دکترحسام جهاندیده

Rhinoplasty is a joint facial surgery that can lead to various complications, including bleeding, edema, and ecchymosis. Many surgeons have shifted towards less invasive surgical techniques to reduce these risks. However, there is insufficient research on the impact of thyroid hormones on post-surgery outcomes. This study aims to assess the effects of two specific thyroid hormones, T4 and TSH, on postoperative edema in rhinoplasty patients. By identifying the role of these hormones, we can enhance patient satisfaction and improve recovery times.

This prospective cohort study was conducted in 2022 on patients referred to the Ear, Nose, and Throat Clinic (ENT) of Rasool Akram Hospital, Tehran, Iran. Before participating, all study candidates were required to sign a written consent form; those who declined were excluded from the study. The protocol received approval from the ethics committee and review board of the Iran University of Medical Sciences (Ethics Code=1399.650). This investigation aimed to measure the levels of two thyroid hormones-thyroxine (T4) and thyrotropin (TSH). We conducted hormone assessments in the first week after the surgery, followed by weekly measurements up to the fourth week. We collected blood samples from each patient at each time point for hormone level evaluations. Additionally, we collected data on potential confounding factors such as age, sex, and body weight. The primary outcome of interest was postoperative edema. Post-surgery edema was assessed using the Visual Analogue Scale (VAS) and physician assessments, which were repeated weekly until the fourth week. The recovery speed was determined by subtracting the VAS score in the first week from the score in the fourth week. Initially, we verified the normality of each variable by employing the Kolmogorov-Smirnov test. We presented the mean and standard deviation for variables adhering to a normal distribution. Variables that deviated from normality were described using the median and interquartile range. Dichotomous variables were reported as the frequency and percentage. Pearson correlation coefficients were utilized to explore the correlation between VAS scores and hormone levels. The relationship between changes in hormone levels and the rate of edema recovery was also examined using the Pearson correlation. All statistical analyses were conducted using SPSS software version 22.0, with a statistical significance threshold set at 0.05.

The study included 58 patients from Rasul Akram Hospital's ear, nose, and throat clinic. The participants had a mean age of 36.3 years with a standard deviation of 6.8 years, and 74.1% were women. Their mean weight was 64.5 kg, with a standard deviation (SD) of 8.9 kg. The mean serum level of thyroxine (T4) was reported at 7.9±1.4, and the mean level of thyroid-stimulating hormone (TSH) was 3.4±1.9.Table 2 highlighted the progression of nasal edema as measured by the VAS from the patient's and the doctor's perspectives. Initially, patients reported a mean VAS score of 8.5 (SD = 1.0), gradually decreasing to 4.9 (SD = 1.4) by the fourth week. Doctors observed a similar downward trend in VAS scores, starting from 7.7 (SD = 0.8) in the first week to 4.5 (SD = 1.4) in the fourth week. The average rate of edema reduction was calculated at 1.2 (SD = 0.3). The analysis explored the correlation between thyroid hormone levels and VAS scores. Pearson's correlation coefficient showed no statistically significant correlation between T4 levels and VAS scores during the study (P-value>0.05). Although there was a slight positive correlation between T4 levels and the rate of edema reduction, it was not statistically significant (P-value=0.079). Conversely, a significant positive correlation was found between TSH levels and VAS scores, indicating that higher TSH levels were associated with increased nasal edema. In the first week, this correlation was significant (Pearson correlation coefficient=0.378, P-value=0.003), intensifying in the second week (coefficient=0.454, P-value<0.001), and remained highly significant in the third and fourth weeks (coefficients=0.565 and 0.559, respectively, P-value<0.001). Additionally, a higher TSH level negatively correlated with the rate of edema reduction, suggesting that increased TSH levels could delay recovery from edema (correlation coefficient=-0.542, P-value<0.001).

Various factors can cause complications after a rhinoplasty. Although medical treatments like steroid medications and surgical techniques have been studied for their impact on postoperative swelling, the potential role of thyroid hormones has yet to be explored as much. This study investigates the influence of thyroxine (T4) and thyrotropin (TSH) on edema after rhinoplasty for four weeks. The study also aims to determine how these hormones affect the rate at which edema resolves. Our analysis found no significant correlation between T4 levels and postoperative edema but a suggestive trend towards a positive association with the rate of edema reduction. The lack of significant T4 findings contrasts with the notable effects of TSH, suggesting a more complex impact of thyroid hormones on surgical recovery. These findings underscore the importance of further research to reveal the potential underlying biological mechanism that T4 might have in the healing process. High TSH levels are associated with postoperative edema, which suggests that thyroid function plays a role in surgical recovery. TSH could be used as a biomarker to manage postoperative healing outcomes. Previous studies show a link between hypothyroidism and the exacerbation and prolongation of inflammatory responses. Kinoshita et al. found that changes in thyroid hormone levels can lead to edema formation. This connection highlights the role of thyroid hormones in fluid regulation, suggesting that they play a crucial role in modulating the extracellular fluid dynamics that underpin edema.Langsdon et al. have linked hypothyroidism to extended edema in patients undergoing facial surgery. This and our research suggest a broader systemic effect of thyroid hormone levels on tissue healing and fluid balance. Evidence indicates the thyroid regulates postoperative recovery, especially in surgeries where tissue disruption and inflammation can lead to significant edema. More significant multicenter studies are needed to provide a more diverse patient population and a broader range of surgical techniques and postoperative care protocols. Additionally, it is essential to consider potential confounding factors that need to be fully accounted for in this study. Some of these factors include pre-existing health conditions, medication use, nutritional status, and lifestyle choices such as smoking and alcohol consumption, which can affect hormone levels and the body's response to surgery. Given the complexity of post-surgical recovery, which physiological and psychological factors can influence, a multifactorial approach is necessary to understand the role of thyroid hormones in this process. Therefore, future studies should aim to control for these confounders through careful study design and statistical analysis.High TSH levels worsen post-rhinoplasty edema, while T4 levels show a non-significant trend toward faster recovery. More multicenter studies are needed to determine thyroid hormones' effects on postoperative edema.

Rhinoplasty is one of the most popular types of cosmetic surgeries performed by otorhinolaryngologists. Rhinoplasty is a challenging and complex surgery because it is designed according to the unique needs of each patient (1). In 2013, men accounted for approximately 20 percent of all rhinoplasty procedures and non-whites accounted for nearly 30 percent of the patient population. In addition, the age of candidates for rhinoplasty was wide and about half of the patients were between 19 and 34 years old and the other half of the patients were under 19 years old or older (2). The existence of tools to measure patients' satisfaction with the results of their surgery can give surgeons a better view to optimize the methods and quality of their surgeries. One of the common methods for evaluating surgical results in terms of patients satisfaction is through the quality of life questionnaires. Especially in rhinoplasty, this method of evaluation aims to examine the direct effect of surgery on patient satisfaction with self-image and consequently self-esteem (3-5). As a result, the validity of such questionnaires is significant. Researchers can use these tools to assess the quality of surgery and optimize methods based on individual characteristics (6). Rhinoplasty Outcome Evaluation (ROE) is one of the questionnaires used today to assess patients' willingness and satisfaction with rhinoplasty (7, 8). In 2021, Mulafikh et al. published a study in Arabic aimed at translating, intercultural matching, and validating the outcome of ROE. This non-randomized prospective study included 50 patients and a control group of 89 healthy individuals who underwent primary rhinoplasty from January to October 2020 in the Department of Otolaryngology, King Saud University, Riyadh, Saudi Arabia. There was a significant difference in ranking between rhinoplasty patients and the control group on both individual questions and total scores. Significant improvement in patient group ranking was observed in 2 weeks and 3 months after surgery compared to preoperative score (P <0.0001). Based on the conclusion of this study, the Arabic version ROE showed good internal consistency, reliability, and credibility and can be used to evaluate the results of rhinoplasty in the Arab population (9). The questionnaire has been translated into German, Turkish, Arabic, and many other languages, but so far in Iran, there is no scale to measure patients' satisfaction with rhinoplasty (10-12). It can be used for many Iranian patients and surgeons. This study aimed to evaluate the validity and reliability of the translated ROE Questionnaire.

The ROE questionnaire was translated by two independent translators and then it was translated back into English and was compared with the original one. With the expert panel reviews, its Content Validity Ratio (CVR) and Content Validity Index (CVI) were calculated. Then, patients who underwent rhinoplasty in Firoozgar Hospital and a private center in Tehran in 2016, for the first time and without any simultaneous facial surgeries, were included in this study, and again two weeks after the operation. This research was done with the approval of the ethics committee of the research vice-chancellor of the Iran University of Medical Sciences (IR.IUMS.FMD.REC.1399.849).

Expert panel consisted of 10 experts that expressed their views on the questionnaire items. The CVR coefficient for all items except the second item was above 0.62, for which the coefficient was measured to be 0.564. The CVI coefficient was also reported to be 0.8 for all items. The mean total score of 87 patients at the first completion was 43.14 (±15.32), which two weeks later reached 41.58 (±15.60) (p > 0.05), this indicates that the Persian version of ROE has good reliability. The postoperative score was 68.48 (±12.49) which was significantly improved (p <0.05).

In our study, differences in gender, age, and education had did not affect postoperative satisfaction scores using ROE. The results of our study are consistent with previous studies (3, 7, 10, 11). This study had a lower item-total correlation coefficient for question 2 like the Arabic version of ROE because unlike the rest of the questions, the second question was related to the functional aspect of rhinoplasty and patients were worried about aesthetic aspects of rhinoplasty (10). Despite this, as the only question about nasal obstruction, and high total post-operative scores we found this question important and applicable for the Persian version of ROE. Izu et al. Introduced a cut-off point of 12 out of 24 or 50% for ROE to be used as a tool to evaluate surgical outcomes and to help predict outcomes (12). In our study, the mean total ROE score in individuals at the first time of completing the questionnaire and after surgery was significantly different (p-value <0.05). Patients reported a score lower than this incision point before surgery and more than 50% after surgery. This indicates the high satisfaction of patients with the surgical outcome. Other studies have used ROE to demonstrate the results of rhinoplasty and its high impact on quality of life, and have concluded that long-term follow-up increases patient satisfaction with rhinoplasty. For this reason, follow-up is important to help evaluate outcomes and long-term patient satisfaction (7, 13, 14). The limitations of the present study were the inability to examine patients in different medical centers, a relatively small sample size, and a short follow-up period. Also, the patients' satisfaction after long-term and medium-term surgery was not evaluated. To increase the accuracy of this questionnaire, this questionnaire should be repeated at different times and places. Also, the surgeon using this questionnaire should pay attention to long-term follow-up of rhinoplasty and ways to improve patients' quality of life.So far, no tool has been introduced to measure patients' satisfaction with the shape of the nose and the outcome of surgery after rhinoplasty, in Iran. The results of our study showed that the Persian version of ROE has good reliability, validity, and credibility, and its results are comparable to ROE questionnaires that have already been translated, adapted, and published in the literature review, as well as the original ROE. Therefore, this tool can be used to evaluate the results of rhinoplasty and many applications can be imagined for it.

Smell disorder such as dostorted olfaction (parosmia) is one of the most common symptoms of COVID-19. Therefore, this study aimed to investigate the improvement of symptoms of parosmia in patients with COVID-19 in 2020.

This cross-sectional study was conducted in summer and spring of 2020 using a data collection form which was validated with Cronbach's alpha of r=0.826. The study was done in an international health center in Tehran. To report descriptive results, mean, standard deviation, absolute frequency and absolute frequency percentage, and for analysis, independent t-test and chi-square test were used using SPSS software version 16 and the significance level was considered to be 0.05.

In total ,350 patients participated in the study, the prevalence of parosmia in patients was 15.14% and the mean and age deviation of patients was 32.71 ± 10.93 years. There was not a significant relationship between parosmia and gender (p value=0.317), age (p value=0.271), previous history of allergic symptoms (p value=0.083), family history of the disease (p value=0.638), taste disorder (p-value=0.768), and smoking (p-value=0.558). 31 cases (58.49 % of Patients) with parosmia had complete remission within 4-6 weeks.

Due to the high prevalence of olfactory disorders, especially parosmia in patients with COVID-19, parosmia and other olfactory disorders can be used to screen and triage patients with COVID-19, especially moderate and mild patients. Patients with parosmia should be followed for at least 4 to 6 weeks and if they do not recover for up to 12 weeks, they should be referred to ENT specialists for more specific measures.

Rhinoplasty is among the most requested plastic surgeries. As the surgery site is on the face and some of these surgeries only performed for aesthetic purposes, suture techniques are mainstay of these procedures. Traditionally, non-absorbable sutures such as nilon sutures were used. However, complications of these materials, alongside introduction of new absorbable materials have changed the trends and many surgenos prefer to use absorbable sutures, in most of their operations. It is reported that tensile strength of the suture, the probability of infection, besides its usability in grasping the tissues during different rhinoplasty maneuvers are among the factors, yielding to the decision of the surgen. There are currently some standard protocols in techniques of suturing during a standard rhinoplasty operation. However, there is no consensus on the type of suture, absorbable or non-absorbable one, for these operations. Recent studies have claimed that in spite of using non-absorbable sutures for suturing nose tip, high rates of complications and side-effects, besided non-inferiority of the absorbable suture in comparison with the non-absorbable ones, due to evidence, current trend is using absorbable sutures for this purpose. The aim of this study was to determine the pattern and frequency of using absorbable or non-absorbable sutures among rhinoplasty surgeons and their experienced side-effects and complications due to their usage.

In this survey on behavior, a 10-item questionnaire was used for data collection. The questionnaire was filled by a face-to-face interview with ENT surgens, attending at the Yearly Conference of ENT Surgens. Years of surgeons’ experience, number of monthly operations, types of suture materials, type and frequency of complications they have faced, while using these suture materials, and whether the brand of the suture is important to them or not was asked and recorded. The data were then registered in computer and analysed using IBM SPSS 22.0 for descriptive and analytical reports and graphs.

Totally 100 ENT surgeons were interviewed, with mean 15.5 years of experience in rhinoplasty surgery. The interviewed surgens reported that in average, they had 20 surgeries monthly (range of 5 to 90). In tip plasty, 52 surgeons exclusively were using absorbable PDS sutures, 32 exclusively were using non-absorbable nylon sutures, and 16 of them were using mixed sutures in different sureries. 66 percent of surgens, preferring non-absorbable nylon suture reported that they had at least one complication in using such type of suture. 76% of the complications were due to abscess formation, 22% was related to suture extrusion, and 9% reported skin reaction on the suture site. On the other hand, only 15 percent of the surgens using absorbable PDS sutures reported the experience of facing complication in suture. Among them, there were 7 cases of abscess formation, 3 cases of suture extrusion, and one case with skin reaction in suture site. All of the complications, reported by doctors using mixed absorbable and non-absorbable sutures had happened in cases of using non-absorbable suture, which were abscess formation in 7 cases, and suture extrusion in 2 cases. In more than half of participants, the brand of suture was not important and This insignificance of suture brand was not related to neither years of rhinoplasty experience (t test p-value = 0.12), nor the number of surgeries (t test p-value=0.525), performed in month.78 of the surgens used vicryl, 13 used chromic, and 1 used monocryl sutures for septum sutures. 17 of these experts had experiences of complication in septum suture: 9 for chromic suture and 8 for vicryl suture. In these cases, sense of bad smell (in 11 cases), abscess formation (in 5 cases), and granulation tissue formation (in 1 case) were among the complications.

It seems that a majority of Iranian rhinoplasty surgens prefer using absorbable sutures in their rhinoplasty surgeries. As the responses suggest, surgens using absorbable PDS sutures are facing less complications than those using non-absorbable nylon suture. Moreover, most of the surgenos, interviewed in this study did not pay attention to the brand of the suture they are using, which was not related to the years of experience in rhinoplasty or the number of the surgeries they perform in month.In addition to nose tip suture, a majority of the experts were using vicryl suture for suturing the septum in their surgeries. However, there were no significant difference in the number of complications, experienced with chromic or vicryl sutures. Most of the complications were due to a sense of bad smell, abscess formation, and granulation tissue formation in one case. Additionally, no case of septal necrosis was reported by the experts.

Respiratory tract is continuously exposed to environmental pollutants, respiratory pathogens and dispersed toxins in the air. Respiratory tract clearance through mucociliary system is the main defensive mechanism in the upper and lower airways. Various studies demonstrated the effectiveness of herbal drugs, however little studies conducted about mechanism of action of these drugs. In this prospective case-series, saccharin test as a measure of mucociliary clearance time, was conducted on 40 subsequently healthy volunteers presenting to otolaryngology clinic of Firoozgar Hospital. Time between placing saccharin over nasal mucosa to sensation of sweet flavor in the pharynx was recorded. Saccharin test was re-performed after administration of 3 doses of 7.5 cc of Prospan syrup. Data were analyzed by Wilcoxon signed ranked test and SPSS V.16. In this study 32 patients (80%) were male and 8 were female (20%) with mean age of 38.4±12.07 years. Mean of time between “placing saccharin on nasal mucosa” to “sensation of sweet flavor in the pharynx” was 15.55±3.67 minutes before Prospan administration and 10.31±4.94 minutes after 3 doses of Prospan. Average reduction in the time of sweet sensation in the pharynx was 5.23±3.7 minutes. This study in conjunction with preliminary studies regarding the effectiveness of the extract of dried Hedera helix leaves on respiratory symptoms shows that “improvement in the function of mucociliary system” is one of the main mechanisms of actions of this drug.