فهرست مطالب

Otorhinolaryngology - Volume:31 Issue:6, 2019
  • Volume:31 Issue:6, 2019
  • تاریخ انتشار: 1398/08/10
  • تعداد عناوین: 11
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  • Mohadeseh Hashemian, Bijan Khorasani, Maryam Tarameshlu, Hamid Haghani, Leila Ghelichi *, Noureddin Nakhostin Ansari Pages 329-334
    Introduction
    Swallowing disorder or dysphagia is a common complication after conventional total thyroidectomy. Traditional dysphagia therapy (TDT) has long been a routine rehabilitation program for patients with dysphagia; however, there is no evidence to support the efficacy of this approach in patients with post-thyroidectomy dysphagia. Regarding this, the purpose of the current study was to explore the effectiveness of TDT in swallowing dysfunction in patients suffering from post-thyroidectomy dysphagia.  
    Materials and Methods
    This pilot clinical trial was conducted on 21 patients with post-thyroidectomy dysphagia. The study population was randomly assigned into two groups of TDT and control. The patients in the TDT group received 18 treatment sessions for 6 weeks, 3 times a week. The Swallowing Impairment Score (SIS-6), Functional Oral Intake Scale (FOIS), and Persian Dysphagia Handicap Index (P-DHI) were the outcome measures. The outcome variables were assessed at the baseline, at the end of the treatment, and after a 6-week follow-up. The main effects of time and group and their interaction effect on SIS-6 and P-DHI scores were examined using repeated measures ANOVA. In addition, the intergroup comparison in terms of the FOIS score was analyzed using the Mann-Whitney U test. The Cohen's d effect size was also measured to ascertain the effects of the treatment.  
    Results
    According to the results, the TDT group showed a significant improvement in the SIS-6, FOIS and P-DHI scores over time (P<0.001). The results also revealed that the interaction effect of time and group was significant on SIS-6 and P-DHI scores (P<0.001). In addition, effect sizes on SIS-6, FOIS, and P-DHI scores were large in the TDT group.  
    Conclusion
    This study suggested that TDT could improve the swallowing dysfunction in the patients suffering from post-thyroidectomy dysphagia. As the results indicated, the improvements persisted 6 weeks after the end of TDT.
    Keywords: Deglutition, Traditional dysphagia therapy, Thyroidectomy, Swallowing disorders
  • Luis, Alejandro Boccalatte *, Natalia, Lucía Gomez, Alejandro Yanzon, Eduardo, Luis Mazzaro, Federico Cayol, Marcelo, Fernando Figari Pages 335-342
    Introduction
    Sarcomas account for 1% of all tumors originated in the head and neck regions in adults. They constitute a heterogeneous group of tumors of mesenchymal origin with multiple histological variants. The undifferentiated pleomorphic sarcoma (UPS) subtype is the most frequent variant with an incidence range of 2.7-38%.  
    Materials and Methods
    This retrospective case series was conducted on 11 patients who were diagnosed with UPS and treated in our institution in the last 11 years.  
    Results
    According to the results, 26.8% of the sarcomas corresponded to UPS variant. Out of 11 patients, 5 cases were female. The median age of the participants was 58 years (range: 18-74 years). Seven and four patients were T1b and T2b, respectively. Ten patients had no metastasis at the moment of diagnosis. Six patients were categorized as intermediate-grade, and the remaining (n=5) were classified as high-grade. The most frequent location was the scalp (n=3). In the patients undergoing surgery, the mean follow-up duration was 52 months. Disease-free survival (DFS) rates were obtained at 70%, 50%, and 50% in the 1st, 3rd, and 5th years, respectively, with the mean DFS of 36 months. In addition, the overall survival rates in the 1st, 3rd, and 5th years were 100%, 100%, and 83%, respectively.  
    Conclusion
    TheUPS represented the most common histological subtype in our series. They tend to be intermediate or high-grade tumors. An acceptable global survival rate justifies surgical treatment as the main therapeutic tool.
    Keywords: Head, Neck, Neoplasms, Sarcomas, Undifferentiated pleomorphic sarcomas
  • Saeedeh Khajehahmadi, Amin Rahpeyma * Pages 343-347
    Introduction
    The inferiorly and laterally based platysma myocutaneous flap contains hair in some ethnics; therefore, it is required to change the myocutaneous flap to myofascial flap to prevent the hair growth after its transfer to the oral cavity.  
    Materials and Methods
    Five male mongrel dogs were selected for this study. De-epithelialized laterally based platysma flap, muscle part facing the oral cavity, was used for buccal reconstruction. The clinical healing process was photographed every week. After 40 days, biopsy specimens were obtained from the transferred flap.  
    Results
    According to the results, all flaps survived. At the end of the first week, the flap was covered with fibrinous exudate. On the third week, only the center of the transferred flap was not covered with mucosa. Within 40 days, the flap was distinguishable clinically from the adjacent buccal mucosa just by hypopigmentation. Hematoxylin and eosin staining of the biopsy specimens taken on day 40 showed thin stratified squamous epithelium covered with a tiny parakeratin layer.  
    Conclusion
    Myofascial platysma flap, muscle part faced oral cavity, survives and undergoes mucosalization after adaptation to the recipient oral tissue.
    Keywords: epithelialization, Platysma flap, Wound healing, Reconstruction
  • Hamid Vaez, Amirhossein Sahebkar, Farhad Pourfarzi, Arshid Yousefi, Avarvand, Farzad Khademi * Pages 349-357
    Introduction

    Based on the World Health Organization reports, infections caused by ampicillin-resistant Haemophilus influenzae strains are a major threat to public health and need urgent therapy with new antibiotics. Given the lack of a previous comprehensive study on the prevalence of the antibiotic resistance of H. influenzae in Iran, this systematic review and meta-analysis was performed to increase the knowledge about antibiotic resistance status of this pathogenic agent.  

    Materials and Methods

    For the purpose of the study, the articles related to the subject of interest and published up to August 2018 were searched in several English and Persian databases, including PubMed, Scopus, Web of Science, Scientific Information Database, and Magiran. The search process was accomplished using the following keywords: “Antibiotic resistance”, “H. influenzae”, and “Iran”. The data were pooled from 13 eligible studies reporting the prevalence of antibiotic resistance of H. influenzae in Iran.  

    Results

    The prevalence of H. influenzae resistance to various antibiotics in Iran, including ampicillin, amoxicillin, cephalexin, cefixime, ceftazidime, cefotaxime, and ceftizoxime, were obtained as 54.8%, 66.6%, 28.6%, 62%, 21.3%, 22.3%, 23.2%, respectively.These rates were reported as 27.7%, 46.7%, 53%, 82.6%, 40.3%, 30.8% for chloramphenicol, tetracycline, trimethoprim/sulfamethoxazole, penicillin, erythromycin, and ciprofloxacin, respectively. Additionally, ceftriaxone, gentamicin, amikacin, kanamycin, rifampin, azithromycin, and clindamycin had the H. influenzae resistance rates of  33.1%, 40.2%, 45.8%, 44.4%, 18.5%, 17.4%, and 71.3%, respectively.  

    Conclusion

    The majority of the antibiotics tested in Iran showed a high rate of resistance to H. influenzae. This may cause serious problems in the treatment of infections in the future. Therefore, precautionary measures, such as monitoring antibiotic prescription and resistance and using the new classes of antibiotics, are necessary.

    Keywords: Antibiotic resistance, H. influenzae, Iran
  • Robabeh Soleimani, Mir Mohammad Jalali, Babak Bakhshayesh, Pasha Rashidi Mojdehi, Seyed Mohammad Sadegh Ghadiri Asli Pages 359-367
    Introduction

    The present study was designed to investigate the psychometric properties of the Persian version of the Dizziness Handicap Inventory (P-DHI). In addition, this research was targeted toward assessing the association of P-DHI withMedical Outcome Study 36-Item Short Form Health Survey (SF-36) and Hospital Anxiety and Depression Scale (HADS). The current study also involved a comparison of the scores of patients and healthy participantsand implementation of a factor analysis.  

    Materials and Methods

    This cross-sectional study was conducted on 113 patients with dizziness and 30 healthy individuals referring to tertiary centers for otolaryngology and neurology, affiliated to Guilan University of Medical Sciences, Rasht, Iran. The mean age of the patients was 44.5±13.6 years. All patients re-completed the P-DHI after 2 weeks. Internal consistency and reproducibility of the inventory were evaluated using the Cronbach’s alpha coefficient, Bland-Altman limits of agreement, and intraclass correlation coefficients. In addition, the relationships of the P-DHI with SF-36 and HADS were evaluated using the Spearman correlation coefficient. An exploratory factor analysis was also run to determine the factor structure of the questionnaire.  

    Results

    The Cronbach’s alpha coefficient of P-DHI scale was obtained as 0.86. In addition, the functional, physical, and emotional subscales of this instrument had the Cronbach’s alpha coefficients of 0.76, 0.52, and 0.80, respectively. The limits of agreement were 16 points for the total scale, and the range of intraclass correlation coefficients was 0.90-0.96. The P-DHI showed a fair correlation with vertigo severity which assesses functional disability subscale. This scale also demonstrated a moderate correlation with SF-36 and HADS. Factor analysis revealed a 2-factor solution which was different from the factor structure of the original DHI.  

    Conclusion

    As the findings indicated, the P-DHI had good psychometric properties; therefore, it could serve as a useful tool for measuring disability in patients with dizziness and unsteadiness.

    Keywords: dizziness, Dizziness Handicap Inventory, Questionnaire, Reliability, Validity
  • Mohammad Faramarzi, Mahmood Shishehgar *, Gholam Abbas Sabz, Sareh Roosta, Mehrdad Askarian Pages 369-375
    Introduction
    Otolaryngology is a field with a high referral rate; however, there is a dearth of research on the quality of referral letters written in this field. This study was carried out to explicitly assess the quality of referral letters, more specifically in the field of otology.  
    Materials and Methods
    Two otologists assessed referral letters written by general practitioners or primary care physicians working as family physicians. They were asked to make independent assessment on different variables related to the quality of referral letters and their appropriateness. A “qualified referral letter” in the current study is defined as a letter with standard items, including, description of chief complaint, description of associated symptoms, relevant physical findings, past medical history, drug history, family history, and reasons for referral.  
    Results
    A total of 1000 referral letters written by 652 primary care physicians were investigated in the current study. The obtained results indicated that 74% of referral letters to otologists contained inadequate information regarding various items in the referral letters. Symptoms, diagnosis, and signs were only reported in 28.3%, 28.9%, and 3.6% of the letters, respectively. The findings showed that most common reasons for referrals were uncertainty in diagnosis (52.4%), persistence of the patient (32.6%), and failed therapy (32%). With regards to case-specific conditions, the highest referral rates were related to external otitis, otitis media with effusion, and acute otitis media.  
    Conclusion
    According to the obtained results of the current study, the content of referral letters were insufficient or inappropriate. Therefore, it is recommended to improve otolaryngology syllabus and provide suitable courses for undergraduate students in order to become familiar with the importance of referral letter writing.
    Keywords: Family Physicians, Otolaryngology, Otology
  • Kausalya Sahu, Deviprasad Dosemane *, Meera Khadilkar, Deeksha Shetty, Madhurya Ramineni Pages 377-381
    Introduction

    Thesinonasal tract is an area that may be affected by various types of neoplastic lesions with more variety than what is encountered in other parts of the upper airway and food passage.

    Case Report

    An elderly gentleman of 65 years complained of nose block on both sides for 3 months. On examination, he had firm polypoidal masses arising from the middle meatus and septum on both sides. Computed tomography scan of the sinuses revealed polypoidal mucosal thickening in bilateral sinuses with bilateral concha bullosa. The patient underwent functional endoscopic sinus surgery with the complete excision of the masses from the lateral wall and septum under general anesthesia. The results of the histopathological examination showed inflammatory changes in polypoidal tissues from the right maxillary, bilateral ethmoidal sinuses, and bilateral septal masses. The lesion in the left middle meatus showed the features of respiratory epithelial adenomatoid hamartoma (READ). The case had no evidence of residual or recurrent lesion during 6 months after the surgery.  

    Conclusion

    The READ  is a rare lesion observed in the sinonasal tract. It is a diagnostic dilemma for clinicians as it can be misdiagnosed as neoplastic lesions, such as inverted papilloma or adenocarcinoma, which would warrant radical surgery or sinonasal polyposis and be treated inadequately.

    Keywords: Ethmoidal polyps, Hamartoma, Nasal mass, Nasal Polyps, Respiratory epithelial adenomatoid hamartoma (READ), Sinonasal tract
  • Liang Chye Goh *, Roslim Siti Norain, Zulkifli Shifa, Anura, Michelle Manuel Pages 383-386
    Introduction

    Branchial arch anomalies represent defects in embryological developments whereby parts of the branchial arch persist in the head and neck regions as sinuses, fistulas, or cysts. These anomalies usually present as a unilateral lesion in the head and neck of young adults and children, which are excised upon the emergence of complications.

    Case Report

    Herein, we presented a rare case of a 4-year-old child, who had been diagnosed with a complete bilateral second arch branchial fistula. The excision was made using the bilateral stepladder approach and tonsillectomy.  

    Conclusion

    The bilateral stepladder approach was a feasible method in excising a complete bilateral branchial fistula. However, larger-scale studies should be conducted on the surgical techniques of bilateral branchial fistulae excision in order to optimize the cosmetic outcome of the surgery.

    Keywords: Branchial, Bilateral, Congenital, Excision, fistula
  • Ahmet Mutlu, Erdem Koroglu *, Selvet Erdogan Pages 387-389
    Introduction

    Surgical procedures, especially total laryngectomy, have a profound adverse effect on the patient's physical, functional, as well as emotional health, and strongly decrease quality of life. Tracheoesophageal puncture is one of the most significant method that is widely performed successfully by physicians. Current valve technology enables long expiring duration; however, general duration for all types of valve appears to be approximately 3 to 6 months.

    Case Report

    A 72-year-old patient with total laryngectomy and tracheoesophageal voice prosthesis (VP) presented our voice clinic with difficulty in swallowing and leakage around the valve of VP. In this report, we aim to present the patient who has used a single voice prosthesis for 17 years without a complication.  

    Conclusion

    In our case, the nutritional habits of our patient may have allowed him to use VP for 17 years without complications. We strongly advise following the suggested renewal time of voice prosthesis.

    Keywords: Biofilms, Tracheoesophageal puncture, Voice prosthesis
  • Ein Wan Chin *, Azreen Zaira Abu Bakar, Shahrul Hitam, Ngan Kah Wai, Maizaton, Atmadini Abdullah Pages 391-397
    Introduction

    Ewing sarcoma (ES), which is described as diffuse endothelioma of the bone, is divided into osseous and extraosseous Ewing sarcoma (EES) mostly affecting children and adolescents. It is a rare, aggressive, and poorly differentiated small blue round cell tumor that seldom affects the head and neck regions.

    Case Report

    Herein, we reported a 46-year-old man presenting with right nasal block, epistaxis,  and epiphora from the right eye for one month. The nasal endoscopy revealed a friable mass  arising from the anterior half of the right nasal cavity. Histological findings were suggestive of  Ewing sarcoma. A contrast-enhanced computed tomography (CT) scan of the paranasal sinuses showed a soft tissue mass in the right anterior nasal cavity with mucosal thickening in the right maxillary sinus, without any bony erosion or distant metastasis. The patient underwent endoscopic medial maxillectomy with modified Denker’s procedure, followed by a 6-cycle course of chemotherapy. He was clinically well after chemotherapy; however, the recent bone scans were suggestive of bone involvement with the tumor.  

    Conclusion

    TheEES of paranasal sinus in the head and neck regions is extremely rare and requires exceptional attention due to their adjacent vital structures. The ES diagnosis-related dilemma  arises from the numerous differential diagnoses of small round blue cell tumors. In this regard, accurate diagnosis is important, since ES requires a multi-modality approach. Furthermore, early diagnosis and aggressive intervention are crucial to obtain good prognosis and function.

    Keywords: Ewing, Epistaxis, Maxillary sinus, Nasal obstruction, Nasal cavity, Sarcoma
  • Abhay Havle *, Swapna A Shedge, Raisha Dalvi Pages 399-402
    Introduction

    Lobular capillary hemangioma (LCH) is caused by exuberant neovascular response to infection, local irritation (e.g., trauma), or hormonal influence (e.g., pregnancy and consumption of oral contraceptive pills).Pyogenic granuloma is considered to be a misnomer.Althoughthe gingiva is involved in most of the cases, there are is rare cases of extragingival involvement. Herein, we reported a case of LCH associated with the dehiscence of the underlying bony hard palate.

    Case Report

    A 50-year-old woman presented with a gradually increasing swelling over hard palate for 2 years. She was a hypertensive patient and mishri user (using tobacco-containing teeth cleaning powder) with known diabetes. She had undergone a teeth extraction 2 years ago. The palatine swelling was reddish-blue, sessile with a lobulated surface, firm in consistency, and non-tender with a of size 4×3 cm. The computed tomography (CT) scan revealed bony dehiscence of the underlying palate. Histopathological examination after excision and curettage was suggestive of LCH.  

    Conclusion

    TheLCH is common in females due to cyclical hormonal changes. Our case was presented in the fifth decade of life. The etiological factors for the patient could be mishiri usage or iatrogenic trauma of teeth extraction rather than mere hormones. The dehiscence of the underlying palatine process of the maxilla could be due to the acquired invasive nature of the lesion. No recurrence was observed in our patient since the elimination of the lesion and strict abstinence from mishiri till this date.

    Keywords: Diabetes Mellitus, Females, Granuloma-pyogenic, Palate, tobacco