Iranian Journal of Otorhinolaryngology
Volume:28 Issue: 5, Sep 2016

Different imaging modalities are used to evaluate salivary gland diseases, including tumors. Ultrasonography (US) is the preferred method on account of its ease of use, affordability, safety profile, and good tolerance among patients. The aim of this study was to evaluate the role of US in differentiating malignant from benign parotid tumors, in the context of previous controversy in the literature on this subject.
A cross-sectional study was performed in patients who presented to Qaem Medical Center with parotid masses and who were candidates for parotidectomy between June 2013 and January 2015. Patients were initially referred for a diagnostic US of the parotid. US examinations were performed and sonographic features were reported. The tumors were then classified as benign or malignant on the basis of literature descriptions of the US features of parotid tumors, and were next diagnosed pathologically. The sensitivity, specificity, positive predictive value, and negative predictive value of US for the purpose of differentiating malignant from benign tumors were then calculated.
Twenty-eight patients (aged 18–92 years) underwent US of parotid masses. Twenty-three tumors were diagnosed as benign and five were diagnosed as malignant. The final histopathologic examination showed 21 benign and seven malignant tumors. The sensitivity, specificity, positive predictive value, and negative predictive value of US for differentiating malignant from benign tumors were calculated as 57%, 95%, 80%, and 87%, respectively.
US has a high specificity in differentiating between malignant and benign tumors. However, fine needle aspiration or core needle biopsy is advocated for an exact diagnosis.

This study was performed to evaluate the correlation between the objective and subjective sensation of nasal patency, assessed through a validated questionnaire, the Italian version of the NOSE scale, and the rhinomanometric results in a large cohort of patients complaining about nasal obstruction.
Data was obtained from a total of 233 adult patients, (123 males, 110 females, with a mean age of 43.7 years) with a diagnosis of septal deviation and complaining about nasal obstruction. Anterior active rhinomanometry was used for objective assessment, while the I-NOSE scale and a visual analog scale (VAS) were used for subjective evaluation.
Positive correlations between I-NOSE scores and VAS and rhinomanometric results were found.The higher correlation was demonstrated between the HUNR (higher unilateral nasal resistance) parameter of rhinomanometry and the second item of the I-NOSE scale (Nasal blockage or obstruction). No significant correlation was found between the fourth item of the I-NOSE (Trouble sleeping) and the VAS score. The VAS score appeared mildly, but still significantly, correlated with the HUNR parameter of rhinomanometry.
The correlation between the subjective sensation of nasal patency and the rhinomanometric data proved to be significant. No correlation between subjective sensation of trouble sleeping and rhinomanometric assessment was found. In counselling with patients complaining of nasal obstruction trouble in sleeping should not be considered as a symptom related to nasal obstruction.

Hearing loss is one of the most disabling impairments. Using a hearing aid as an attempt to improve the hearing problem can positively affect the quality of life for these people. This research was aimed to assess satisfaction of hearing impaired patients with their hearing aids regarding the employed technology and style.
This descriptive-analytic cross-sectional research was conducted on 187 subjects with hearing loss who were using a hearing aid. The subjects were over 18 years of age and were using a hearing aid for at least 6 months. The Persian version of Satisfaction with Amplification in Daily Life (SADL) questionnaire was the instrument which was used for assessing satisfaction with the hearing aid. Cronbach’s alpha was calculated to be 0.80 for instrument reliability.
A significant difference was observed among satisfaction subscales’ mean scores with hearing aid technology. Also a significant difference was observed between the total satisfaction score and the hearing aid model. With respect to the analysis of satisfaction with the hearing aid and its style, cost and services was the only subscale which showed a significant difference (P=0.005).
Respondents using hearing aids with different technology and style were estimated to be quite satisfied. Training audiologists in using more appropriate and fitting hearing aids in addition to using self-reporting questionnaires like SADL for estimating patients’ social condition and participation in their life can essentially change their disability condition and countervail their hearing loss.

Adenotonsillar hypertrophy (ATH) may present with growth retardation. Insulin-like growth factor 1 (IGF-1) mediates the anabolic effects of growth hormone (GH) on tissues. Most of the circulating IGF-1 molecules are bound to insulin-like growth factor-binding protein 3 (IGFBP-3). IGF-1 and IGFBP-3 serum levels reflect the levels of daily mean serum GH and are used as indices for evaluating the serum level of GH. This study aimed to determine the effect of adenotonsillectomy on IGF-1 and IGFBP-3 serum levels in patients with ATH or recurrent tonsillitis. Furthermore, we aimed to investigate the effect of adenotonsillectomy on growth indices such as weight and height.
A total of 100 randomly selected children with a diagnosis of ATH or recurrent tonsillitis with a mean age of 10.2 ± 1.4 years (range, 3-17 years) were enrolled in the intervention group. Of those, 53 were boys and 47 were girls. The control group included 100 healthy children (62 boys and 38 girls) with a mean age of 8.5 ± 1.5 years (range, 4-15 years). Growth indices such as weight and height were measured and documented at the time of surgery and 6 months after the operation. Blood samples were taken preoperatively and repeated 6 months after adenotonsillectomy. The coated-tube immunoradiometric (IRMA) method was used to measure IGF-1 and IGFBP-3 levels.
Postoperative IGF-1 and IGFBP-3 serum levels as well as weight and height showed were significantly greater in comparison with preoperative measurements in both the intervention and control groups (P This study shows that adenotonsillectomy in children with ATH or recurrent tonsillitis increases IGF-1 and IGFBP-3 serum levels in comparison with preoperative levels by affecting the GH-IGF-1 axis, and subsequently leads to a faster increase in growth indices compared with healthy peers during the same period.

The surgical management of chronic frontal sinus disorders remains a challenge for rhinologists. The aim of this study was to evaluate the result of Draf III in a series of patients who underwent this procedure.
Twenty patients were included in this study. Demographic data, history of prior surgery, asthma, aspirin sensitivity and Lund–Mackay score were recorded. A visual analog scale was used for frontal-related symptoms. Patients were followed for a mean duration of 17.5 months and the patency of the frontal sinus ostium was closely monitored.
Fifteen patients with chronic frontal sinusitis, two patients with mucoceles, two with malignancy, and one with osteoma underwent Draf III. The mean symptoms score significantly decreased from 5.9 to 3. No ostial closure was seen in the follow-up period. Among 15 patients with chronic frontal sinusitis, 12 had patent ostia of whom three had significant stenosis. All patients with mucocele and osteoma had patent ostia in the follow-up period but patients with sinonasal malignancy showed significant stenosis.
Draf III frontal sinusotomy is successful in alleviating patient symptoms and the frontal sinus neo-ostium will remain patent in long-term follow-up of most patients. Revision surgery will be required in some cases, which seems to be related to the nature of the underlying chronic sinus diseases.

Children with cochlear implants (CIs) may experience few opportunities for positive musical experiences, and musical perception is therefore often not sufficiently developed. This paper investigates and discusses the relationship between intelligence quotient (IQ) and musical ability in children with CIs compared with children with normal hearing.

This was a comparative analytical study conducted in 48 children with unilateral CI and 48 normal-hearing children, 6–8 years of age, with ‘normal’ IQ and no formal music training. The average IQ score in the experimental and control groups were 105.41 and 106.31, respectively. No statistically significant differences were detected between Raven’s IQ scores in both groups. Data were collected by administering Raven's Colored Progressive Matrices IQ Tests and the Montreal Battery of Evaluation of Musical Abilities (MBEMA) Test, consisting of scale, contour, interval, rhythm, and memory sections.
Mean total MBEMA score in the experimental and control groups was 58.93 and 72.16 (out of 100), respectively. Significant differences were evident between scores of children with CIs in comparison with their normal-hearing peers (P≤0.001). A remarkable direct correlation between IQ and musical scores in both the control (r≥0.38) and experimental (r≥0.37) groups was observed.
IQ has a noticeable effect on music processing and facilitates the perception of various musical elements. With regard to the mutual relationship between IQ and musical skills, this study illustrates the advantage of determining music perception scores and highlights the importance of appropriate musical intervention in order to enhance auditory neural plasticity, especially in children with cochlear implantation.

The ectopic ciliated cyst is a rare non-odontogenic cyst which occurs as a delayed complication after maxillary sinus radical surgery; this lesion emerges due to the destruction of the sinus mucosa during the surgery and entrapment of the respiratoryepitheliumin the region. This lesion has been observed in very rare cases following genioplasty and bimaxillary orthognathic surgery.
Case Report: We reported a case of the ectopic ciliated cyst in in the mandible of a 37-year-old Iranian woman following genioplasty and Lefort 1 surgery after 2 years. Its treatment was enucleation.
Long-term follow-up after cosmetic surgery of both jaws is recommended due to the probability of this cyst.

Sialadenoma papilliferum (SP) is a rare benign tumor, which originates from the minor salivary gland. It occurs at sites that have minor salivary glands, such as the palate, retromolar pads, buccal mucosa, and lips. The most common location for tumor development is on the hard palate. A differential diagnosis consists of ruling out other salivary gland tumors. Transoral robotic surgery (TORS) is a new technology used in head and neck surgery within certain centers around the world.
Case Report: Herein, we present the first successful case of SP tumor removal by TORS.
This particular case highlights the identification of this rare tumor in an unusual location. Furthermore, it demonstrates the utilization of TORS, leveraging the superior visualization to obtain excellent local control with minimal acute and long-term morbidity, in comparison to conventional transoral surgical approaches.

Hydatid disease caused by larval stage of Echinococcus has been recognized endemically in many countries. Liver and lungs are the most commonly affected organs. Involvement of the head and neck region is rare and bony erosion due to hydatidosis is even rarer.
Case Report:We report a case of a 17-year-old girl from a poor socio-economic background who presented with a right sided supraclavicular lump, which after surgical excision and histopathological examination was diagnosed as hydatid cyst of neck.
Because of its rarity in the neck region, primary diagnosis of hydatid cyst is overlooked and usually not included in the differential diagnosis of cystic neck swellings. A high index of suspicion is necessary to diagnose hydatid disease in an unusual location even in endemic areas.

Herpes zoster Infection (HZI) is a viral disease with painful skin rashes and blisters in a limited area on one side of the body, often in a strip. Osteonecrosis with spontaneous exfoliation of teeth in association with HZI of the mandibular nerve is a rare phenomenon. In this report, such an unusual complication of HZI is presented.
Case Report:The clinical course of a 53-year-old woman and a 54-year-old man with HZI associated with alveolar bone necrosis and tooth exfoliation were reviewed in order to develop a patient profile for this rare combination of physical findings.
In immunocompromised patients, the clinicians should consider HZI as a possible cause of tooth mobility, exfoliation, and alveolar osteonecrosis, which needs early intervention to prevent secondary complications.

Cochlear nerve (CN) aplasia refers to the absence of a visible CN on oblique sagittal magnetic resonance images of the lateral aspect of the inner auditory canal (IAC). Magnetic resonance (MR) is the preferred technique in patients with sensorineural hearing loss and/or vertigo; however, computed tomography (CT) is used to evaluate the IAC or facial nerve canal. Three types of aplasia or hypoplasia can be distinguished (Table 1).
A 46-year-old woman came to our ENT consult after being referred for right hearing loss since childhood. There was neither a history of infections nor tinnitus. Otoscopy was normal. Audiometry showed left normoacusia and right profound sensorineural hearing loss. CT scan showed left middle ear normal, with a focal dehiscence in the tympanic portion of the facial nerve, a right middle ear with the ossicles normal, a focal dehiscence in the tympanic portion of the facial nerve and a reduction in the width of the internal auditory canal with normal anterior and posterior labyrinth (Fig. 1).
MR was performed to thoroughly evaluate the right inner ear, which confirmed hypoplasia of the cochlear nerve (Figs. 2,3).
Cochlear nerve aplasia/hypoplasia can be suspected by CT finding of an internal auditory canal less than 1.5 mm in width because the presence of normal cranial nerves is required for the formation of the IAC and therefore, congenital deficiency of CN VIII (or CN VII) also results in a small or stenotic IAC. It has been reported that IAC stenosis can occur without cochlear nerve hypoplasia; therefore, MR should be performed to detect nerve aplasia or hypoplasia, a challenging diagnosis for the radiologist. In most of the cases, it is associated with profound hearing loss. Nearly all inner ear malformations can be detected on thin-section T2-weighted gradient-echo images or comparable fast spin-echo images. Casselman reported that the cerebellopontine angle should be used as a reference to check the facial and cochlear nerve because he found that the latter was nearly 1 ½-2 times longer than the facial nerve and was never smaller. The nerves are best evaluated and compared on images made perpendicular to the nerves and IAC. This is a case of an adult patient referring to the clinic for right hearing loss since childhood, without ENT evaluation until now. It is important to assess every patient with verified sensorineural hearing loss and no medical history, with radiology tests (CT and MR).