Iranian Journal of Otorhinolaryngology
Volume:30 Issue: 4, Jul - Aug 2018

Electrically evoked compound action potential (ECAP) is an objective auditory response that can be used in the programing of cochlear implants. The aims of this study were to monitor ECAP thresholds and auditory, language and speech progress for 6 months after cochlear implant surgery and to evaluate any relationship between them.
Ten children with a mean age of 4.2 (±0.6) years and bilateral congenital and profound sensorineural hearing loss underwent cochlear implant surgery and post-operation auditory and speech training. The auditory, language, and speech abilities (Newsha level) and ECAP thresholds (for apical, medial and basal region of cochlea) were evaluated 1, 3 and 6 months after surgery.

ECAP threshold showed no significant improvement in any of the evaluated areas in the 6 months after surgery (P>0.05); however, the Newsha level improved for all patients (P=0.00).
There was no relationship between ECAP thresholds and auditory, language, and speech abilities (Newsha level) in the first 6 months after surgery. ECAP thresholds may be a poor indicator of improvement in auditory, language, and speech abilities, and depend on many factors.

Computed tomography (CT) imaging is the choice of investigation for evaluation of extent of tumor under the mucosa, locally and regionally. This study was undertaken to assess the accuracy of preoperative CT imaging in the staging of carcinoma of the larynx and hypopharynx.
In this retrospective study, all cases who were clinically (c) staged T3–T4 and who underwent surgery were evaluated. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy (Ac) of a preoperative CT scan to detect cartilaginous penetration and spread outside the larynx was evaluated. Clinical T-stage by CT imaging was compared with postoperative histopathological T-stage.
There were 22 (96%) male patients and one (4%) female patient. Patients were aged from 48 to 64 years (mean, 56 years). Twenty (87%) patients had laryngeal carcinoma, whereas three (13%) had hypopharyngeal carcinoma. Four (17%) patients had T3 tumors and 19 (83%) had T4a lesions. Preoperative imaging over-staged one of five pathological (p) T3 cases and three out of three pT2 cases, and was accurate in the remaining 19 cases. In a comparison of the results of imaging with histopathological T-classification, T-staging was found to be 82.6% accurate.
CT is a precise and non-invasive imaging method with high sensitivity but relatively lower specificity because of increased false positives. CT imaging may be useful to guide the choice of surgical procedure, which can heavily impact a patients’ quality of life.

Hyperbilirubinemia is a common neonatal problem with toxic effects on the nervous system that can cause hearing impairment. This study was conducted to assess the risk factors for sensorineural hearing loss and other coexisting problems in icteric infants.
In a case-control study, 200 term infants with bilirubin levels higher than 20 mg/dl admitted to the neonatal intensive care unit of Ghaem Hospital, Mashhad during 2007–2015 were investigated. Profiles of infants with hearing impairment (n=60) were compared with those of icteric newborns with normal hearing (140 newborns) as the control group. After confirming the clinical diagnosis of jaundice by laboratory findings, a validated questionnaire containing mother and infant profiles were used for data collection. The auditory brainstem response test was used for assessment of infant hearing status after discharge.
Sensorineural hearing loss among infants with severe hyperbilirubinemia was found to be 4.8%. Serum total bilirubin (P=0.001), creatinine levels (P=0.002), direct Coombs test results (P=0.001), etiology (P=0.000) and treatment for jaundice (P=0.000), eye movement disorders (P=0.001), opisthotonos (P=0.001), and microcephaly (P=0.001) were found to be significantly different between the two groups (P Hearing impairment occurs about 10–50 times more frequently in neonates with severe jaundice. Total bilirubin level has the highest predictability for infant hearing status. Blood group and Rhesus (Rh) incompatibilities between mother and child and G6PD deficiency are important known causes for hearing impairment due to jaundice.

Mandibular continuity defects after pathologic resections or traumatic events are difficult cases for reconstruction. Defects involving both hard and soft tissue loss are more challenging, because of problems in soft tissue coverage. The role of the submental flap in this regard is presented.
In a retrospective study from the archived files of Ghaem Hospital, Mashhad, Iran between 2007–2016, lateral mandibular defects that were managed with submental flap for soft tissue coverage were selected.
Ten patients had been treated, of whom four cases were due to trauma/gunshot events and six cases were defined as pathologic resection; five patients with malignant lesions and one with benign intraosseous pathology, but with soft tissue invasion. There was one complication overall, concerning orocutaneous fistula formation.
Submental flap is indicated for coverage of the reconstruction plate when the lateral mandible is resected/avulsed with soft tissue loss limited to the oral cavity or due to through and through defects in the lower third of the face.

It seems that diabetes mellitus (DM) can affect the auditory system due to neuropathy, micro-vascular complications, and hearing cell damage during hyperglycemic states. In the current study, we aimed to compare hearing status in patients with type 2 DM (T2DM) according to their blood-sugar control status.
This cross-sectional study was carried out in 104 patients with T2DM attending the diabetic clinics of Guilan University of Medical Sciences within a period of 1 year (2014–2015). One group consisted of 52 patients with poor control and the other consisted of patients with moderate-to-good control (according to glycated hemoglobin [HbA1c] level). All subjects underwent pure tone audiometry (PTA) and distortion product otoacoustic emission (DPOAEs) assessments. A hearing threshold higher than 20 dB and a signal-to-noise ratio ≤3 in each frequency were considered abnormal.
In PTA, poorly controlled patients showed more frequent hearing loss compared with the well-controlled group, especially at higher frequencies (8 kHz: 67.3% vs 46.2% [P=0.029]; 10 kHz: 46.2% vs 21.2% [P=0.025]). Also, patients in the poorly controlled group had worse cochlear function according to the DPOAE test (4 kHz: 32.7% vs 17.3% [P= 0.002] and 8 kHz: 70.6% vs 40.4% [P=0.006]).
DM and poor control status of diabetes can affect hearing sensation and cause hearing loss, especially at high frequencies. According to our findings, it seems that diabetic patients with a duration of diabetes >10 years, diabetic complications, poor control status or comorbidities should undergo both endocrine and audiologic follow-up to prevent greater sensory neural hearing loss.

In this study, we examined the role of immunological factors on sudden sensory neural hearing loss (SSNHL).
This prospective case-controlled study was performed in patients with SSNHL who referred to the ear, nose, and throat (ENT) ward. Fifty-six patients with SSNHLoccurring within a 72-hr period were selected as the case group and 56 participants who had no recent history of disease were assigned to the control group. Mean levels of immunological factors including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibody (ANA), anti-neutrophil cytoplasmic antibody (ANCA) (C, P), anti-cyclic citrullinated peptide (anti-CCP), DSM, hemoglobin (Hb), complement component 3 (C3), and complement component 4 (C4) were evaluated in the blood samples in each group.
There were 31 male and 25 female participants in the control group, while the case group had 26 male and 30 female participants. The mean age of the participants was 36.2 ± 13.4 years in the control group and 40.80 ± 13.37 years in the case group. The two groups differed significantly in terms of mean ESR, ANA, C3, C4 and monocytes, with higher levels in the case group (P0.05).
Because some of the immunological factors investigated in this study were significantly higher in patients with SSNHL, it can be concluded that there is an association between these immunological factors and SSNHL. Further studies are recommended to accurately determine the effect of these factors on the development of SSNHL and its treatment.

This study aims to report a rare case of a respiratory epithelial adenomatoid hamartoma (REAH) of the lateral nasal wall that had initially presented as a fungating mass, similar to that of a sinonasal malignancy, and its complete removal from the lateral nasal wall.
Case Report: We report the case of a 58-year-old woman who presented to us with a chief complaint of recurrent right-sided epistaxis and nasal blockage for the past 4 months, which was progressively worsening. Histopathological examination confirmed the presence of a REAH instead of a sinonasal malignancy. The tumor was surgically excised from the lateral nasal wall using electrocautery under endoscopic guidance. The patient was then carefully followed-up after surgery, and the wound was successfully healed 3 months after the initial surgery. There was no evidence of recurrence 6 months after the initial surgery
This case demonstrates the rare presentation of a REAH, which had arisen from the lateral nasal wall. Clinically, it is difficult to distinguish a REAH from a more notorious mass such as a sinonasal malignancy. Therefore, biopsy is mandatory in all cases of lateral nasal mass in order to rule out malignancy before confirming nasal REAH. Fortunately, as seen in this case, a lateral nasal REAH, once diagnosed, can be safely and easily removed from the lateral nasal wall using electrocautery with good surgical outcomes and a low rate of recurrence.

Tuberculosis is a communicable disease caused by mycobacterium tuberculosis that primarily affects the lungs. Primary tuberculosis of the nose in the pediatric age group is rare. The diagnosis of this common entity in the present case was challenging.
Case Report: We report the case of a 3-year old girl who presented with a painless swelling over the dorsum of the nose for 7 months. Imaging revealed a mass lesion eroding nasal bones, septum and frontal bone with intracranial extension. Endoscopic examination showed a friable mass in the superior aspect of the nasal septum, extending intracranially. Histopathology confirmed the diagnosis of nasal tuberculosis, and the patient improved on category I anti-tubercular therapy.
Midline nasal swelling in children needs to be differentiated from congenital nasal swelling. A high index of suspicion is required for correct diagnosis of a patient with nasal tuberculosis. Anti-tubercular therapy is the mainstay of treatment.

Foreign bodies in the esophagus are considered to be a life-threatening condition in adults and children because of esophageal perforation, chemical pneumonitis, airway obstruction, and development of a fistula, leading to high morbidity and mortality with this condition. Most cases present with immediate symptoms. However, in rare cases, the foreign body can migrate within the tissues and become symptomatic at a later date.
Case Report: We report a rare case of a foreign body in the esophagus following fishmeal ingestion. The foreign body had traversed the lumen of the esophagus and migrated into the neural foramina with impingement of the left C6 root with resulting left C6 radicular pain. Radiology and successful surgical management is discussed herein, along with relevant literature.
Radiculopathy after foreign body ingestion is very rare. In patients presenting with persistent radicular pain, in particular in close proximity to the neurovascular structures, we advise early surgery to prevent a neurological deficit.

Temporal bone osteomyelitis is more commonly seen in immunocompromised patients and is very rare in non-immunocompromised individuals. Mucormycosis is a fulminating fungal infection caused by Mucor which is a saprophytic fungus commonly seen in diabetic patients. Here we report a case of temporal bone osteomyelitis in a child with a traumatic history which was causing clinical features of lateral sinus thrombosis. The patient was successfully treated and doing well post-operatively.
Case Report:An 11-year-old girl was reported to the emergency dept with fever and headache for 2 weeks. She had a fever of 100–102 °F without chills and rigors which was associated with severe headache on the right side and not associated with any vomiting, nausea, or aura. The patient did not have any other significant complaints except a history of falling 2 years previously when she was 9 years of age. The patient was admitted and a complete evaluation was performed clinically and radiologically. High-resolution computed tomography (HRCT) of the temporal bone was suggestive of soft tissue density at the sigmoid sinus of the right mastoid. The patient underwent surgery for debridement, and the tissue was sent for diagnosis. This revealed mucormycosis of the temporal bone and the patient started medical management. At the present date, the patient remains under follow up.
Fungal chronic osteomyelitis is a disease among immune-compromised patients involving the temporal bone, and is very rare. In particular mucormycosis is very rare in the temporal bone but is not expected in normal individuals. HRCT of the temporal bone is the gold standard investigation, and tissue biopsy is diagnostic. Tissue debridement and long-time medical management with anti-fungal medication is mandatory to achieve good results.