IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY
Year:2004 | Volume:16 | Issue:1 (35)|Papers Count:16

Introduction:Airway foreign bodies are one of the important emergencies in otolaryngology that can be life-threatening. Early diagnosis and treatment prevent complications and death. Airway foreign bodies can mimic other conditions such as asthma and pneumonia. The Goals: Determination of foreign body distribution from the point of age, sex, clinical and radiological findings, type and location, duration of enlodgement, the way of referring, and negative bronchoscopy. Study Design: The retrospective study of 1000 cases of foreign body aspiration in the Department of Otolaryngology of central Childrens Hospital of Tabriz. Results: Foreign body aspiration in boyswas 1.7 times more common than girls. The most common age group was between 1-2 years. The most common symptom was cough. In 24.6% the bronchoscopy was negative. CXR was normal in 54.2%, and the most common abnormality was obstructive emphysema. The most common location was the right bronchus (44.2%), and the foreign body was vegetative matter in 82.5%. IN 29.7% duration of enlodgement was 1-5 days. Preferance was by parents more than others (42.4%). Conclusion:Delay in diagnosis causessome complications. The lackof clinical and radiological findings can not rule out foreign body aspiration. In any patient with suspected history of aspiration bronchoscopy is necessary for definitive diaqnosis. Education of parents is important in prevention.

Objective: Determining the epidemiologic pattern of sudden idiopathic sensorineural hearing loss in hospitalized patients. Material and Method: Patients to the hospital due to sudden sensorineural hearing loss were evaluated thoroughly (history, physical examination, lab tests, imaging). Those with a certin diagnosis were excluded, and in the unknown etiology group the preferred information was obtained. All patients were treated with prednisone, acyclovir, and low salt diet. Daily audiologic tests were performed. Results: The peak incidence was the fourth decade, with women being affected more than men. The onset was more common in the early morning and in the fall. The accompanying signs were tinnitus (90%) and vertigo (50%). Hearing loss was profound (dB >90) in 80% of the patients. Hearing enhancement in 75% of hospitalized patients was negligible (none or less than 20dB), and only in 15% was there a dramatic response (improvement more than 50dB). Conclusion: Hearing enhancement (prognosis) in severely affected patients is not prominent despite using widely accepted therapy.

Maligment tumors of sinonasal tract are rare lesions. These tumors are diagnosed in late stage due to nonspecifications and symptomsThe best treatment for nonepithelial tumors are combined (radical surgery and postoperative radiotherapy). In this study 25 patient with sinonasal tumors are reviewed. The most important cause of treatment failure was late diagnosis and incomplete follow up due to uncooperative patients. The median DFS in the patients with malignant epithelial tumors who were treated with radical surgery was 48 months

Objective: Helicobacter Pylori has a precipitating role in the ethiopathogenesis of several benign or malignant gastrointestinal and extra- gastrointestinal diseases. The purpose of this study is determining the correlation between Helicobacter Pylori and SCC of larynx and hypopharynx. Method: Serum samples of 30 patients with documented laryngeal and hypopharyngeal SCC were analyzed in search of IgG anti-H pylori using Elisa technique. Moreover, as an adjunct study we examined the presence of Helicobacter pylori in the laryngeal tumor mass using appropriate stain and specific culture medium. We did the serologic test in 30 properly matched controlswho did not have carcinoma of larynx/hypopharynx. Results: Sixty-three percent of the patient group and 26% of the control group were seropositive, which supports the role of H Pylori in the genesis of laryngeal/hypopharyngeal cancer (P<0.005, t-test). The organism was also isolated in one-third of tumoral tissues. Conclusion: Helicobacter Pylori infection can be a risk factor for laryngeal/hypopharyngeal cancers in the same way as gastric cancer. This might be through a contributing effect with cigarettes and alcohol, or it may be an independent factor. More extensive studies in various communities are recommended.

Objective: The aim of this study was prevalence of acute otitis media in children (6mo.-6yr.) with febrile convulsion admitted to the Pediatric Ward of Hospital,2001-2002 (Khordad1380- 81). Method: Fifty children (6mo.-6yr.) with febrile convulsion were admitted to the Pediatric Ward of Ghaem Hospital between the 15th of Khordad 1380 to the 15th of Khordad 1381.All of them were examined within the first six hours of admission. A questionnaire was filled for each child. Results: The patients mean age was 27.59 months (range 6.5mo.-5yr.) 35 patients were male, and 15 were female. Fifty-four percent of all patients had simple and 46% had complex febrile convulsions. The most common disease was acute otitis media (36%), followedby upper respiratory tract infections (34%),and gastroenteritis (30%). Association of acute otitis media with febrile convulsion in males was more in females (88.9% ,vs 11.1%, P = 0.029) There was not significant statistical relation between acute otitis media and febrile type convulsions (simple-complex) (P= 0.87).

Forty-seven patients were enrolled in this prospective, randomized, controlled study for determining of the efficacy of Phenylephrine hydrochloride, a topical vasoconstrictor, in preventing tympanostomy tube obstruction. Mehr 1378 to Mehr 1380, 40 patients (80 ears) returned for postoperative evaluation. In all patients preoperative diagnosis was bilateral otitis media with effusion. Twenty-two patients were males and 18 females. Mean age of the patients was 5 years/old (range 3 to 10). Myringotomy with tymanostomy tube insertion was performed in all ears. Forty control ears received no medication, but 40 treatment ears received topical Phenylephrine immediately after the insertion of tubes. Two weeks and 2 months after surgery, tympanometry was done, and patency of tube was evaluated. The overall incidence of tympanostomy tube obstruction was 8.75% : 5% in the treatment group and 12.5% in the control group. That shows obstruction to be more than twice as much in the control group. Of course, by using Fishers exact test, based on alfa = 0.05, pvalue was 0.43, so there was no significant difference between the two groups. According our plan Phenylephrine drops could be efficient in prevention of ventilation tube obstruction and safe for the inner ear.

Nasal bone fracture, more than other bone fractures, involves a medicolegal social problem. In a retrospective study on 166 cases of nasal fractures 146 patients (123 male, 23 female) were included in the authors specialized practice, mainly in a clinic south of Tehran (Naziabad) during the decade 1981 to 1991. The most common causes of nasal fracture were conflict (48.65%), falling from the second floor or the beds of a sanatorium, and vehicle accidents (10.13%), Traumatic causes lead to nasal fracture. Football lead to nasal fracture (9.45%). The most common age involved in nasal fracture was the third decade, approximately 55.48% . Most patients referred to my clinic within the first week rather later (70.39%); 36.84% visited the clinic within the first two days.

Lingual thyroid is a developmental congenital abnormality with a reported incidence ranging from 1:10 to 1:100,000. It is characterized by the failure of the thyroid gland, or remnants, to descend from is embryologic site of origin of the foramen cecum to its usual pretraceal position. Clinical Presentation: We reported three patients with diagnosis of lingual thyroid during the years 1371 - 1381. One patient a 23 years old male presented with dysphangia and oral bleeding during solid ingestion from 7 year ago. Other patient a 47 years old female presented with intermitant oral bleeding, dyspnea and snoring during sleep from 20 years ago. Third patient a 16 years old female presented with sore throat and articulation disorders from 2 months ago. Intervention: Thyroid scan with iodine 123 showed high uptake zone in the base of tongue without activity in the normal thyroid bed. The patients were operated with transhyoid anterior pharyngotomy approach and pathology revealed normal thyroid tissue. Conclusion: Definitive diagnosis of lingual thyroid is on based on iodine 123 thyroid scan. When the mass is causing functional impairment, suppressive doses of thyroid hormones may be sufficient; when it is not, total excision should be considered.

The thyroglossal duct cyst (TOC) is the most common anomaly observed during thyroid development, but carcinoma is found in approximately 1% of these lesions. To date, approximately 250 cases have been reported, the majority of them being papillary carcinoma (PC). The cysts are usually asymptomatic. The presentation of the patient with carcinomais similar to TOC. The case we are reporting is a 36-years-old man who had been exposedto chemical warfare agents during the Iraq-Iran war. He presented with a cystic nodule above the thyroid, and the diagnosis of TOC was made during operation. Histopathologic examination reveald PC in a TOC. Although thyroid examination and scan were normal, because of exposure to chemical warfare agents, total thyroidectomy was performed and reveald multifocal PC of the thyroid. Therefore, exposure to chemical warfare agents can be a high risk factor for thyroid malignancy, and total thyroidectomy in every case of PC to TOC with a history of chemical warfare injury is recommended.

Fungal infection of the nose and paranasal sinuses is an uncommon condition which is now being increasingly recognized in both normal and immunocompromised individuals who usually have a predisposing factor. Aspergillus is the most common reported cause of Fungal sinusitis followed by mucormycosis, Candida, Penicillium and Fusarium. The maxillary sinus is involved in most of the cases followed in order of frequency by the ethmoid and frontal sinuses. Lesions limited to sphenoid sinus are relatively rare with only 71 cases reported in the literature. We describe a 72 y/o patient who had a mocucele like lesion of the sphenoid sinus on her preoperative CT scan. The sphenoid was opened through transnasal endoscopic approach, and multiple clay - like tenacious material was removed under direct endoscopic vision. Histopathologic examination revealed areas of necrosis, chronic inflammation and septated hypheas. Types and classifications of fungal infections, differential diagnosis of isolated sphenoid sinus disease, and the role of radiology in preoperative evaluation of the patients are also discussed.

Background: The essence of parathyroid surgery is finding the diseased gland or glands. Even experienced surgeons have a small miss rate despite numerous paraclinical localizing tecniques. The surgeons information about location of glands is the most important factor in finding them. The goal of anatomical research is to determin the location of glands and help improve surgeons information. Methods and Cases: To find ectopic cases of parathyroid glands this descriptive study which took 1.5 years was done on 100 cadavers which had been dissected for legal purposes. Obtained samples were dissected by classical method, and 871 tissue samples which were considered as parathyroid tissue were sent for pathological evaluation. Results: Four hundred-eleven tissue samples were diagnosed as parathyroid tissue. Fortyseven (11.5%) were ectopic. Seventeen ectopic glands were found in the postrosuperior part of the thyroid gland, 15 mediastinum and thymus, 8 in the posterior part of the esophagus and pharynx, and 7 in thyroid tissue. Seventeen percent of ectopic cases were in upper glands and 30% of ectopic glands were in lower glands (P =0.002). Conclusion: Possibility of existence of ectopic cases of parathyroid glands in thyroid and mediastinum should be considered during thyroid surgery.

Fibrovascular polyp is a benign a benign and very rare tumor in the hypopharynx and esophagus. It is more common in elderly men. This lesion, in spite of its large size, could be asymptomatic for a long time. We are reporting here a 65 - year - old woman with this tumor from the ENT Department of Ghaem Hospital, Mashhad. IT may be the first reported case in Iranian publications. Her chief complain which brought her to us was feling a mass in the oral cavity upon straining.