فهرست مطالب

Otorhinolaryngology - Volume:28 Issue: 3, 2016
  • Volume:28 Issue: 3, 2016
  • تاریخ انتشار: 1395/02/16
  • تعداد عناوین: 12
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  • Nicola Fuiano*, Cristoforo Incorvaia Pages 169-175
    Introduction
    The diagnostic work-up of allergic rhinitis (AR) is first and foremost based on the combination of clinical history data and results of skin prick tests (SPT). Other tests, including specific IgE measurement, nasal challenge, and, as a third option, component resolved diagnosis or basophil activation test, may be useful when the diagnosis is difficult because of polysensitization or when negative results of SPT are observed despite a suggestive history for allergy. The atopy patch test (APT) that assesses the type 4 delayed hypersensitivity allergy is currently not sufficiently used. The data obtained in recent studies on the diagnostic utility of the APT in patients with AR was reviewed.
    Data Sources: Review of the literature.
    Conclusion
    The data from available studies show that the APT is frequently positive in patients with AR, especially when there is a positive history for atopic dermatitis. Very often, APT is the only positive test and therefore performing only SPT or in vitro IgE measurement may lead to an erroneous diagnosis of nonallergic rhinitis. Recent data suggest a role for APT not only for diagnosis but also in epidemiological investigation on respiratory allergy.
    Keywords: Allergic rhinitis, Allergens, Atopy patch test, Diagnostic tests, Sensitization
  • Seyyed Amir Hossein Ghazizadeh Hashemi, Sadegh Jafarzadeh*, Majid Haddadi Aval, Reza Hosseinabadi Pages 177-181
    Introduction
    Patients with bilateral weakness (BW) have many difficulties in gaze stability that interfere with their normal function. The aim of this study was to evaluate ocular motor functions in patients with BW to better understand the problem of gaze instability in these patients.
    Materials And Methods
    Patients were referred from the Otolaryngology Department for Vestibular Assessment to our clinic between November 2014 and March 2015. We assessed ocular motor function (gaze, saccade, and smooth pursuit) in patients over the age of 18 years with BW, as verified by a caloric test.
    Results
    Seventy-eight patients completed all the tests. The mean age of patients was 51.9 (±15.9) years, and 47 (60%) were female. Abnormal results were found in five (6.4%), 32 (41%), and seven (9%) patients with respect to gaze, smooth pursuit, and saccade, respectively. There were positive but relatively weak relationships between age and ocular motor results.
    Conclusion
    Patients with BW suffer from dizziness and unsteadiness. These patients have abnormal function in ocular motor (especially smooth pursuit) tests. The ocular motor dysfunction is responsible for gaze instability in static positions such as standing.
    Keywords: Gaze stability, Ocular motor, Vertigo
  • Hui Tong Wong*, Sien Hui Tan, Aun Wee Chong Pages 183-188
    Introduction
    Tonsillectomy is one of the most common procedures performed by Ear, Nose, and Throat surgeon. Usually, the procedure is carried out as an inpatient surgery. With the increasing need to reduce healthcare costs, spare precious hospital beds, and shorten elective surgery lists, there is currently a trend towards performing tonsillectomy on a daycare basis.
    Materials And Methods
    A prospective review of all tonsillectomies performed at the University Malaya Medical Center was undertaken for the year 2013. Demographic details, qualifying indications, and complication rates were evaluated.
    Results
    There was no incidence of primary hemorrhage among the 96 tonsillectomies performed. There was no significant correlation in terms of secondary hemorrhage between inpatient and day-case tonsillectomy (P=0.54). Only two patients required revision surgery to stop post-tonsillectomy bleeding. None of the patients required blood transfusion, and there were no mortalities.
    Conclusion
    Daycare tonsillectomy is safe as long as the patient is carefully selected. Both medical and social aspects should be taken into consideration. A post-operative observation period of at least 6 to 8 hours is important. The surgeon should personally review the patient post-operatively and decides if he or she should be hospitalized for observation, or safe for discharge.
    Keywords: Daycare, Hemorrhage, Post, tonsillectomy bleeding, Tonsillectomy
  • Mohsen Rajati, Mahmoud Reza Azarpajooh, Mohsen Mouhebati, Mostafa Nasrollahi, Maryam Salehi, Ehsan Khadivi, Navid Nourizadeh, Firoozeh Hashemi, Mehdi Bakhshaee* Pages 189-195
    Introduction
    Sudden sensorineural hearing-loss (SSNHL) patients constitute approximately 2–3% of referrals to ear, nose and throat (ENT) clinics. Several predisposing factors have been proposed for this condition; one of which is vascular disorders and perfusion compromise. In this research the atherosclerotic changes and their known risk factors are studied in SSNHL patients.
    Materials And Methods
    Thirty SSNHL patients and 30 controls were evaluated with regard to cardiovascular risks including history, heart examination, blood pressure, body mass index, waist circumference, electrocardiogram, blood sugar, triglycerides, cholesterol, high-sensitivity C-reactive protein (HSCRP); also, carotid artery color Doppler study was undertaken to measure intima media thickness(IMT).
    Results
    IMT and HSCRP showed an increased risk in the case group compared with the controls (P= 0.005 & P=0.001). However, waist circumference, history of smoking, fasting blood sugar, lipid profile, and electrocardiogram revealed no significant difference between the two groups. Interestingly, blood pressure and body mass index were higher in the controls in this study.
    Conclusion
    Sudden sensorineural hearing loss may be associated with subclinical atherosclerosis.
    Keywords: Atherosclerosis, risk factors, Carotid Intima, Media Thickness, Doppler C, reactive protein, Ultrasonography, Sudden sensorineural hearing loss
  • Saeid Atighechi, Mojtaba Meybodian*, Mohammad Hossein Dadgarnia, Mohammad Hossein Baradaranfar, Nasim Behniafard Pages 197-202
    Introduction
    The human papilloma virus (HPV) can play a role in the development of head and neck squamous cell carcinoma (SCC). Our aim was to assess the prevalence of HPV DNA in SCC of the larynx. The impact of HPV infection on patient survival was also evaluated.
    Materials And Methods
    This case-control study was performed in 44 patients with SCC of the larynx (case group), while the control group comprised samples obtained from cadavers with no previous history of malignancy. A preliminary pathologic evaluation was performed on all samples in the control group (36 samples) to ensure the absence of dysplasia or malignancy. Polymerase chain reaction (PCR) was used to detect HPV DNA. After completing the treatment protocol, patients were followed to assess the impact of HPV infection on overall survival (OS).
    Results
    PCR evaluation in the case group showed that HPV DNA was successfully isolated from 11 (25%) samples, while only two (5.6%) HPV DNA-positive were obtained from cadavers. According to these results, a significant difference was obtained in the prevalence of HPV DNA and laryngeal SCC between cases and controls (P=0.031). No statistically significant difference was observed in the OS of patients with or without HPV infection in the case group (P=0.235).
    Conclusion
    Based on these results, we suggest that the prevalence of HPV infection is higher in laryngeal SCC subjects compared with healthy individuals. Although a longer OS was seen in HPV-positive patients, survival analysis did not show a significant difference in the comparison of HPV-positive and negative findings in SCC patients.
    Keywords: Human Papilloma Virus (HPV), Larynx, Survival, Squamous Cell Carcinoma, Risk
  • Vishal Sharma, Sanjeev Bhagat*, Ravinder Singh, Bhimsain Verma, Surinderpal Singh, Shelja Wadhwa Pages 203-208
    Introduction
    The incidence of multidrug resistant tuberculosis is increasing in developing countries. Aminoglycosides are an integral part of second-line drugs, however ototoxicity is a major limitation for their use. This study aims to determine the extent of hearing loss in patients taking one of the commonly prescribed drugs for Multidrug resistant tuberculosis (MDR-TB), Kanamycin, at a Government Medical College, Patiala, Punjab, India, which is a 1200 bed tertiary care hospital.
    Materials And Methods
    A total of 100 patients (68 males and 32 females) with confirmed diagnosis of MDR-TB were included in this study conducted between January 2012 and February 2014. Subjects were between 15 to 60 years of age, with a mean age of 37.46 ± 10.1. Pure tone audiometry (PTA) was performed before the start of the therapy, as a baseline, and was repeated after 1 week and 6 weeks of Kanamycin use to assess hearing loss as an effect of therapy.
    Results
    Of the 100 patients examined, ototoxicity was found in 18 subjects post therapy. Incidence of high frequency hearing loss was 2% at week 1, and 12% after 6 weeks of follow up. However, 4% of the cases developed flat loss at week 6. The hearing loss was bilateral in 13 patients and unilateral in 5 patients. Ototoxicity was more common in males (66.67%) compared to females (33.3%). Maximum cases were found in the age group of 36 to 45 years (36.8%), the majority being from a rural background (83.3%). The association with socioeconomic status (P=0.024) and co-morbid conditions like diabetes and hypertension (P=0.001) reached statistical significance.
    Conclusion
    Lack of specific guidelines to monitor patients taking aminoglycosides makes ototoxicity a major adverse effect of their use in MDR-TB. More studies are mandated to study the risk factors associated with the development of ototoxicity and for the development of alternate drugs for the treatment of MDR-TB.
    Keywords: Co, morbidity, Kanamycin, Ototoxicity, MDR, TB, Pure tone audiometry, Socioeconomic status
  • Nikzad Shahidi*, Masoud Naderpoor, Taghi Hemmatjoo Pages 209-214
    Introduction
    Tympanoplasty is the standard and well established procedure for closure of tympanic membrane perforations .This paper compares the results of tympanoplasty in terms of hearing improvement and graft incorporation in patients with chronic perforation of the tympanic membrane between two groups with and without active drainage at the time of surgery.
    Materials And Methods
    Sixty referring patients to specialty and subspecialty clinics between the age 15 to 60 years-old were selected. All patients suffered from Chronic Otitis Media and they were categorized into two groups: a) those with wet ears and b) those with dry ears. Tympanoplasty surgery was performed through the use of embedding technique of temporalis fascia graft and in medial position (Medial Graft Technique). Finally, the data about the level of hearing improvement and the repair of tympanic membrane were analyzed.
    Results
    Although there was hearing improvement in both groups - with wet or dry ear - no statistically significant difference was observed between two groups. Following the surgery, tympanic membrane in two patients with wet ear and one with dry ear was not repaired, however according to the statistical analysis this difference was not significant.
    Conclusion
    The results of this study showed that in contrast to the common perception that tympanoplasty results in the patients with wet ear is poorer than those with dry ear, there was little difference in the results of the operations performed on two groups.
    Keywords: Tympanoplasty, Wet Ear, Dry Ear, Audiometric Result
  • Ehsan Khadivi, Mohammad Akbarian, Kamran Khazaeni*, Maryam Salehi Pages 215-219
    Introduction
    Unilateral vocal cord paralysis (UVCP) is not an uncommon finding. Several procedures are available to manage glottal insufficiency. We conducted a clinical trial to evaluate the outcome of fat injection laryngoplasty.
    Materials And Methods
    Liposuctioned lower abdomen fat was injected for augmentation of paralyzed vocal cord in 20 patients with UVCP. Autologous fat was harvested with an 18G needle and a 20-ml disposable syringe using a liposuction technique. Clinical follow-up after the injection was carried out from 1 to 6–21 months
    Results
    Voice and glottal protective function were significantly improved after the surgery. Vocal elements were immediately improved after the surgery, and after 1 year of follow-up.
    Conclusion
    Fat injection laryngoplasty by liposuction is simple, safe, effective and has a low cost for patients with UVCP with aspiration and breathy voice dysphonia.
    Keywords: Autologous Fat, Laryngoplasty, Vocal Cord Paralysis
  • Swati Tandon*, Satinder Singh, Shalabh Sharma, Asish Lahiri Pages 221-226
    Introduction
    Congenital anomalies of the cochlea and labyrinth can be associated with meningitis and varying degrees of hearing loss or deafness. Despite antibiotics, meningitis remains a life threatening complication.
    Case Report: We report a case of recurrent meningitis following episodes of otitis media in a cochlear implantee child with bilateral vestibulocochlear malformation, due to fistula in the stapes footplate. Intrathecal fluorescin was used to identify the leak site.
    Conclusion
    Recurrent meningitis can indicate for possible immunological or anatomical abnormalities as well for chronic parameningeal infections. Intraoperative use of intrathecal fluorescin is an ideal investigative tool to demonstrate cerebrospinal fluid (CSF) leak site in patients in whom other investigations fail to do so.
    Keywords: Cochlear implant, Inner ear malformations, Intrathecal fluorescin, Recurrent meningitis
  • Amin Rahpeyma, Saeedeh Khajehahmadi* Pages 227-231
    Introduction
    Reconstruction of the oral cavity witha flap design containing the buccal mucosa and buccinator muscle but excluding the facial artery and vein is the topic of these case reports.
    Case Reports: This article uses random pattern vertically oriented partial thickness buccinator myomucosal flap for intraoral reconstruction in two cases. The first was for lining the mandibular anterior vestibule in a trauma patient. The second was for oral side coverage of bone graft in special cleft patient. In both patients, this flap survived and good bone coverage with non-keratinized mucosa was obtained.
    Conclusion
    Thin long buccal myomucosal flap not including facial artery and vein can survive.
    Keywords: Artery, Flap, Mandibular Reconstruction
  • Ghodrat Mohammadi*, Arezu Khansarinia Pages 233-236
    Introduction
    Malignant mesenchymal tumors of the larynx are rare. One type of malignant mesenchymal tumor is synovial sarcoma with unknown histogenesis, which occurs predominantly in the lower extremities of young adults. The head and neck region is a relatively rare location. There are few cases of malignant mesenchymal tumors with laryngeal localization in literature.
    Case Report: In this report, a new case in a 23-year-old man, which was referred with increasing hoarseness for eight months, and dysphagia, odynophagia, and dyspnea since nearly one year ago, is reported. Indirect laryngoscopy revealed a laryngeal submucosal mass. The patient was operated and the histopathological diagnosis of synovial sarcoma was confirmed by IHC (Immunohistochemisry).
    Conclusion
    Synovial sarcoma occurs predominantly in the lower extremities of young adults. Because very few cases of laryngeal synovial sarcoma are reported, every new case will bring some new information about diagnosis and therapy. It is of utmost importance to get to know new aspects and therapeutical modalities of this rare tumor.
    Keywords: Synovial sarcoma, Larynx, Malignant mesenchymal tumors
  • Praveer Banerjee, Abhineet Jain, Manjunath D Pages 237-240
    Introduction
    Kimura’s disease is a rare chronic inflammatory disease of unknown etiology, presenting as painless subcutaneous nodules with lymphadenopathy and peripheral eosinophilia, mainly disturbing the head and neck region. It mainly affects Asian males in their 2nd to 4th decade of life. One such case of Kimura’s disease, which is uncommon in Indian natives, is reported.
    Case Report: A male patient presented with an insidious onset of a progressive painless disfiguring swelling over his nose since four years, which was associated with nasal obstruction and postaural swelling with a history of an inconclusive incisional biopsy. Clinical examination showed a bilobed subcutaneous swelling present over the nose and a collapsed nasal valve area on anterior rhinoscopy. FNAC was non-diagnostic and CT scan showed a mildly enhancing mass lesion over the external nose. Complete surgical excision was performed. Diagnosis was confirmed upon postoperative histopathology. During his 2nd week follow up, the patient had a small nasal recurrence, which was treated medically with oral steroids, cetirizine, and pentoxyphylline for 4 weeks. The patient was disease free for 6 months.
    Conclusion
    Kimura’s disease, although difficult to diagnosis clinically, should be considered in the differential diagnosis of patients who have a primary lymphadenopathy with eosinophilia with or without subcutaneous nodules. It should be investigated accordingly as the disease has an indolent course and good prognosis
    Keywords: Kimuras, Lymphadenopathy, Subcutaneous mass, Candida, Eosinophilia, IgE