Iranian Journal of Otorhinolaryngology
Volume:26 Issue: 4, Autumn 2014

Adenoid hypertrophy is the most common cause of chronic airway obstruction in children. The aim of this study was to evaluate the effect of adenotonsillectomy on sleep and behavioral disorders in children with adenotonsillar hypertrophy. In a prospective observational study, all children with an indication of adenotonsillectomy based on American Academy of Otolaryngology – Head and Neck Surgery criteria and sleep disorders referred to our otolaryngology clinic were enrolled and examined. Rutter Children’s Behavior (RCBQ) and Child Sleep Habit Questionnaires (CSHQ) were completed by the children’s parents both before and 3 months after the operation. A total of 44 children (25 boys and 19 girls) with a mean (standard deviation [SD]) age of 7.86± 2.26 years and mean (SD) body mass index (BMI) of 16.37±1.35 kg/m2 were studied. Mean scores of RCBQ and CSHQ decreased significantly 3 months after adenotonsillectomy, and sleep habits and behavior improved significantly (P<0.05). Although there was no significant relationship between improvement of behavior and the gender, age or BMI of the children, there was a significant relationship between improvement of sleep habits and age as well as BMI (P<0.05). As adenotonsillectomy causes significant improvements in children`s quality of life (including sleep and behavior), it is recommended in children with adenotonsillar hypertrophy.

Antibiotic therapy before or after orthognathic surgery is commonly recommended by surgeons to minimize the risk of wound infection. This article evaluates the value of Prophylactic antibiotic therapy in order to diminish the incidence of postoperative wound infection after orthognathic surgery. Fifty candidates for bimaxillary orthognathic surgery were divided into cases and controls. Cefazolin (1g) was administered intravenously to all participants 30 mins prior to surgery followed by a similar dose 4 hours later. Case-group patients ingested amoxicillin (500 mg) orally for 7 days after surgery. Postoperative wound infection was assessed using clinical features, and the P-value significance was set at P Both groups were similar according to gender, age, and operating time. During the follow-up period no infection was observed in either the case or control group. The results of this study suggest that long-term postoperative antibiotic therapy is not essential for the prevention of postoperative infection, and that application of aseptic surgical technique and hygiene instruction after surgery are sufficient.

Radiotherapy is a common treatment modality for patients with head and neck malignancies. As the nose lies within the field of radiotherapy of the head and neck, the olfactory fibers and olfactory receptors may be affected by radiation. The aim of this study was to evaluate changes in olfactory threshold in patients with head and neck malignancies who have received radiation to the head and neck. The olfactory threshold of patients with head and neck malignancies was assessed prospectively before radiation therapy and serially for up to 6 months after radiotherapy using sniff bottles. In vivo dosimetry was performed using 82 LiF (MCP) chips and a thermoluminescent dosimeter (TLD) system. Sixty-one patients were recruited before radiotherapy was commenced. Seven patients did not return for evaluation after radiation. Fifty-four patients were available for follow-up assessment (28 women, 26 men; age, 22–86 years; median, 49 years). Total radiation dose was 50.1 Gy (range, 30–66 Gy). Mean olfactory threshold scores were found to deteriorate significantly at various timepoints after radiotherapy (11.7 before radiotherapy versus 4.0 at Month 6, general linear model, P<0.0001). With in vivo dosimetry, we found that the median measured dose to the olfactory area was 334 µC. We also identified a cutoff point according to the dose to the olfactory epithelium. Olfactory threshold was significantly decreased 2–6 weeks after initiation of therapy, with cumulative local radiation >135 µC (Mann-Whitney U test, P=0.01). Deterioration in olfactory threshold scores was found at 6 months after initiation of radiation therapy. Provided that these results are reproducible, an evaluation of olfactory functioning in patients with head and neck malignancies using in vivo dosimetry may be useful for determining the optimal dose for patients treated with conformal radiotherapy techniques while avoiding the side effects of radiation.

Nausea and vomiting after ear, nose and throat (ENT) surgery is one of the most common and notable problems facing anesthesiologists in this area. This study was conducted to determine the effect of a pharyngeal pack on the severity of nausea, vomiting, and sore throat among patients after ear, pharynx, and throat surgeries. This randomized clinical study was performed in 140 patients (61 men and 79 women; age range, 20–40 years) who had undergone nasal surgery in 2010. Patients were divided into two groups: the first group were treated using a pharyngeal pack (case group) and the second group were managed without a pharyngeal pack (control group). Statistical analysis was performed using the Chi-square test and the Mann-Whitney U test. SPSS software was used for data analysis. The mean severity of nausea and vomiting in the two groups was 2.057, 1.371 and 1.100, respectively, with no significant differences between groups. However, the mean severity of sore throat was 1.714 in the group with the pharyngeal pack and 1.385 in the group without pharyngeal pack (P=0.010). Not only does a pharyngeal pack in ENT surgery not reduce the extent and severity of nausea and vomiting, but it also increases the severity of sore throat in patients when leaving the recovery room and discharging hospital.

Cochlear implantation (CI) improves language skills among children with hearing loss. However, children with CIs still fall short of fulfilling some other needs, including musical perception. This is often attributed to the biological, technological, and acoustic limitations of CIs. Emotions play a key role in the understanding and enjoyment of music. The present study aimed to investigate the emotional perception of music in children with bilaterally severe-to-profound hearing loss and unilateral CIs. Twenty-five children with congenital severe-to-profound hearing loss and unilateral CIs and 30 children with normal hearing participated in the study. The children’s emotional perceptions of music, as defined by Peretz (1998), were measured. Children were instructed to indicate happy or sad feelings fostered in them by the music by pointing to pictures of faces showing these emotions. Children with CI obtained significantly lower scores than children with normal hearing, for both happy and sad items of music as well as in overall test scores (P<0.001). Furthermore, both in CI group (P=0.49) and the control one (P<0.001), the happy items were more often recognized correctly than the sad items. Hearing-impaired children with CIs had poorer emotional perception of music than their normal peers. Due to the importance of music in the development of language, cognitive and social interaction skills, aural rehabilitation programs for children with CIs should focus particularly on music. Furthermore, it is essential to enhance the quality of musical perception by improving the quality of implant prostheses.

Hearing loss is one of the most common occupational diseases. In most workplaces, workers are exposed to noise and solvents simultaneously, so the potential risk of hearing loss due to solvents may be attributed to noise. In this study we aimed to assess the effect of exposure to mixed aromatic solvents on hearing in the absence of exposure to hazardous noise. In a cross-sectional study, 99 workers from the petrochemical industry with exposure to a mixture of organic solvents whose noise exposure was lower than 85 dBA were compared with 100 un-exposed controls. After measuring sound pressure level and mean concentration of each solvent in the workplace, pure-tone-audiometry was performed and the two groups were compared in terms of high-frequency and low-frequency hearing loss. T-tests and Chi-square tests were used to compare the two groups. The mean hearing threshold at all frequencies among petrochemical workers was normal (below 25 dB). We did not observe any significant association between solvent exposure and high-frequency or low-frequency hearing loss. This study showed that temporary exposure (less than 4 years) to a mixture of organic solvents, without exposure to noise, does not affect workers’ hearing threshold in audiometry tests.

Chronic rhinosinusitis (CRS) is a multifactorial disease. Allergies are considered a predisposing factor to CRS; however, this remains controversial. The objective of this research was to investigate the prevalence of co-morbidities and allergic reaction, and to specify the most common allergens in patients with confirmed CRS. One hundred patients with signs and symptoms of CRS who met the diagnostic endoscopic and radiologic criteria of chronic rhinosinusitis were selected. They filled out a questionnaire and underwent a skin prick test for the common inhalant allergens. Allergic rhinitis was diagnosed according to the history and positive skin prick tests. The mean age of patients was 34. Males were slightly more involved (54%). The prevalence of polypoid and none-polypoid rhinosinusitis was 54% and 46% respectively. The patients’ most common symptoms were nasal discharge (95%), blockage (94%), smell disorders (63%), cough (45%), halitosis (41%), lethargy (37%), and aural fullness (36%). Allergy to at least one allergen was noted in 64% of the CRS patients which is higher than general population in Mashhad, Iran with allergic rhinitis (22.4%). Salsola was the most common allergen. There was no significant difference in allergic reactions between polypoid and non-polypoid CRS patients. Allergic reactions was found in Iranian CRS patients with or without polyposis to be much higher than general population in Mashhad with allergic rhinitis alone.

The important sequelae of facial nerve palsy are synkinesis, asymmetry, hypertension and contracture; all of which have psychosocial effects on patients. Synkinesis due to mal regeneration causes involuntary movements during a voluntary movement. Previous studies have advocated treatment using physiotherapy modalities alone or with exercise therapy, but no consensus exists on the optimal approach. Thus, this review summarizes clinical controlled studies in the management of synkinesis and asymmetry in facial nerve palsy. Case-controlled clinical studies of patients at the acute stage of injury were selected for this review article. Data were obtained from English-language databases from 1980 until mid-2013. Among 124 articles initially captured, six randomized controlled trials involving 269 patients were identified with appropriate inclusion criteria. The results of all these studies emphasized the benefit of exercise therapy. Four studies considered electromyogram (EMG) biofeedback to be effective through neuromuscular re-education. Synkinesis and inconsistency of facial muscles could be treated with educational exercise therapy. EMG biofeedback is a suitable tool for this exercise therapy.

A hydatid cyst of the head and neck is a very rare condition, even in areas where Echinococcus infestation is endemic. Case Report: We report a rare case of primary hydatid cyst of the right maxillary sinus in a 40-year-old man. The initial diagnosis of the presence of a cystic mass was the result of physical examination and computed tomography (CT) scan. We resected the cystic mass using the Caldwell-Luc procedure. A definitive diagnosis was confirmed by postoperative histopathologic examination. Hydatid cyst of the maxillary sinus is an extremely rare presentation. However, this condition should be considered in differential diagnosis of cystic lesions of the maxillary sinus.

First branchial cleft anomalies manifest with duplication of the external auditory canal. Case Report: This report features a rare case of microtia and congenital middle ear and canal cholesteatoma with first branchial fistula. External auditory canal stenosis was complicated by middle ear and external canal cholesteatoma, but branchial fistula, opening in the zygomatic root and a sinus in the helical root, may explain this feature. A canal wall down mastoidectomy with canaloplasty and wide meatoplasty was performed. The branchial cleft was excised through parotidectomy and facial nerve dissection. It should be considered that canal stenosis in such cases can induce cholesteatoma formation in the auditory canal and middle ear.

Lipomas of the larynx are very rare benign lesions; macroscopically, they resemble retention cysts, so their diagnosis is usually made after surgery. Case Report: A rare case of pediatric paraglottic space Lipoma in an 11-year-old boy is explained. The mass was mobile, soft, without fluctuation or pulsation. CT scan revealed a 5.7 cm cervical fat density with regional lymphadenopathy. After lateral neck incision, a mass located deep in the carotid artery, which was attached to the larynx and which extended to the paraglottic space, was excised completely. Pathologic evaluation revealed Lipoma without any evidence of malignant cells present. This rare differential diagnosis for neck masses in pediatric population should be considered.