Iranian Journal of Otorhinolaryngology
Volume:32 Issue: 1, Jan-Feb 2020

Cochlear implantation (CI) is now regarded as a standard treatment for children with severe to profound sensor neural hearing loss. This study aimed to compare the efficacy of the round window approach (RWA) and standard cochleostomy approach (SCA) in the preservation of residual hearing after CI in pediatric patients. This double-blind randomized controlled trial was conducted on 97 pediatric patients receiving CI with 12-month follow-up. The study population was divided into two groups according to the surgical approaches they received, including RWA and SCA. Consequently, the patients were evaluated based on the Categories of Auditory Performance scale (CAP) and Speech Intelligibility Rating (SIR) test 45-60 days and 3, 6, 9, and 12 months post-surgery. The CAP and SIR mean scores increased in both groups during the 12-month follow-up. This upward trend was significant in both groups (P<0.001). There was no significant difference between the two treatment groups in any of the follow-up stages regarding the CAP mean score. The mean SIR score (P=1.14±0.40) was significantly higher in the RWA group 3(P=0.001), 6(P=0.008), and 9(P=0.006) months after the surgery. However, there was no significant difference between the RWA and SCA groups, regarding 1-year SIR (P=0.258). The CI with either RWA or SCA could improve hearing and speech performance in pediatric patients. Although mid-term speech intelligibility was better for RWA, there was no significant difference in the 1-year outcome between these two methods.

Noise is one of the most common and harmful physical factors in the working environment and has physical and psychological effects on individuals. In this study, the audiometry results of industrial workers were modeled and the effect of noise and other factors on hearing loss was examined.                                                                                                    This was a longitudinal study based on the records of workers who had worked over 10 years in the industry and had recorded audiometries since their employment. Data was analyzed through linear mixed models.   During each year of noise exposure, hearing loss was 1.9 db at 4000 Hz; 0.059 in low frequencies and 0.62 db in high frequencies. At 8000 Hz the effect of the age at employment on hearing loss was significant (P=0.014). At low frequencies the interaction of smoking and age at employment was significantly related to hearing loss (P˂0.001).   This study showed that despite acquaintance with safety measures, workers still face hearing loss in industry and employers should put workers under more surveillance for using protective gear. Smoking might be another risk factor for hearing loss.

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a relatively common disease with serious impacts on patient quality of life. Recurrence of polyps after functional endoscopic sinus surgery (FESS) is a dilemma. Vitamin D3 (VD3) is known to inhibit the proliferation of nasal polyp-derived fibroblasts. The present study aimed to investigate the effects of oral VD3 on the recurrence of polyposis after FESS. This triple-blind placebo-controlled clinical trial was conducted on 40 patients with CRSwNP who did not respond to medical treatment and were candidates for FESS. In addition, the patients had VD3 insufficiency. Following the surgery, all the patients received routine treatment (i.e., fluticasone spray, irrigation, cefixime 400 mg daily for 10 days, and montelukast for a month). Moreover, the case group received oral VD3 tablets 4000 IU (single daily dose) for a month, and the control group received placebo in the same manner. The Sino-Nasal Outcome Test (SNOT-22) and Meltzer endoscopic grading scores were recorded at months 1, 3, and 6 after the study. In this study, 6 months following the intervention, the severity of polyposis was reported to be significantly lower in the VD3 group compared to the placebo group based on SNOT-22 (16.25±10.16 in the VD3 group vs. 47.45±13.55 in the placebo group; P<0.001) and Meltzer scores (0.50±0.60 in the VD3 group vs. 2.65±0.93 in the placebo group; P<0.001). No adverse effects were observed in the case group.                      This study showed the efficacy and safety of vitamin D supplementation in the reduction of polyposis recurrence after FESS in patients with CRSwNP.

Based on the previous data, among the general population aged between 30 and 60 years, snoring is observed in 44% and 28% of males and females, respectively. Therefore, it is important to treat snoring to reduce the disruption of the bed partner's sleep and the patients’ own problems. This study aimed to present a minimally invasive procedure which is easy to perform with less tissue damage. This study included 13 patients suffering from primary snoring with soft palate length of 2.5cm or more. All of the patients were examined and their partners were asked to fill-out the relevant questionnaires at baselines, 90 days, 6months and 1 year after the surgery in order to assess snoring. A crescent strip of oral mucosa along with the underlying muscle were removed under general anesthesia followed by the insertion of a piece of oval-shaped titanium mesh. Moreover, two subjective methods were employed to assess the snoring of all patients. 11 patients were male, and the mean age and the mean body mass index of the patients were 48.69 years and 28.34 kg/m2, respectively. The scores obtained from the Visual Analog Scale for snoring loudness before surgery reduced from 7.63 to 3.54, which was statistically significant (P<0.05). None of the patients experienced major complications after surgery; however, there was a partial extrusion of the implant in one case which was managed conservatively with spontaneous healing. Titanium snoreplasty was successful in the reduction of snoring in this study. This method is a single-stage treatment of simple snoring with the multiple effects of palatal shortening, space increasing, and palatal stiffening.

Abstract The present study was conducted to investigate the association between the serum vitamin D levels and severity of disease in chronic rhino sinusitis (CRS) patients. This prospective cross-sectional study was conducted on a total of 93 patients suffering from chronic rhino sinusitis with nasal polyposis (CRS w NP). Serum level of 25-hydroxyvitamin D was detected using a simple blood test. A22-item questionnaire, namely the sinonasal outcome test-22 (SNOT-22), was used to assess the subjective disease severity and patients' quality of life. In addition, the radiographic signs of the disease severity were evaluated using the Lund-Mackay Scale (LMS). The mean age and serum vitamin D level of the patients were measured at 37.7±13.6 years and 24.6±16.9 ng/ml, respectively. Moreover, the mean of LMS and SNOT-22 scores were calculated at 14.2±11.2 and 40.8±17.6, respectively. There was a negative correlation between the SNOT-22 and serum levels of vitamin D (P=0.034). Similarly, LMS and serum vitamin D levels were correlated negatively (P=0.027). Furthermore, the results revealed a direct relationship between LMS and SNOT-22 (P<0.0001). According to the obtained results, there was a significant relationship between the serum vitamin D levels and severity of disease in patients with CRS w NP. Therefore, serum vitamin D levels could be added to the routine workup of the patients suffering from CRS w NP.

Various surgical approaches to parapharyngeal space (PPS) tumors are introduced to obtain complete removal with the preservation of the surrounding structures in parapharyngealneoplasms. Here, we will discuss the main techniques and their outcome.   This retrospective study was conducted on 78 patients undergone either transoral, transcervical or a combination of these two approaches for the resection of PSS tumors from January 2010 to January 2015. A number of 33 male and 45 female patients with the mean age of 40.9 ± 9.1 were evaluated. 42.3% of the patients were asymptomatic at the initial presentation. Pleomorphic adenoma and schwannoma were a permanent diagnosis in 61(78.2%) and 11(14.1%) patients, respectively. PPS tumors were resected using transoral, transcervical and combined approaches in 35(44.8%), 33(42.3%) and 10 (12.9%) cases, respectively. Recurrence occurred in 10 patients all of whom had apre-styloid pleomorphic adenoma, operated transcervical (P< 0.0001).Three cases of tenth nerve palsy occurred in schwannomas which were operatedtranscervically (P=0.04). Mean hospital stays were 2.11,3.69, and 4.9 days after transoral, transcervical and combined approaches, respectively (P= 0.001). Transoral, transcervical and combined approaches are all able to provide adequate visualization with comparable outcomes.

Arteriovenous malformations (AVMs) are uncommon vascular lesions that can arise in any part of the body. Case Report: In this case study, we presented a huge AVM of the upper lip in a 70-year-old man that he noticed since 5years ago with slow growth in this period. Computed tomography angiography revealed a large AVM with feeders from the right facial artery and its branch superior labial artery. Right facial artery showed increased diameter and tortuous changes. Selective catheterization of right carotid was performed followed by super selective catheterization of the right facial artery. Then, the embolization of the tumor blush was conducted. Surgical removal of the tumor was carried out10days after the embolization. The AVM treatment is challenging, and there is a high chance of recurrence and progression. Every case should have an individualized approach that needs an accurate diagnosis and a multidisciplinary team.

Giant cavernous hemangioma involving the nose extending to the nasopharynx and oropharynx with complete obstruction of the airway is very unusual and is yet to be described in the literature. In the present case, we have described a giant cavernous hemangioma successfully managed with endoscopic excision. Case Report: A 38-year-old male patient presented with recurrent nasal bleeding for 24 months and progressive obstruction of the right nasal cavity for 8 months. Diagnostic nasal endoscopy showed a greyish mass filling the whole of the right nasal cavity and contrast-enhanced CT scan of the nose and paranasal sinus revealed a large heterogeneous contrast enhanced lesion in the nasal cavity. The endoscopic biopsy was suggestive of cavernous hemangioma. Endoscopic excision was done and the patient has been followed up for the past 12 months without any recurrence of the disease. Cavernous hemangioma is an uncommon benign entity of the nose and paranasal sinus. Due to the nonspecific clinical and radiological pictures, it is often a challenge for the preoperative diagnosis. A high index of suspicion and complete understanding of the clinicopathological profile of the patient is vital as the major differential diagnosis is the sinonasal malignancy simulating with a similar clinical picture.

Rhabdomyosarcoma is the most frequently occurring intrusive soft tissue sarcoma in the pediatric age group. Orbit is the most common location for a pediatric rhabdomyosarcoma, but it can occur in the oral cavity, pharynx, face and neck in the descending order of incidence. Rhabdomyosarcoma in the ear is extremely rare. 

A 5-year-old girl presented to the outpatient department of our tertiary care hospital with complaints of foul smelling, non-blood stained right ear discharge of one-month duration and deviation of angle of mouth to the left side of acute onset. Investigations revealed a diagnosis of embryonal rhabdomyosarcoma. Multimodal therapy was carried out, and the child was rendered disease-free after two years.  

Embryonal rhabdomyosarcoma of the head and neck mimics chronic otitis media. Early diagnosis is essential to deliver prompt treatment and prevent locoregional spread and metastasis.

Elective tonsillectomy remains one of the most commonly performed operations in otolaryngology, with postoperative hemorrhage (PTH) being the most significant potential complication. Anecdotal evidence among ENT Surgeons suggested that bodybuilding athletes may be at increased risk of suffering from PTH, a notion corroborated by a recent case report, regarding primary PTH. The problem has been attributed to muscle-enhancing dietary supplements, or androgenic anabolic steroid abuse, albeit without satisfactory explanation regarding the mechanism of potential action. That is because, blood coagulation tests performed preoperatively are typically normal, and extensive blood coagulation workup postoperatively is not suggestive of any bleeding tendency. We recently came across two cases of PTH in male patients practicing body building. Both were in their mid-twenties, had regularly been using muscle enhancing dietary supplements, and occasionally androgenic anabolic steroids; the first up to four months preoperatively, whereas the second was still an active user at the time of the tonsillectomy. The first patient experienced five episodes of PTH, from the fourth until the 23rd postoperative day, and required bipolar cautery in theatre on the first two occasions, with the latter three episodes being managed with oxygen peroxide-soaked tamponade in an outpatient setting. The second patient experienced persistent intraoperative bleeding and two postoperative PTHs on the first and 11th day, requiring bipolar cautery in theatre. Pre- and postoperative blood coagulation workup were normal in both patients, and abdominal U/S did not suggest a fatty liver. Hence, the condition of the tonsillar vasculature remained as the last potentially implicated part of the patients’ bleeding tendency. Indeed, vascular fragility resulting from pressure and minor traumas is known to be a potential complication of hypercorticism (i.e. anabolic steroid abuse), and incipient vasculitis may be associated with high protein and amino-acid intake for muscle enhancement, due to the occurring oxidative stress and the ensuing free radical cascade. PTH is a common emergency encountered in ENT surgical practice, affecting 2.5-4.1% of patients with normal coagulation studies. However, bodybuilding enthusiasts may represent a subgroup of an otherwise healthy population with higher potential risk of PTH, not only requiring appropriate preoperative informed consent, with frank account of the substances used for performance enhancement, but also increased perioperative vigilance, and prolonged period of postoperative observation. ENT Surgeons should be aware of the increased possibility of PTH even in apparently healthy and fit bodybuilding enthusiasts, and the necessity of repeated surgical management in most of these cases.