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 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: Lymphatic metastasis is a determining factor in treatment modality selection and prognosis of laryngeal cancer. It occurs because of separation of tumor cell from primary foci and deposition in lymphatic nodules which in turn occurs because of weakening of cell-cell adhesion. E-cadherin is a cellular adhesion molecule. Abnormal expression of this molecule may lead intercellular connection weakening and following metastasis. In this study we assess the correlation of abnormal expression of this molecule and metastasis.Materials and Methods: it is done as a prospective study on 47 proved laryngeal cancer. Initially, samples are divided into metastatic and non metastatic group. In next step, Immunohistochemistry was done to show E-cadherin expression. It was done as a blind study.In this study we use from a scoring system in order to convert qualitative data to semi quantitative ones.Results: From total 47 cases, 21 case were metastatic and 26 cases were non metastatic. Nearly 70% had altered E-cadherin expression. We found significant statistical correlation between Abnormal expression of E-cadherin and tumor grade and metastasis P=0.000 and P=0.002, respectively. Also, tumor grade and metastasis had significant correlation.Conclusions: Abnormal expression of E-cadherin is a common finding among laryngeal cancers. It is directly related to metastasis and tumor grade. So, it can be used as predicting marker in order to choose more-aggressive treatment modality to improve prognosis and probably survival.

Introduction: This and similar studies show that surgeons can not rely on the immediate effect of scoring on the cartilage at the operation period. A straight septum on the operating table may deviate toward the opposite side by passing time.Materials and Methods: During a period of 5 years, 283 cases have undergone rhinoplasty and in 227 patients, septoplasty accompanied the operation. Patients were divided into two groups of 125 and 158 cases. In the first group, septal deviation was corrected mainly by cross hatching of the quadrilateral cartilage accompanied by other modalities. In latter group, who were operated on recently, different methods of rigid fixation of septum in addition to the previous classic manner were used.Results: The outcome was over correction of septum toward the opposite side in 18 cases of the first group. No more iatrogenic over correction of septum was diagnosed in the second group, (P<0.0001).Conclusions: We recommend rigid fixation for correction of septal deviation instead of simple cross notching

Interdiction: Rhinoplasty is the most common aesthetic surgery in Iran which is done more and more. In majority, lateral osteotomy is the integral part of rhinoplasty that has two major methods: external (perforating or non-continuous) and internal (endonasal or continuous). It is the surgeon’s choice according the experience and comfort. Edema and ecchymosis are major sequels of this operation. We compared these two techniques regarding ecchymosis and edema.Materials and Methods: it is done as a clinical prospective randomized trial on two 40- patient groups with informed consent. In one group, we did lateral external osteotomy and in another group, internal lateral osteotomy was done in the same condition. Data were gathered and recorded according visual scoring system which was done by two blinded examiners by comparing sample in data sheath with patient. We compared both sequels in second and seventh day.Results: Edema was the same in both groups in second and seventh days. Ecchymosis was not significantly different in seventh day in both groups. But, ecchymosis was significantly less in internal group, comparing with External group in second days.Conclusions: External and internal osteotomy techniques were the same regarding edema but internal technique produced less ecchymosis in second postoperative day.

Introduction: The aim of this study is determine the auditory performance of congenitally deaf children following cochlear implantation and comparisons of auditory performance before and after cochlear implantation.Materials and Methods: This is a prospective study of 53 children having been implanted in khorasan center, and followed for 5 years. All children are aged less than 8 years at the time of implantation the mean of age at implantation is 42 months. Auditory performance is assessed by using the Categories of Auditory Performance scale (CAP).Results: Prelingually deaf children showed significant improvement in the auditory performance with implant experience. Six-month after implantation 91% of children could rassed to speech sound 96% could discriminate speech sounds at the 12 month interval. 80% of children who reaches the three year interval could understand common phrases without lip reading.Conclusions: These results indicate the ability of cochlear implants to provide significant auditory skills for young congenital deaf children.

Introduction: Necrotizing fasciitis is an overwhelming infection common to perineum, abdominal wall, and extremities. It is a surgical emergency related to a high mortality rate that is more often seen in elderly and immunocompromised patients. Necrotizing fasciitis occurs uncommonly in the head and neck region.Materials and Methods: A retrospective study conducted on fasciitis necrotizing patients that were treated at Ghaem hospital since 2002–2005.Results: Over a 4-year period, 4 cases of necrotizing fasciitis of the head and neck region collected at Ghaem hospital. The demographic, predisposing factors, clinical presentation and management were analyzed. The most common associated systemic disease was diabetes. Local swelling and erythematous changes was the most common sign. The cornerstones of proper management include early diagnosis, aggressive surgical debridement, broad-spectrum antibiotics and intensive supportive care.Conclusions: Necrotizing fasciitis mostly occurs in old patients with systemic disease specially diabetes mellitus which the common cause was dental infection.

Introduction: Tracheomalacia is abnormal collapse of the tracheal wall. It may occur in an isolated lesion or can be found in combination with other lesions that cause compression of the airway tracts. Tracheomalacia is usually benign, with symptoms due to airway obstruction. Recurrent pneumonia is common in these patients, presumably because airway collapse during coughing prevents effective clearance of airway secretion. The majority of these patients will respond to conservative management, consisting of humidified air, chest physiotherapy, slow and careful feedings, and control of infection and secretion with antibiotics. Surgical therapy is required when conservative measures are not adequate or when reflex apnea is present. Surgery includes correction of the underlying cause, such as vascular ring, teracheostomy, and aortopexy aortopexy is the accepted operative treatment for severe tracheomalacia. The standard surgical approach involves a left anterior thoracotomy often under broncoscopic control.Case Reports: In this paper we report aortopexy in 3 patients with severe, intractable tracheomalacia secondary to esophageal atresia, bronchogenic cyst and huge mediastinal cystic lymphangioma.Results and conclusions: The children with airway obstruction with or without lung infection especially in patients susceptible to tracheomalacia should examine with rigid bronchoscope for diagnosis. If bronchomalacia confirmed and conservative managements were not effective, aortopexy is one of the treatment modalities that were effective in our patients with good to excellent results.