فهرست مطالب

Otorhinolaryngology - Volume:30 Issue: 3, May - Jun 2018

Iranian Journal of Otorhinolaryngology
Volume:30 Issue: 3, May - Jun 2018

  • تاریخ انتشار: 1397/02/29
  • تعداد عناوین: 10
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  • Maryam Mardani, Azadeh Andisheh-Tadbir, Mohammad Ali Ranjbar *, Bijan Khademi, Mohammad Javad Fattahi, Ahmad Rahbar Pages 125-130
    Introduction
    Endostatin is a C-­terminal proteolytic fragment of collagen XVIII and, as with angiostatin and thrombospondin, is known as an anti­angiogenic agent. The aim of this study was to assess the level of serum endostatin in patients with oral squamous cell carcinoma (SCC), and its association with the clinicopathological characteristics of the tumor.
    Materials And Methods
    Using an enzyme-linked immunosorbent assay (ELISA) kit, we investigated the circulating levels of endostatin in the blood serum of 45 patients with oral SCC and 45 healthy controls.
    Results
    The mean level of serum endostatin in patients was significantly lower (68.8±85 ng/ml) than in healthy controls (175.6±73 ng/ml) (P0.05).
    Conclusion
    Findings of the present study suggest the prognostic and anti-metastatic role of endostatin, and this may be used as a tool for monitoring tumor progression.
    Keywords: Endostatin, Mouth, Serum, Squamous cell carcinoma
  • Ahmad Reza Khatoonabadi, Hassan Khoramshahi *, Seyyedeh Maryam Khoddami, Peyman Dabirmoghaddam, Noureddin Nakhostin Ansari Pages 131-137
    Introduction
    Use of patient-based voice assessment scales is an appropriate method that is frequently used to demonstrate effectiveness of voice therapy. This study was aimed at determining the effectiveness ofvoice therapy among patients with secondary muscle tension dysphonia (MTD) and vocal mass lesions.
    Materials And Methods
    The study design was prospective, with within-participant repeated measures. Thirty-three patients with secondary MTD and vocal mass lesions participated in the study, selected on the basis of voice history, laryngeal palpation, and videostroboscopy examination. An experienced otolaryngologist and one experienced speech language pathologist undertook the diagnostic process. Voice therapy included both direct and indirect techniques and lasted approximately 2 months for all included patients. The voice handicap index (VHI) was used to evaluate the effectiveness ofvoice therapy among included patients. Paired t-test, size of the standardized effect (ESI),and mean standardized response (ESII) were used to analyze effectiveness of the target voice therapy.
    Results
    The findings of this study indicate astatistically significant improvement after the voice therapy protocol (P1.96). Results of ESI and ESII demonstrate that the VHI scale is sufficiently responsive to detect voice therapy change (ES>0.8).
    Conclusion
    This study recommends a combination of direct and indirect voice therapy in the vocal rehabilitation of patients with secondary MTD and vocal mass lesions. Furthormore, we recommend use of the VHI scale to show voice therapy changes for both clinical and research purposes.
    Keywords: Muscle tension dysphonia, Voice handicap index, Vocal mass lesions, Voice therapy
  • Ebrahim Karimi, Akbar Bayat, Mohammad Reza Ghahari, Sara Rahavi-Ezabadi, Mehrdad Jafari * Pages 139-143
    Introduction
    The major presenting symptom of nasal polyps is nasal obstruction. The role of nasal obstruction in the genesis of laryngeal disorders is still unknown.
    Materials And Methods
    The aim of this study was to evaluate laryngeal videostroboscopic changes after functional endoscopic sinus surgery (FESS) in patients with nasal polyposis. A longitudinal study was carried out from March 2012 to June 2013. Thirty patients with bilateral nasal polyposis who did not respond to maximum medical treatment and were candidates for FESS were recruited. Laryngeal videostroboscopy was performed before and 3 months after FESS. Glottic gap, true vocal cord (TVC) borders and pliability, false vocal cord (FVC) movement, laryngeal erythema and mucosal edema were documented.
    Results
    Laryngeal erythema and TVC edema were significantly decreased after FESS. Laryngeal erythema was documented in 18 patients after a 3-month follow-up. Four patients (13.3%) showed mild-to-moderate TVC edema and 26 patients (86.7%) had normal TVC mucosa.
    Conclusion
    The results of this study show that FESS has a significant impact on laryngeal videostroboscopic features including laryngeal erythema and TVC edema.
    Keywords: Endoscopy, Erythema, Edema, Laryngoscopy, Nasal polyps, Nasal obstruction, Stroboscopy
  • Jose Ferreira-PenEda *, Raquel Robles, Isabel Gomes-Pinto, Pedro Valente, Nuno Barros-Lima, Artur CondE Pages 145-152
    Introduction
    Peripheral facial palsy (PFP) is commonly diagnosed in every emergency department. Despite being a benign condition in most cases, PFP causes loss in quality of life mostly due to facial dysmorphia. The etiology of PFP remains unknown in most cases, while medical opinion on epidemiology, risk factors and optimal treatment is not consensual. The aim of this study was to review the demographic characteristics of our patients and the medical care administered in our emergency department.
    Materials And Methods
    Emergency episodes occurring in a 4-year period and codified as facial nerve pathology were analyzed. IBM SPSS software was used for statistical analysis.
    Results
    In total, 582 emergency episodes were obtained. Due to inexpressive representation of other causes of PFP in our study, we focused our analyses on the 495 patients who were considered to have idiopathic PFP. There was equal distribution among genders, and all age ranges were affected. There were no clear epidemic phenomena. Hypertension was not a statistically significant risk factor for Bell's palsy. Most patients sought medical care in the early stages of the disease and complained of isolated facial weakness. Most patients had mild-to-moderate symptoms. Previous upper way infections (PUAI) were more frequent among children. There was a statistically significant difference regarding computed tomography (CT) scan requests among specialties.
    Conclusion
    Epidemiologic findings were consistent with most literature on Bell's palsy. Drug therapy is widely used and follows current guidelines. The role of PUAI in the pediatric population must be investigated. Despite evidence of good medical practice, there was an excess of CT scans requested by physicians other than otorhinolaryngologists.
    Keywords: Bell Palsy, Herpes simplex, Otorhinolaryngologic disease, Peripheral Facial paralyses
  • Keyvan Aghazadeh, Sasan Dabiri Satri, Amirsina Sharifi *, Maryam Lotfi, Bita Maraghehpour, Arsalan Hashemiaghdam Pages 153-158
    Introduction
    Laryngeal squamous cell carcinoma (SCC) can invade the thyroid gland leading to unnecessary thyroidectomies with subsequent hypothyroidism and hyperparathyroidism. Thus, clinicopathological variables should be defined in order to predict thyroid gland invasion preoperatively.
    Materials And Methods
    We performed a retrospective analysis of 1,465 patients with laryngeal SCC referred to our center between March 2009 and January 2016. Among these patients, 60 individuals underwent total laryngectomy and either thyroid lobectomy and isthmectomy or total thyroidectomy.
    Results
    Thyroid gland invasion was observed in 20% of samples. The following variables were associated with thyroid gland invasion: transglottic spread of the tumor (odds ratio [OR]: 2.04, 95% confidence interval [CI]: 1.15–5.81, P=0.004), thyroid cartilage involvement (OR: 1.53, 95% CI: 0.94–2.50, P=0.02), and anterior commissure involvement (OR: 5.75, 95% CI: 0.86–38.42, P=0.01). In addition, the largest dimension of the tumor was significantly associated with thyroid gland involvement (r=0.36, 95% CI 0.05–0.67, P=0.004). Multivariate linear regression analysis confirmed these findings.
    Conclusion
    The rate of thyroidectomies performed in cases of laryngeal SCC is much higher than the actual rate of thyroid gland invasion. Thus, preoperative evaluation to find transglottic spread of the tumor, thyroid cartilage, and anterior commissure involvement should be considered.
    Keywords: Larynx, Neoplasm invasion, Squamous cell carcinoma, Thyroid
  • Farnaz Hashemian, Hoda Jafari Moez, Mohammad Ali Seif -Rabiei, Javaneh Jahanshahi * Pages 159-166
    Introduction
    Halitosis and foreign body sensation are two common and disturbing symptoms of chronic caseous tonsillitis (CCT). The aim of this study was to compare the efficacy and safety of temperature-controlled radiofrequency (TC-RF) tonsil ablation with CO2-laser cryptolysis (CO2-LC) in the treatment of patients with halitosis caused by CCT.
    Materials And Methods
    Sixty-two patients who suffered from halitosis and/or foreign body sensation due to CCT were enrolled in the present randomized clinical trial, and were randomly assigned into two groups. Group A underwent TC-RF tonsil ablation and Group B received CO2-LC. The severity of symptoms including halitosis and foreign body sensation was reported 7 days, 1 month, and 6 months after the procedure. Patient pain levels and amount of bleeding were evaluated as safety outcome measures. Pain levels were evaluated during the intervention, and at Day 1, 3, and 7 following the procedure using a visual analog scale (VAS).
    Results
    Mean rank of pain score in the RF tonsil ablation group was found to be higher than in the CO2-LC group at all measured timepoints following the procedure. The amount of bleeding in the LC group was found to be significantly less than in the RF group (P
    Conclusion
    Both procedures were found to be effective and safe in the treatment of CT-associated halitosis. However, LC showed better results based on lower pain levels, lower incidence of bleeding, and faster progression to a routine diet.
    Keywords: Halitosis, Laser, Pain, Tonsillitis
  • Sadegh Jafarzadeh *, Mohammad Reza Golrokhian Sani Pages 167-170
    Introduction
    Bilateral vestibular dysfunction (BVD) is an uncommon finding in vestibular assessment, and the combination of BVD and orthopedic problems represents a rare and challenging case for treatment.
    Case Report: The patient had several previous back surgeries and received gentamycin after surgery. After 6 months, she experienced continuous dizziness, unsteadiness and oscillopsia. The patient underwent complete vestibular assessment and received an individualized vestibular rehabilitation program for 9 months. She achieved a complete recovery from all symptoms and returned to active social function.
    Conclusion
    Vestibular rehabilitation could be an effective treatment for complicated cases of BVD. Adaptation exercises may be useful in young patients with BVD.
    Keywords: Adaptation, Bilateral vestibular dysfunction, Gentamicin, Ototoxicity, Vestibular rehabilitation
  • Nuthan Kumar *, Thirunavukkarasu Saravanamuthu, Arathi Srinivasan, Thulasiraman Ramalingam, Julius-Xavier Scott Pages 171-176
    Introduction
    An inflammatory myofibroblastic tumor (IMT) is a rare tumor of intermediate malignant potential. It may occur in a wide range of anatomical locations. One-third are found in the respiratory tract. We report two cases of IMT of the airway diagnosed at our institution.
    Case Report: Case 1: A 6-year-old male child presented with a 1-month history of hoarseness of the voice. On evaluation, a polypoid nodule was noted in the right vocal cord which was excised through the endolaryngeal route. Histopathology was suggestive of anaplastic lymphoma kinase (ALK)-negative IMT. He presented with recurrence after 4 months, for which he underwent endolaryngeal reexcision and tracheostomy for airway protection. A third recurrence after 6 months was managed with laser excision, and the patient was started on oral celecoxib. After 1.5 years of follow up, endoscopic examination showed no recurrence, and celecoxib was continued. Case 2: A 7-year-old male child presented with cough and respiratory distress. Bronchoscopy and high resolution computed tomography showed a polypoidal lesion with calcification arising from the left anterolateral wall of the trachea with significant narrowing of the lumen. The patient underwent biopsy followed by endoscopic excision, and was diagnosed with IMT. Currently the patient is under follow up with no recurrence.
    Conclusion
    IMT indicates a proliferative myofibroblastic growth. Surgical resection should be recommended for all lesions if not prohibited by anatomic location or morbidity. Patients should be followed up closely for recurrence. In most cases, complete surgical excision will suffice; however multiple recurrences can be managed with chemotherapy. These two cases highlight the importance of a multidisciplinary approach in rare tumors in difficult anatomical locations.
    Keywords: Airway, Children, Inflammatory, Myofibroblastic, Recurrence
  • Mohammad Hossein Baradaranfar, Sedighe Vaziribozorg, Mojtaba Mirzadeh *, Mostafa Salari Pages 177-180
    Introduction
    Pneumocephalus is the presence of air or gas within the cranial cavity. It can occur following otorhinolaryngological procedures. A small pneumocephalus spontaneously heals without any treatment. In severe cases, conservative therapy includes a 30-degree head elevation, avoidance of the Valsalva maneuver, analgesics, osmotic diuretics, and oxygen therapy.
    Case Report: A 56-year-old woman was referred to the emergency department due to a severe headache in the frontal area for 2 days before admission. The patient experienced nausea and vomiting in the morning and had no history of seizures or decreased consciousness. Examination of neurological symptoms was completely normal and showed no symptoms of meningeal irritation. In terms of past history, the patient had undergone tympanomastoidectomy surgery and resection of the cholesteatoma 1 week previously. The Mount Fuji sign was found on the brain computed tomography (CT) scan of the patient. Treatments such as CBR (complete bed rest), 30-degree head elevation, anti-fever, analgesics and oxygen therapy, along with anti-compulsive drug (phenytoin), were prescribed. At the end of 5 days, the patient's pneumocephalus was resolved completely.
    Conclusion
    Pneumocephalus should be considered a post-operative complication of tympanomastoidectomy. In most cases, pneumocephalus responds to conservative therapy. Supplemental oxygen increases the rate of absorption of pneumocephalus. Serial imaging is needed to ensure gradual reduction of the pneumocephalus.
    Keywords: Mount Fuji sign, Mastoidectomy, Pneumocephalus
  • Nikhil Arora, Ruchika Juneja *, Ravi Meher Pages 181-184
    Introduction
    Complication of an odontogenic infection to an orbital abscess is not a common presentation. The progression from a simple toothache to a condition that may lead to loss of vision is sudden and severe.
    Case Report: We report a rare case in which a patient developed facial cellulitis that progressed to orbital abscess after unsterile dental manipulation by a medical fraudster (“quack”). The patient was initiated on high-grade antibiotics, which resolved the facial cellulitis. However, the patient developed orbital abscess with restricted mobility of the right eye in the lateral gaze. After radiological confirmation of the abscess, it was drained by an external approach. Due to timely intervention, the extra-ocular mobility was regained, and the vision remained unaffected.
    Conclusion
    Knowledge of the routes of the spread of dental infection to the vital structures and the urgent need for aggressive multidisciplinary management is paramount. Furthermore, awareness of the rising quack culture in developing nations needs to be increased.
    Keywords: Orbital abscess, odontogenic infection, facial cellulitis