IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY
Year:2007 | Volume:19 | Issue:1 (47)|Papers Count:14

Introduction: A double blind, randomized study was designed to determine the efficacy of dexamethasone in decreasing periorbital edema and ecchymosis after rhinoplasty Materials and Method: Sixty rhinoplasty patients undergoing open rhinoplasty surgery with tip modification, hump resection and bilateral osteotomy were included in the study and were enrolled in 3 groups: group 1: 20: a single dose of 8 mg dexamethasone at the beginning of operation. Group 2: 20: three doses of 8 mg dexamethasonefirst at the beginning of operation and then 24 and 48 h postoperatively. Group 3: 20 control group with no medication used.Results: Significant reduction in periorbital edema and ecchymosis was obvious in groups land 2 compared with control group 3. Periorbital edema and ecchymosis during the end of first postoperative week was lower in group 2 compared with group 1.Conclusion: steroid administration before osteotomy reduced edema and ecchymosis significantly. Patients can return to their normal lives earlier with this reduction in postoperative edema and ecchymosis.

Introduction: Treatment of subjective idiopathic tinnitus is very difficult and many different treatments are available at present with different response rate. In this study, the effectiveness of transcutaneous electrical stimulation in subjective tinnitus was evaluated.Materials and Methods: 62 patients with subjective tinnitus were entered to this study. Transcutaneous electrical stimulation was applied weekly by dual channel TENS stimulator.Results: 51.2% of patients have had good response to this treatment. All of these patients explained a tinnitus which was tolerable and there was not sleep disturbance at least for 6 months.

Introduction: CT scan is the standard method for purposes of diagnosis, disease monitoring, and surgical planning of paranasal sinuses. Yet there are varying reports of both positive and negative correlation between sino - nasal symptoms and CT evidence of sinusitis. We designed a study for survey of relative frequency of signs and symptoms of chronic sinusitis that correlate in clinical diagnosis with computed tomography scan results.Materials and Methods: Signs and symptoms of 200 patients with clinical diagnosis of chronic sinusitis after coronal CT scan results were evaluated and analyzed for sensitivity, specificity, positive and negative values.Results: 111 patients (55.5%) had chronic sinusitis with respect to CT scan findings, but 89 patients (44.5 %) didn't have any evidence of chronic sinusitis on CT scan. Age, sex and duration of disease didn't have significant statistical difference between these groups. The most sensitive symptoms were nasal stuffiness and facial or forehead pain and least sensitive but most specific was facial pressure. Least specificity was related to facial or forehead pain. The greatest positive predictive value was facial pressure and the least, was facial or forehead pain.Conclusion: The most valuable predictor symptom in diagnosis of chronic sinusitis is facial pressure, and least reliable of them is facial or forehead pain. Generally clinical symptoms have a little value in diagnosis of chronic sinusitis and must be checked with CT scan findings.

Introduction: Fiberoptic laryngoscopy (FOL) is usually used in the management of difficult airway intubations. Since its introduction, it has been used for few other indications.Materials and Methods: In this paper we present a new indication of fiberoptic bronchoscopy (FB) to detect the exact location of tracheoesphageal fistula (TEF) intraoperatively in fourteen cases of pediatric group patients to prevent an unnecessary traumatic manipulation during operation.Results: In all of these cases (12 esophageal atresia and TEF and 1 recurrent TEF and 1 pure TEF) we were able to detect the exact location of TEF with using a LF type Fiberoptic laryngoscope which was been passed through the endotracheal tube. The TEF could then be found and repaired perfectly with minimal dissection and trauma to the trachea and esophagus through thoracotomy (Except 1 case that did not need thoracotomy) Postoperative course was uneventful and all of the patients were discharged in good condition.Conclusion: We believe that intraoperative fiberoptic bronchoscopy in these types of operations not only leads to shortening the operation time, but it can also prevent unnecessary trauma to vital thoracic organs.

Introduction: Multiple sclerosis (MS) is a chronic demylinated disease of central nervous system which strikingly has racial and geographic differences in prevalence and symptoms. Audiovestibular involvement is relatively common in MS.Materials and Methods: In a descriptive prospective cross-sectional study on 36 patients who fulfill McDonald criteria of MS history of Audiovestibular symptoms was recorded and audiologic assessment including tunning fork, speech and pure tone audiometry, tympanometry and auditory brainstem response (ABR) performed.Results: The mean age was 29 year (range: 18-48) and female to male ratio was 17. The most common symptoms in otoneurologic domain were balance disorders (63.5%) and in 16.7% cases there was true vertigo. In audiometry 22.2% sensoryneural hearing loss mainly unilateral was repotted. ABR in 44.4% had abnormality in morphology or latency. Vertigo in 5.6% and hearing loss in 2.8% were the first symptoms. Conclusion: Audio vestibular involvement is fairly common and occasionally it can be the first symptom in MS, so an otorhinolaryngologist has better consider this diagnosis when a patient refers with this symptom especially in young women.

Introduction: Juvenile nasopharyngeal angiofibroma (JNA) is uncommon benign tumor that occur exclusively in the lateral portion of nasopharynx of adolescent boys. Sex selectivity at JNA may suggest relation its pathogenesis to hormonal changes of pubertal period. Some reports showed indirect evidence for the presence of androgen (AR), estrogen (ER), and progesterone (PR) receptors, in these tumors.The goal of the current study was to show direct evidence of sex hormone receptor expression in angiofibroma with use of immunohistochemical technique and to document which cells population express these receptors.Materials and Methods: 30 cases of juvenile nasopharyngeal angiofibroma and equal number of normal nasopharyngeal tissue were selected from archive of pathology department of mashhad Ghaem hospital then standard Immunohistochemical technique was performed in theirs paraffin blocks with ER, PR and AR immunohistochemical markers. Nuclear immunoreactivity was examined in stromal and endothelial cells of each case then these results analyzed with Pearson Chi-Square test.Results: AR, and ER expression was seen in angiofibroma in 80% and 26.7% and in normal tissue 26.7% and 10% of cases respectively. We did not find any PR expression in both normal and tumoral tissue. Differences between AR expression in tumoral and normal tissue was meaningful but this correlation do not true about ER and PR.Conclusions: our results maybe agree with the significant role of androgen receptors in the pathogenesis of angiofibroma and benefit of antiandrongeic drugs for therapeutic response.

Introduction: Primary malignant neoplasm of trachea is very rare and there is limited information about them. Adenoid cystic carcinoma is a slow-growing malignant tracheal tumor and the best method of treatment is surgical resection. This study was conducted for evaluation of patients with adenoid cystic carcinoma of trachea after treatment.Materials and Methods: In this descriptive study, all patients treated for adenoid cystic carcinoma between 1995 to 2006 in Mashad Ghaem hospital and Tehran Imam Khomeini hospital, were analyzed statistically.Results: Of nine patients, female to male ratio was 2/1, the mean age of patients was (56.3) years, dyspena and stridor were the most common presenting symptoms (88.8%) and CT scan was the best diagnostic imaging method. The most common site of involvement was in lower third of trachea (44.4%). (77.7%) of patients underwent surgical resection, hospital mortality after tracheal resection occurred in one patient due to complication (14.2%) aspiration pneumonia. During three years follow up just one patient (11.1%) had tumor recurrence and resection with post operative radiotherapy was performed in this cases overall three-year survival was 88.8%.Conclusion: Because of the nature of adenoid cystic carcinoma in trachea, surgical resection is the best method of treatment, but if surgical margin is positive, post operative radiotherapy will be necessary. In patients who are not candidates for resection, radiotherapy can be an effective alternative treatment.

Introduction: To introduce the results of the treatment of 47 antrochoanal polyps patients managed by endoscopic procedure.Materials and Methods: 47 patients with antrochoanal polyposis underwent endoscopic sinus surgery From March 2000 to august 2006.Results: 47 patients (29 men & 18 women) underwent FESS endoscopy. There was no major complication. Only 4 brief epistaxis reported postoperatively. There was no report of recurrence in follow up duration.Conclusion: In 6-45 months follow up of 47 patients with antrochoanal polyps who underwent FESS, we hadn't any complication or recurrence.

Introduction: Hemangiopericytoma is a relatively rare tumor first described in 1942, with approximately 300 cases has been described in the literature till now. In most cases it affects the trunk and lower extremities. The head and neck incidence is less than 20%, mostly in adults. We describe a rare case of malignant hemangiopericytoma in a woman located in her post neck.Case report: A60 years old female patient noted presence of a firm painless mass of 7cm diameter located in her post neck with Growing since 10 years ago and rapid enlargement. During last 6 Mounts. The patient had neither history of any skeletal, sensory or motor complaints nor respiratory symptom. MRI Sequences represent non-homogenous medium signal density in T1 and homogenous high signal density in T2 Sequences After complete removal pathologic study revealed hemangiopericytoma. The patient is fine during regular follow up without any functional disability.

Introduction: Osteoid osteoma is a benign tumor, which is mostly seen in the long bones but occasionally originates and grows inside the paranasal sinuses. It rarely may impinge the dura with growing upward inside the ethmoid sinus. As a result, it can cause dural rupture, CSF leak and tension pneumocephalus. This needs complete resection with dural repair as an effective treatment.Case report: In this case report, a 72 year old man with osteoid osteoma is reported who had been referred with headache, rhinorrhea, memory loss, mood disorder and mutism.Pneumo-encephalus due to injury of dura of the skull base by a left ethmoid sinus osteoma was later found by CT scan. This tumor was completely resected and dura repaired by a surgical team including neurosurgeon and otorhinolaryngologist. The signs and symptoms were disappeared during the next few days.

Introduction: Xeroderma pigmentosum is a group of rare autosomal recessive inherited disorders that have extreme skin sensitivity to DV and frequency of skin cancers.Pathophysiology of XP is defect in repair of DNAXP is a clinical diagnosis that is based on history of sun hypersensitivity and skin neoplasma Patient must avoid the sun to protect their skin.Case report: The case was a 16 years old male with advanced BCC over the nose that managed by total rhinectomy and repaired by up and down forehead flap.