Iranian Journal of Otorhinolaryngology
Volume:26 Issue: 1, winter 2014

Cholesteatoma is traditionally diagnosed by otoscopic examination and treated by surgery. The necessity for imaging in an uncomplicated case is controversial. This study was planned to investigate the usefulness of a preoperative high-resolution computed tomography (HRCT) scan in depicting the status of middle ear structures in the presence of cholesteatoma and also to compare the correspondence between pre- and intraoperative CT findings in patients with cholesteatoma. This prospective descriptive study was performed from January 2009 to May 2011 in 36 patients with cholesteatoma who were referred to the Kashani and Al-Zahra Clinics of Otolaryngology. Preoperative high-resolution temporal bone CT scans (axial and coronal views) were carried out and compared with intraoperative findings. Evaluation of 36 patients and their CT scans revealed excellent correlation for sigmoid plate erosion, widening of aditus, and erosion of scutum; good correlation for erosion of malleus and tegmen; moderate correlation for lateral canal fistula (LCF) and erosion of mastoid air cells; and poor correlation for facial nerve dehiscence (FND), incus, and stapes erosion. A preoperative CT scan may be helpful in relation to diagnosis and decision making for surgery in cases of cholesteatoma and ossicular erosion. The CT scan can accurately predict the extent of disease and is helpful for detection of lateral canal fistula, erosions of dural plate, and ossicular erosions. However it is not able to distinguish between cholesteatoma and mucosal disease, facial nerve dehiscency, incus, and stapes erosion.

Neonatal hypernatremia dehydration (NHD) is a dangerous condition in neonates, which is accompanied by acute complications (renal failure, cerebral edema, and cerebral hemorrhage) and chronic complications (developmental delay). Children begin learning language from birth, and hearing impairment interferes with this process. We assessed the hearing status of infants with hypernatremia dehydration. In a case-control study in 110 infants presenting at the Ghaem Hospital (Mashhad, Iran) between 2007 and 2011, we examined the incidence of hearing impairment in infants suffering from hypernatremia dehydration (serum sodium >150 mEq/L) in comparison with infants with normal sodium level (serum sodium ≤150 mEq/L). Three of 110 cases examined in the study group showed a transient hearing impairment. A mean serum sodium level of 173mg/dl was reported among hearing-impaired infants. Transient hearing impairment was higher in infants with hypernatremia; although this difference was not significant (P>0.05). Hearing impairment was observed in cases of severe hypernatremia.

Tinnitus is a perception of sound without external source. The exact etiology of tinnitus is not fully understood, although some researchers believe that the condition usually starts in the cochlea. The aim of this study was to determine the potential contribution of outer hair cell dysfunction to chronic tinnitus, by application of Distortion-Product Evoked Otoacoustic Emission (DPOAE) and Transient Evoked Otoacoustic Emission (TEOAE) and also to determine the relationship between tinnitus loudness and the amplitude of these two potentials. This study was conducted on 20 tinnitus patients aged 20–45 years and 20 age- and gender-matched control subjects. DPOAE and TEOAE were performed on each subject. The difference in the amplitudes of TEOAE between the two groups was not significantly different (P=0.08), but the amplitude of DPOAE in patients with tinnitus was significantly lower than the corresponding value in the control subjects (P=0.01). There was no correlation between tinnitus loudness and the amplitudes of neither DPOAE nor TEOAE. Abnormal findings in the DPOAE of tinnitus sufferers suggest some form of cochlear dysfunction in these patients. As there was no correlation between the amplitude of the recorded potentials and tinnitus loudness, factors other than cochlear dysfunction may also influence the loudness of tinnitus.

In recent years, the surgical management of angiofibroma has been greatly influenced by the use of endoscopic techniques. However, large tumors that extend into difficult anatomic sites present major challenges for management by either endoscopy or an open-surgery approach which needs new technique for the complete en block resection. In a prospective observational study we developed an endoscopic transnasal technique for the resection of angiofibroma via pushing and pulling the mass with 1/100000 soaked adrenalin tampons. Thirty two patients were treated using this endoscopic technique over 7 years. The mean follow-up period was 36 months. The main outcomes measured were tumor staging, average blood loss, complications, length of hospitalization, and residual and/or recurrence rate of the tumor. According to the Radkowski staging, 23,5, and 4 patients were at stage IIC, IIIA, and IIIB, respectively. Twenty five patients were operated on exclusively via transnasal endoscopy while 7 patients were managed using endoscopy-assisted open-surgery techniques. Mean blood loss in patients was 1261± 893 cc. The recurrence rate was 21.88% (7 cases) at two years following surgery. Mean hospitalization time was 3.56 ± 0.6 days. Using this effective technique, endoscopic removal of more highly advanced angiofibroma is possible. Better visualization, less intraoperative blood loss, lower rates of complication and recurrence, and shorter hospitalization time are some of the advantages.

In open reduction and internal fixation for the treatment of mandibular fracture, the fixation technique used is very important in reducing post-operative complications and promoting the healing process. This study assessed the results of fixation of the mandible using two mini-plates perpendicular to each other in the lower border of the mandible for fracture treatment. Access to the fractures was via an extraoral approach (through existing scars or incisions). After reductions of mandibular fractures, the fracture line fixation was accomplished using two mini-plates perpendicular to each other. One-week intermaxillary fixation (IMF) was applied and 3 weeks of soft diet was recommended in the post-operative period. All patients were followed up for at least 1 year regarding infection and malocclusion. Twenty-five patients (28 fracture lines) underwent this technique. Most (81.8%) patients were male and the mean age was 41.3±7.59 years (range, 17–73 years). Symphyseal fracture (frequency, 52%) was the most prevalent followed by angle (32%) and body (16%) fractures. Among the patients who underwent surgery, only one malocclusion and no cases of infection were observed. No cases [Rachel1] of facial nerve weakness or damage were observed in this study. This method can be used in specific cases to replace treatment with one mini-plate, which necessitates a more intensive fixation or reconstruction plate therapy.

The purpose of this retrospective study was to evaluate the outcome following stenting over a period of 10 years in patients with chronic laryngotracheal stenosis. Between 2000–2010, out of 111 patients with laryngotracheal trauma, 71 underwent tracheal T-stenting for laryngotracheal stenosis in the Department of Otorhinolaryngology at the Government Medical College and Hospital, Chandigarh, India. All 71 patients underwent stenting by tracheal T-stent through an external approach. The follow-up period ranged from 3–10 years (mean, 3.2 years). The tracheal T-stent was removed after a minimum period of 6–12 months. The majority of patients in this study were aged less than 10 years or between the ages of 20–30 years. A pre-operative tracheostomy (emergency or elective) was performed in all patients. of 71 patients, decannulation was not possible in six (8%). Management of laryngotracheal stenosis is a challenging problem that demands a multidisciplinary approach from surgical teams well trained in this field. The ideal treatment option should be individualized according to patient characteristics. The use of silastic stents has both advantages and disadvantages.

Neonatal nasal airway obstruction induces various degrees of respiratory distress. The management of this disease, including surgical repair, will depend on the severity and location of the obstruction. We describe here a case of congenital nasal nostril stenosis that required surgical repair for stenting of both nares after coanal atresia repair. Case Report: A 2 days old female newborn referred to neonatal department of Tabriz Children’s Hospital affiliated to the University of Medical Sciences of Tabriz, Iran on the 3rd of December, 2011 immediately after birth with respiratory distress due to bilateral coanal atresia and nasal hypoplasia with very small nostrils. CT scan showed normal brain and bilateral choanal atresia with normal size Pyriform apertures. Nasal obstruction can lead to airway compromise and respiratory distress. Congenital bony nasal deformities are being recognized as an important cause of newborn airway obstruction. Nasal hypoplasia is seen in many craniofacial syndromes. Although our patient had hypoplastic nostrils with respiratory distress due to bilateral coanal atresia, correction of hypoplastic nostrils was necessary for completing the operation of choanal atresia.

Injury to cranial nerves IX, X, and XII is a known complication of laryngoscopy and intubation. Here we present a patient with concurrent hypoglossal and recurrent laryngeal nerve paralysis after rhinoplasty. Case Report: The patient was a 27-year-old woman who was candidate for rhinoplastic surgery. The next morning after the operation, the patient complained of dysphonia and a sore throat. 7 days after the operation she was still complaining of dysphonia. She underwent a direct laryngoscopy, and right TVC paralysis was observed. Right hypoglossal nerve paralysis was also detected during physical cranial nerve function tests. Hypoglossal and recurrent laryngeal nerve function was completely recovered after 5 and 7 months, respectively, and no complication was remained. Accurate and atraumatic intubation and extubation, true positioning of the head and neck, delicate and gentle packing of the oropharynx, and maintenance of mean blood pressure at a safe level are appropriate methods to prevent this complication during anesthesia and surgical procedures.

Thyroid gland is well known to resist infections by rich blood supply and lymphatic drainage, high glandular content of iodine which can be bactericidal and separation of the gland from other structures of neck. Primary thyroid abscess resulting from acute suppurative thyroiditis (AST) is an unusual type of head and neck infection and it is a rare condotion in children so that progression to abscess formation is even more uncommon. Case Report: In this article we report a 9 years old girl who presented thyroid abscess. She had fever, painful swelling in the neck, sore throat, tachycardia, restriction of neck movements and dysphagia for 6-7 days with a history of mild fever from 10 days, prior to that. The responsible organism was found to be staphylococcus aureus. Treatment began with Intravenous antibiotics and continued with incision and drainage. Thus the process led to an uncomplicated recovery. Although thyroid abscess is rare, but must be considered. Most common organism that cause is staphylococcus aureus. With early diagnosis and proper treatment, it can be prevented from complications. Since this disease can be associated with anatomic abnormalities such as pyriform sinus fistula, must be roule outed.

A 48 year old man presented to our outpatient department with the history of absolute dysphagia, and fever for two days. On examination patient was febrile with drooling of saliva. Oropharynx was minimally congested. Indirect laryngoscopy revealed odematous epiglottis with pus pointing over the lingual surface. Radiography of soft tissue, neck lateral view, showed the thumb sign which suggested epiglottitis. Incision and drainage was performed under general anaesthesia after haematological investigations. Patient was extubated the next day, and was discharged after two days, also oral antibiotics, and analgesics were prescribed. Patient was reviewed after 2 weeks, and indirect laryngoscopy revealed a normal epiglottis.Although pharyngitis is the most common cause of sore throat in adults, acute epiglottitis must be considered in differential diagnosis when there is unrelenting throat pain, and minimal objective signs of pharyngitis. Epiglottic abscess formation is more common in adults than children. They most commonly occur as a complication of acute pharyngitis or with abscess of lingual tonsil. The abscess most frequently comes to a point on or near the lingual surface of the epiglottis. Streptococcus was isolated more frequently. Other organisms reported were Haemophilus influenzae, E.coli, Pseudomonas, Micro- coccus catarrhalis, Pneumococci. In our case, there were no preceding symptoms of acute pharyngitis. Risk factors include adult age at onset, diabetes mellitus, trauma, presence of a foreign body, and immune- compromised state. This case is unusual because of the absence of above risk factors. Incision and drainage under general anaesthesia is the treatment of choice. To the author’s knowledge, very few cases of acute epiglottic abscesses have been reported in the literature. This case is unusual because there are no preceding symptoms of pharyngitis or tonsillitis, and no association of risk factors like diabetes mellitus, trauma, foreign body or immunocompromised state.