Iranian Journal of Otorhinolaryngology
Volume:31 Issue: 4, Jul-Aug2019

Rhinosinus polyposis is associated with voice quality reduction. There has been little evidence about the efficacy of rhinosinus polyps surgery on patients' voice quality so far. The aim of the present study was to evaluate the nasality and acoustic voice changes after rhinosinus polyposis surgery.   The population in this study composed of 30 eligible patients with rhinosinusitis and rhinosinus polyposiss. The functional endoscopic sinus surgery (FESS) was the therapeutic intervention. Acoustic voice parameters were jitter (%), shimmer (db), noise to harmonic ratio (NHR), and fundamental frequency (F0) for the vowels [a, o, e, aa, ie, and ou]. For nasality evaluation, the articulation of vowel [a] was examined using nasometer device. The changes regarding the patients’ voice were evaluated one day before and one month after the surgery. The mean age of the participants was 41.2±14.3 years. Considering gender distribution, 20 (66.7%) subjects were men. After the operation, the nasality increased significantly from 40.8% to 74.3% (P<0.001). In addition, the findings revealed the increase of shimmer and F0 (P>0.05). On the other hand, jitter and NHR changes were insignificant.   The findings of the current study showed that hyponasality decreased a month after the treatment of rhinosinus polyposis with FESS. However, the acoustic quality of voice had no significant changes after the surgery.

This study evaluated the effect of gelfoam impregnated with botulinum toxin on the symptoms induced by allergic rhinitis. In total, 30 patients with allergic rhinitis who did not respond to common therapies were included in this clinical trial study. All patients were treated with intranasal gelfoam impregnated with botulinum toxin type a (40 unit in each side) placed in the middle meatus of each nostril. The main symptoms of allergic rhinitis were scored from zero to three by the patients. Symptoms recorded and compared before and two months after the treatment. The mean age of patients was 31.03±6.9 years. The mean score for sneezing was 2.23 before the treatment which significantly decreased to 1.06 after the treatment (P<0.05). The mean scores of rhinorrhea, nasal congestion, and nasal itching were 2.53, 2.03, and 1.93, respectively, before the treatment which significantly decreased to 0.93, 1, and 0.8 after the treatment (P<0.05). No reported side effects was observed in this study. According to the results, treatment with gelfoam impregnated with botulinum toxin is an effective and safe method in patients who have not responded to common therapies for allergic rhinitis. Accordingly, it is recommended to relieve symptoms in patients with seasonal allergic rhinitis in order to maintain the effectiveness of this treatment at least 8 weeks.

Otitis media with effusion (OME) is prevalent among children in such a way that it is the most common cause of hearing loss and surgery in childhood. Immunoglobulin E (IgE) mediated hypersensitivity has been proposed as a causative factor in the development of OME; however, there has been contrasting data in this regard. Therefore, the present study aimed to detect the possibilities of interconnection. In this study, 37 OME children were selected as the case group and 52 children were randomly chosen as the control group. Allergic rhinitis prevalence, serum total IgE concentration, serum eosinophil count, and nasal scraping cytology were evaluated in all the children. Furthermore, the skin prick test was performed in the OME group and suspected allergic rhinitis patients in the control group. Allergic rhinitis prevalence was notably higher among OME patients than in the control group (P=0.01). There were no remarkable differences in eosinophil counts and serum IgE concentrations in the two groups. Nasal smear eosinophils did not show any significant difference between the two groups; however, Appreciable difference was observed in the allergic rhinitis patients, compared to other OME patients (P=0.004). There may be a correlation between allergic rhinitis and development of OME. Therefore, it seems reasonable to examine allergic rhinitis patients for OME.

 Intratympanic therapy, as a widely used treatment for inner ear diseases, is regarded as a therapeutic method in controlling the vertigo of the patients with Meniere’s disease. This study was designed to evaluate the effect of the Intratympanic dexamethasone-hyaluronic acid combination on patients suffering from Meniere’s disease.   This study was a clinical trial on patients with Meniere’s disease during 2016-2017. Patients received two Intratympanic injections of dexamethasone plus hyaluronic acid as a mixture within a month. Before and 2 weeks after the intervention, pure tone average (PTA) at 0.5, 1, 2, and 4 KHz frequencies, speech discrimination score (SDS), dizziness handicap inventory (DHI), and tinnitus handicap inventory (THI) scores were evaluated for each patient. The obtained scores were statistically analyzed.   This study was conducted on a total number of 25 patients with Meniere's disease. The mean age of participants in this study was 44.71±4.92 years. Gender distribution among participants revealed that 36% of patients were male. The mean values of PTA, SDS, and THI were not significantly different before and after the intervention. However, the mean score of DHI decreased significantly after the intervention (P<0.001).   Intratympanic dexamethasone/hyaluronic acid had a positive effect on the vertigo of the investigated patients without any significant improvement in hearing impairment and tinnitus in the short term.

One of the major concerns in laryngeal laser surgery is the risk of airway fire. The introduction ofwrapped tubes and metal tubes has reduced the fire hazards. However, these tubes are expensive and do not provide convenient access to the surgical field. There are few laboratory studies addressing the resistance of polyvinylchloride tubes against ignition in the given circumstances. Nevertheless, its safety should be approved in clinical practices.   This  retrospective studyevaluated the airway management on 1024 patients undergoing laryngeal laser surgery. The data collection included the information about the type of endotracheal tube (ETT), mode of ventilation, and airway hazards (e.g., tube ignition).   Polyvinylchloride tubes and conventional positive pressure ventilation was applied for most of the patients (84.1%). The tube cuff was pierced with laser beam in 22 cases (2.5%). However, there was no case of ETT ignition or airway fire.   Polyvinylchloride tubes can be safely used in this subset of surgeries pending meticulous attention to the safety recommendations.

Maxillary sinuses are among the largest paranasal sinuses with various shapes and volumes. The dimensions and volumes of maxillary sinuses play an important role in the surgical treatment plan. The higher levels of pneumatization of alveolar bone lead to the increase of odontogenic sinusitis which cause problems in dental implantation. Therefore, this study aimed to evaluate the relationship between maxillary sinus volume and pneumatization and anatomical factors.   In this cross-sectional study, computed tomography (CT) images of the healthy maxillary sinuses of 199 adult patients were reviewed.  Amira software was used for the measurement of sinus volume. Sinus pneumatization of the alveolar bone in coronal CT scan images in the posterior teeth areas was measured. Moreover, anatomical variations of the sinonasal region, such as nasal septal deviation, and size of the ostium were measured and recorded. The Kolmogorov-Smirnov test, the t-test, and the Pearson’s and Spearman's correlation coefficients were applied for data analysis.   According to the obtained results, the mean value of the maxillary sinus volume and the alveolar bone pneumatization were 15.54 mm3 and 3.54 mm, respectively. The mean value of the maxillary sinus volume was statistically higher among males than females (P<0.001). The prevalence of nasal septal deviation, concha bullosa, and maxillary sinus septa were 14.6%, 14.6% and 6% respectively. There were no association between anatomical factors, including the nasal septal deviation, the size of the ostium, concha bullosa, and maxillary sinus septa and maxillary sinus volume and pneumatization. P-value less than 0.05 was statistically significant.   No correlation was observed between the anatomical variations of the sinonasal region and maxillary sinus volume and pneumatization.

Presence of vestibular schwannoma and a simultaneous glomus jugulare tumor is an extremely rare event. There is only one case report regarding the incidence of a contralateral vestibular schwannoma, along with a glomus jugulare tumor. Herein, we present the second case with a contralateral tumor.   Case Report: A 69-year-old woman presented with a long history of bilateral hearing loss and a 2-year history of left-sided pulsatile tinnitus. The patient also suffered the itching of the left ear canal and mild vertigo; however, she had no recollection of middle ear infection, ear discharge, or ear pain. Magnetic resonance imaging (MRI) revealed a right-sided 8-mm extrameatal vestibular schwannoma and a left-sided almost purely extracranial glomus jugulare tumor of 18 mm. The pure-tone average values were 63 and 43 dB HL for the right and left ears, respectively. Speech audiometry showed a discrimination score of 76/88 (%). Caloric irrigation was performed and revealed a unilateral weakness of 81% towards the side of vestibular schwannoma. The patient was included in a watchful waiting regimen with annual MRI scans.   Though vestibular schwannomas and glomus jugulare tumors are pathophysiologically different, they are similar in terms of symptomatology, growth pattern, diagnostic process, and therapeutic strategy. Based on this case report, it can be concluded that a vestibular evaluation demonstrates a unilateral vestibular weakness towards the side of the vestibular schwannoma, thereby facilitating clinical discrimination between the lesions.

Internal jugular vein ectasia is a condition in which there is a dilatation of the internal jugular vein. A patient usually presents in the first decade with swelling in the neck, which aggravates in size while straining or coughing. This is a very rare condition and the chances of misdiagnosis are quite high. It is diagnosed by proper history taking, examination, and radiological study.   Case Report: We reported the case of a seven-year-old female presenting with right-sided swelling in the neck aggravating in size while straining or coughing. Regular follow-up was advised. Swelling regression was observed after one year of follow-up without any surgical treatment.   This is a self-limiting condition and usually the treatment is not warranted. Regular follow-up is advised for the patient.

Idiopathic subglottic tracheal stenosis is a rare inflammatory disease of the trachea; most commonly affects females within the age range of 20-50 years. No etiologic factor has yet been identified for this rare tracheal disease and therefore it should be diagnosed after the exclusion of other inflammatory, traumatic, and autoimmune diseases of the trachea. The familial or genetic predisposition to this disease is still unknown although one published report in the literature showed some familial predisposition.   Case Report: A 41-year old woman presented with progressive dyspnea and stridor. The bronchoscopic evaluation revealed subglottic tracheal stenosis; however, there was no significant etiology of this disease after complete evaluations. Therefore, the idiopathic subglottic stenosis was the final diagnosis. After two years, her identical twin sister presented with the same signs and symptoms. There was also no etiology for her tracheal stenosis. The first patient was managed surgically through cricotracheal resection. However, the second sister didn’t need surgical resection due to the mild to moderate tracheal stenosis.   The obtained results of our cases along with the previously reported family cases can potentiate the hypothesis that there is some genetic predisposition to the development of this disease.

Lupus vulgaris is the most common form of cutaneous tuberculosis caused by contiguous spread from an underlying infective focus or lymphatic or hematogenous spread. It can also develop at the site of direct inoculation (e.g., tattooing and ear piercing) or Bacillus Calmette-Guerin vaccination. The solitary involvement of the pinna is rare and may face clinicians with a diagnostic dilemma. Herein, we reported the case of a 37-year-old female presenting with lupus vulgaris of the left pinna with a history of ear piercing.   Case Report: Our case was a 37-year-old female presenting with asymptomatic erythematous plaques on the left pinna for 2 years. She had a history of ear piercing done 20 years ago. After 6 months of ear piercing, she suffered from recurrent infections at the site of piercing in the left ear, while the other ear was normal. Two years earlier, she developed a small erythematous papule, which slowly progressed in size to the present status. On examination, well-defined erythematous scaly plaques were noted on the left helix. The histopathology of the skin biopsy showed multiple confluent granulomas consisting of the epithelioid cells and lymphocyte with a focal area of necrosis in the dermis. Acid-fast bacilli were not seen in modified Ziehl-Neelsen (ZN) and routine ZN staining. A final diagnosis of lupus vulgaris was made, and the patient was started on antitubercular drugs. There was a significant resolution of the lesion after 2 months of treatment.   Cutaneous tuberculosis should be considered in the differential diagnosis of chronic nonhealing granulomatous skin lesions developing at the site of ear piercing.

 Carcinoma of the larynx is an extremely uncommon clinical entity in pediatric age. The diagnosis of the laryngeal carcinoma is often delayed due to the low index of suspicion. The factors contributing to delayed diagnosis include the similarity of its symptoms to common benign lesions of the larynx in childhood and difficult examination of the larynx in pediatric patients. The treatment of laryngeal carcinoma is still a challenge due to the lack of available guidelines among pediatric patients.   Case Report:  An 11-year-old male presented with hoarseness of voice over the last 3 month and was diagnosed with laryngeal carcinoma based on the fiberoptic nasopharyngolaryngoscopy examinations and biopsy. He was treated with a complete course of radiotherapy.   This case is reported due to the paucity of the laryngeal carcinoma cases among pediatric patients in medical literature. The obtained results will create awareness among clinician to rule out laryngeal carcinoma in pediatric patients with laryngeal symptoms, such as the hoarseness of voice which will help early diagnosis and treatment.

I read the manuscript entitled “Case Report of An Open Neck Procedure Complication Associated with Laryngeal Mask Airway Use” by Subramaniam T et al. This is a valuable manuscript describing iatrogenic complications during level-2 cervical lymph node biopsy, in which the airway is managed with laryngeal mask airway (LMA). During the procedure, the surgeon realized that the mass was actually the LMA and that the pharyngeal wall had been dissected, resulting in an iatrogenic pharyngeal tear. LMA is a safe method to establish airway control during general anesthesia; however, it is controversial during open-neck procedures. In particular, during lymph node biopsy and branchial cyst excision procedures, the surgeon can feel the cuff of the LMA as a mass, and complications can occur during surgery. Besides these complications, LMA is not appropriate during lymph node biopsy procedures, particularly for level-2 cervical lymph nodes. During LMA usage for anesthesia, the natural position of the neck disappears and it is not possible to palpate the lymph node. Even if the surgeon marks the place of the lymph node before the operation, after LMA usage the surgeon is not able to palpate the lymph node accurately, and may even lose the lymph node. Therefore, during open-neck procedures, endotracheal intubation is a more appropriate technique than LMA usage.