Iranian Journal of Otorhinolaryngology
Volume:27 Issue: 3, May 2015

Post-operative sore throat and cough are common complications of endotracheal intubation. These conditions may be very distressing for the patient and may lead to unpleasant memories. This study was performed in order to determine whether beclomethasone and lidocaine spray could reduce the frequency of post-operative sore throat and hoarseness after tracheal extubation. Ninety women (18–60 years of age) with an American Society of Anesthesiologists (ASA) physical status I or II and undergoing elective mastoidectomy were randomized into three groups of 30 patients. The endotracheal tubes in each group were sprayed with 50% beclomethasone, 10% lidocaine hydrochloride, or normal saline (control group) before endotracheal intubation. Patients were examined for sore throat (none, mild, moderate, or severe), cough, and hoarseness at 1 and 24 h after extubation. There was a significantly lower incidence and severity of post-operative sore throat in the beclomethasone group than the lidocaine and control groups (P<0.05) at each observation time point. At 24 h after extubation, the incidence and severity of sore throat and cough was significantly lower in the lidocaine compared with the control group. The incidence of hoarseness was not significantly different among the three groups. Spraying beclomethasone and lidocaine on the endotracheal tube is a simple and effective method to reduce the incidence and severity of post-operative sore throat.

The Dysphagia Handicap Index (DHI) is one of the instruments used for measuring a dysphagic patient’s self-assessment. In some ways, it reflects the patient’s quality of life. Although it has been recognized and widely applied in English speaking populations, it has not been used in its present forms in Persian speaking countries. The purpose of this study was to adapt a Persian version of the DHI and to evaluate its validity, consistency, and reliability in the Persian population with oropharyngeal dysphagia. Some stages for cross-cultural adaptation were performed, which consisted in translation, synthesis, back translation, review by an expert committee, and final proof reading. The generated Persian DHI was administered to 85 patients with oropharyngeal dysphagia and 89 control subjects at Zahedan city between May 2013 and August 2013. The patients and control subjects answered the same questionnaire 2 weeks later to verify the test-retest reliability. Internal consistency and test-retest reliability were evaluated. The results of the patients and the control group were compared. The Persian DHI showed good internal consistency (Cronbach’s alpha coefficients range from 0.82 to 0.94). Also, good test-retest reliability was found for the total scores of the Persian DHI (r=0.89). There was a significant difference between the DHI scores of the control group and those of the oropharyngeal dysphagia group (P‹0.001). The Persian version of the DHI achieved Face and translation validity. This study demonstrated that the Persian DHI is a valid tool for self-assessment of the handicapping effects of dysphagia on the physical, functional, and emotional aspects of patient life and can be a useful tool for screening and treatment planning for the Persian-speaking dysphagic patients, regardless of the cause or the severity of the dysphagia.

The distance between the anterior commissure of the larynx and the first tracheal ring (AC.T. distance) is of great importance in laryngotracheal surgeries. The amount of narrowing of the subglottic airway is used as a quantitative mean to determine whether the lesion is subglottic or has extended to the trachea and therefore helps in the prediction of the final prognosis. In this study, the larynx was exposed by direct laryngoscopy under general anesthesia. The case was considered to be difficult because the exposure did not optimally reveal the anterior commissure, therefore a cricoid tape or anterior commissure laryngoscope was used. A zero degree Hopkins lens was used to view the anterior commissure and the first tracheal ring. Special markers were used to mark the two points with the distance between those being considered as the AC.T. distance. The relationship between AC.T. distance and the patient''s age, sex, BMI, and laryngeal exposure condition during laryngoscopy was also studied. Eighty-two patients participated in this study. The mean AC.T. distance was measured and was found to be 32.67±3.34 mm in males and 29.80± 3.00 mm in females. This difference was statistically significant between the two groups (P<0.05). There was no statistically significant relationship between BMI, age, laryngeal exposure condition, and the AC.T. distance. The AC.T. distance was measured to be around 3 cm; with males measuring greater than females. However, future studies may lead to a more accurate practical scale for laryngotracheal surgeries due to possible technical or human errors, in addition to racial differences.

The purpose of this study was to investigate the relationship between serum levels of interleukin-6 (IL-6) and the severity and extent of squamous cell carcinoma (SCC) of the larynx based on stage of tumor progression and histological grade. All patients with a diagnosis of laryngeal cancer who underwent laryngoscopy and biopsy while hospitalized in Imam Khomeini Hospital in Ahvaz were enrolled. Tumor stage was calculated based on the TNM system, and divided into early (stage 1,2) or advanced stage (stage 3,4). In addition, patients were divided into low-grade (well differentiated) or high-grade (moderate and poorly differentiated) groups based on pathology reports from biopsy specimens. Several healthy volunteers were also enrolled as the control group. After collecting the blood samples, quantitative serum levels of IL-6 were measured (pmol/L) using IL-6 kits (Bender MedSystem, Germany). Results for quantitative variables are presented as mean and standard deviation and qualitative variables as percentages. Mann-Whitney, Kruskal-Wallis and Pearson’s chi square tests were used for statistical analyses. Thirty-eight patients (82.6%) were male and eight patients (17.4%) were female. IL-6 serum level was 28.8±4.7 pmol/L in the patient group and 2.64±2.88 pmol/L in the control group (P=0.0001). The serum level of IL-6 was 7.27 ± 5.31 pmol/L in early-stage patients and 54.43 ± 6.06 pmol/L in advanced-stage patients (P<0.0001). IL-6 levels increased significantly with increasing N (according to TNM) (P=0.002). Levels of IL-6 in patients with metastasis were significantly higher than in the group without metastasis (P=0.024). Moreover, IL-6 levels increased significantly with increasing local tumor spread (T) (P<0.0001). This study shows that IL-6 is a gender-independent factor, serum levels of which are higher in patients with laryngeal SCC than in normal subjects. The results of this study also show that serum levels of this cytokine increase significantly with progression of this malignancy.

The clinical outcome of patients with squamous cell carcinoma (SCC) located in the head and neck has remained poor despite ongoing advances in diagnosis and management. Interleukin-6(IL-6) is a multi-functional cytokine that plays an important role in the process of cell differentiation and is increased in several malignancies. The aim of this study was to investigate the serum levels of interleukin-6 in patients with oral tongue SCC. In a cross-sectional study, 17 patients with oral tongue SCC were compared with the same number of age- and gender-matched healthy subjects. Serum IL-6 level fluctuation was determined using an immunological technique, before detecting its possible association with the subjects’ age, gender, drinking and smoking history, cancer site, and disease severity. The intensity of serum IL-6 in patients with oral tongue SCC was statistically significantly higher than that in healthy subjects (P<0.001). Serum IL-6 level was independent of the patients’ age, gender, smoking and drinking history as well as cancer stage. IL-6 is a valuable biomarker in the diagnosis of oral tongue SCC. Its high sensitivity makes prediction of this condition possible, while this biomarker can also be used to screen high-risk patients.

Dacryocystorhinostomy (DCR), a popular surgical procedure, has been performed using an endoscopic approach over recent years. Excellent anatomical knowledge is required for this endoscopic surgical approach. This study was performed in order to better evaluate the anatomical features of the lacrimal apparatus from cadavers in the Isfahan forensic center as a sample of the Iranian population. DCR was performed using a standard method on 26 cadaver eyes from the forensic center of Isfahan. The lacrimal sac was exposed completely, then the anatomical features of the lacrimal sac and canaliculus were measured using a specified ruler. A total of 26 male cadaveric eyes were used, of which four (16.7%) were probably non-Caucasian. Two (8%) of the eyes needed septoplasty, one (4%) needed uncinectomy, and none needed turbinoplasty. Four (16%) lacrimal sacs were anterior to axilla, one (4%) was posterior and 20 (80%) were at the level of the axilla of the middle turbinate. The distance from the nasal sill to the anterior edge of the lacrimal sac (from its mid-height) was 39.04 (±4.92) mm. The distance from the nasal sill to the posterior edge of the lacrimal sac (from its mid-height) was 45.50 (±4.47) mm. The width and length of the lacrimal sac was 7.54 (±1.44) mm and 13.16 (±5.37) mm, respectively. The distance from the anterior edge of the lacrimal sac to the posterior edge of the uncinate process was 14.06 (±3.00) mm, while the distance from the anterior nasal spine to the anterior edge of the lacrimal sac (from its mid-height) was 37.20 (±5.37) mm.The height of the fundus was 3.26 (±1.09) mm. The distance from the superior punctum to the fundus was 12.70 (±1.45) mm, and the distance from the inferior punctum to the fundus was 11.10 (±2.02) mm. Given the differences between the various studies conducted in order to evaluate the position of the lacrimal sac, studies such as this can help to better identify the position of lacrimal sac during surgery based on ethnic differences. In addition, these studies can help novice surgeons to better navigate in a surgical scenario.

Squamous cell carcinoma of the oral cavity is one of the most important and common types of head and neck malignancy, with an estimated rate of 4% among all human malignancies. The aim of this study was to determine the association between expression of matrix metalloproteinase 2 and 9 and the clinicopathological features of oral squamous cell carcinoma (OSCC). One hundred existing samples of formalin-fixed paraffin embedded specimens of OSCC were evaluated by immunohistochemistry staining for matrix metalloproteinase 2 and 9 antibodies. Samples were divided into four groups: negative, <10%, 10–50%, and >50%. Patient records were assessed for demographic characteristics such as age and gender, smoking and family history of OSCC as well as tumor features including location, differentiation, stage and lymph node involvement. In this study, 58 patients (58%) were male and 42 (42%) female. The mean age of patients was 60.38±14.07 years. The average number of lymph nodes involved was 8.9±3.8. Tumoral grade, tumoral stage, lymphatic metastasis and history of smoking were significantly related to MMP2 and MMP9 expression. Our study demonstrated that MMP2 and MMP9 expression are important in the development of OSCC.

Sinonasal malignancies are uncommon neoplasms with several histological subtypes. These malignancies have a poor prognosis and, because of the nonspecific nature of the symptoms, most patients are diagnosed late when the disease is already at an advanced stage. Therefore, most sinonasal malignancies tend to be treated with surgery and postoperative radiotherapy. Understanding the incidence and prevalence of clinical symptoms, pathology, diagnosis, and subsequent prognosis of the disease is important for early diagnosis. Medical records of patients with a confirmed diagnosis of sinonasal malignancy in a tertiary referral center from 1998 to 2009 were retrospectively investigated by chronological examination. Information relating to symptoms, pathology, and treatment of patients were collected from the checklists and used to generate tables and graphs, while descriptive statistical tests were used to compare data. The records of 69 patients were examined, including 45 (65.2%) male and 24 (34.8%) female patients with a combined mean age of 54.07±16.04 years. Twenty-one patients (30.4%) were aged less than 45 years and 48 (69.6%) were more than 45 years of age. The most common symptom was facial swelling in 46 (66.6%) patients and the most common kind of tumor was squamous cell carcinoma in 28 (40.6%) patients. The primary location of the tumor in most patients was the maxillary sinus (54 patients; 78.3%). A majority of patients present in advanced stage (stage III or more) with intraorbital (39.1%) or intracranial (4.3%) involvement, or regional lymphatic (28.99%) or distance metastasis (7.2%). The most common treatment was surgery (17 patients; 24.6%). Due to their nonspecific symptoms, most sinonasal malignancies are diagnosed at an advanced stage of the disease. Therefore, all patients with nonspecific symptoms, especially older males, should be evaluated for sinonasal malignancies in order to eliminate this diagnosis.

Tuberculous otitis media (TOM) is an uncommon, insidious, and frequently misdiagnosed form of tuberculosis (TB). In particular, TOM is usually secondary to direct transmission from adjacent organs, while the primary form has been rarely reported. The main aim of treatment is to start the patient on an antitubercular regime and early surgical intervention to decompress the facial nerve if involved. Case Report: The case report of a twenty year-old male with bilateral tuberculous otitis media, who presented himself with fever followed by sequential bilateral facial nerve paralysis, bilateral profound hearing loss, and abdominal tuberculosis leading to intestinal perforation, is presented. To the best available knowledge and after researching literature, no such case depicting the extensive otological complications of tuberculosis has been reported till date. Tuberculosis of the ear is a rare entity and in most cases the clinical features resemble that of chronic otitis media. The diagnosis is often delayed due to varied clinical presentations and this can lead to irreversible complications. Early diagnosis is essential for prompt administration of antitubercular therapy and to prevent complications.

Tuberculosis is an infectious disease that has displayed increasing incidence in the last decades. It is estimated that up to 20% of tuberculosis cases affect extra-pulmonary organs. In the ENT area, soft palate and tongue are the least probable locations. Case Report: A 62-year-old female with a history of rheumatoid arthritis and treatment with corticosteroids and Adalimumab, developed a foreign body sensation in the pharynx accompanied by a sore throat and halitosis. The laryngoscopy with a 70 degree rigid telescope showed an ulcerated hypertrophic lesion in the right vallecula of about 2-3 cm in the base of the tongue. Acid-alcohol resistant bacilli were found positive for M. tuberculosis, through the Ziehl Neelsen method and Löwenstein culture the patient was treated with tuberculostatic medication. TB is a possible diagnosis when in the presence of an ulcerated lesion at the base of the tongue, accompanied by sore throat, dysphagia, or foreign body sensation.

A rare case of basaloid squamous cell carcinoma (BSCC) of the larynx, which has not been previously reported, is described. Case Report: A 60-year-old man was presented to the Otolaryngology Department with progressive dyspnoea and dysphagia to solids for over a period of 1 week. Direct laryngoscopy revealed a tumour at the laryngeal aspect of the epiglottis, which prolapsed into the laryngeal inlet each time the patient inspired. This resulted in an inspiratory stridor despite adequate glottic opening and normal mobility of the vocal cords. Therefore, in cases where a ball-valve lesion causes intermittent life-threatening airway obstruction, BSCC of the larynx, though rare, must be considered as a differential diagnosis.

Ingestion of a foreign body is a common problem among all age groups. Most of the foreign bodies in the pharynx are usually lodged at the level of cricopharynx. The diagnosis is based on history, clinical, and radiological examination. Most foreign-body ingestions are accidental, but there may be contributory factors such as mental disorder, alcoholism, and prison incarceration. Toothbrush ingestion is uncommon and requires prompt medical attention. Case Report: In this article, a rare case of a toothbrush foreign body is presented. The ingestion was caused by a seizure and the toothbrush was removed through surgical management. An ingested toothbrush will not pass spontaneously. The best management is early endoscopy performed by a skilled surgeon. If this is unsuccessful, surgical management can be performed.