فهرست مطالب

Otorhinolaryngology - Volume:32 Issue: 4, 2020
  • Volume:32 Issue: 4, 2020
  • تاریخ انتشار: 1399/04/11
  • تعداد عناوین: 10
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  • Soudabeh Haddadi *, Shideh Marzban, Arman Parvizi, Shadman Nemati, Aamer Chohdari, Zahra Atrkar Roshan, Hedieh Ramezani Pages 197-205
    Introduction
    Adenotonsillectomy is the main treatment for symptomatic tonsillar hypertrophy with postoperative pain as the most common associated complication. The present study aimed to compare the efficacy of gabapentin with that reported for acetaminophen on the postoperative pain of adenotonsillectomy in children.  
    Materials and Methods
    In this double-blind clinical trial, a total of 60 children within the age range of 7-15 years undergoing adenotonsillectomy were randomly allocated to two groups of gabapentin (n=30) and acetaminophen (n=30). The first group received a 10 mg/kg dose of gabapentin suspension preoperatively and placebo (suppository) after the intubation. The second group received a 40 mg/kg dose of acetaminophen suppository and placebo suspension simultaneous with that in the case group. Using the pain scale (based on the scoreof visual analog scale, prescribed drugs, dosage as well as incidence of postoperative nausea and vomiting were recorded 0, 2, 4, 6, 12, and 24 h after the surgery. The data were analyzed using SPSS software (version 22.0). A p-value less than 0.05 was considered statistically significant.  
    Results
    There was no significant difference between the two groups considering the pain scores at 0, 2, 4, 6, 12, and 24 h after the surgery. In addition, the trend of pain intensity statistically decreased within 0 to 24 h in both acetaminophen (P<0.001) and gabapentin (P<0.001) groups. No statistically significant difference was observed between the two groups regarding the postoperative incidence of nausea and vomiting.  
    Conclusion
    The obtained results of the present study showed that the administration of gabapentin and acetaminophen significantly reduced the postoperative pain of tonsillectomy and need for narcotics in these patients after the surgery. However, in this study, there was no particular reported superiority for any of the two groups in terms of the effects of gabapentin suspension and rectal acetaminophen.
    Keywords: Acetaminophen, Adenoidectomy, Gabapentin, Pain, Tonsillectomy
  • Arvinder Singh Sood, Pooja Pal *, Gurupreet Singh Gill Pages 207-212
    Introduction

    Various efforts have been made to reduce post tonsillectomy pain in children. The present study was undertaken to evaluate the efficacy and safety of Ropivacaine in post-operative pain management in these children.

    Materials and Methods

    This study is a Randomized control study on 140 patients between 4 - 12 years of age, in whom tonsillectomy was performed in a tertiary care centre between January 2017 to November 2018 using standard dissection and snare surgical technique. Postoperatively, patients were randomized into 2 groups of 70 patients each, receiving tonsillar fossa infiltration with 0.2% Ropivacaine or 0.9% normal saline respectively. Patients were assessed as per Wong Baker’s Faces Scoring System at 2 hours, 4 hours, 8 hours, 18 hours, 24 hours, and 48 hours postoperatively.  All the results were analyzed by SPSS software. Chi- square test and Mann-Whitney test were used for assessment of level of significance, with P- value of less than 0.05 taken as significant.   

    Results

    Both the groups were comparable with respect to age and sex. At 48 hours, in study group, maximum number of patients 35 (50%) had Wong Baker score 0, while in control group, maximum number of patients 52 (74.3%) had Wong Baker score 4 (P< 0.01). The difference in the mean Deglutition time between both groups was significant (P< 0.01).

    Conclusion

    Ropivacaine infiltration is a effective modality for post-tonsillectomy pain management in children, with minimal side-effects.

    Keywords: Post operative analgesia, Ropivacaine, Tonsillectomy
  • Lum Sai-Guan *, Salina Husain, Farah Dayana Zahedi, Norfazilah Ahmad, Balwant Singh Gendeh Pages 213-222
    Introduction

    Sniffin’ Sticks smell identification test is a tool used for evaluation of olfactory function but the results are culture-dependent. It relies on the subject’s familiarity to the odorant and descriptors. This study aims to develop the Malaysian version of Sniffin’ Sticks smell identification test suitable for local population usage.

    Materials and Methods

      The odorant descriptors and distractors of the original version of Sniffin’ Sticks were translated into Malay language. It was then tested for familiarity and identifiability in 30 normosmic subjects. The descriptors were replaced until the familiarity of all descriptors and identification rates of odorants achieved ≥ 70%. The validity of the new cultural-adapted version was tested in 60 hypo-anosmic subjects and 60 normosmic subjects with Student t-test. The test-retest reliability was evaluated after two weeks with interclass correlation.

    Results

    Two odorant descriptors and nine distractors achieved familiarity <70% (13.3% - 66.7%) and were replaced. Another three culturally inappropriate distractors were also replaced. The mean score among the healthy subjects was significantly higher than the subject with smell dysfunction [13.7 (1.12) and 7.3 (3.42); t= 7.24 (df= 34.23), P<0.001]. The coefficient of correlation (r) between test and retest scores was 0.93 (P<0.001).

    Conclusion

    The cultural adapted Malaysian version of Sniffin’ Sticks smell identification test is valid and has high test-retest reliability. This is the first smell identification test validated in Malaysia. It is effective for evaluation of olfactory function in local population.

    Keywords: cultural adaptation, Olfaction, Smell, Smell Identification, Sniffin’ Sticks
  • Ebrahim Karimi, Reza Erfanian, Payman Dabirmoghaddam, Saeed Shakiba, Saeed Sohrabpour * Pages 223-227
    Carbon dioxide (CO2) laser surgery as a conservative tool plays a peculiar role in the management of head and neck cancer. Numerous patients who were candidates for transoral laryngeal microsurgery have forced us to eliminate frozen-section evaluation of surgical margins and use a magnified view of the larynx. The present study evaluated surgeon-judged negative margins with permanent microscopic pathologic evaluation.  
    Materials and Methods
    In this cross-sectional study, we evaluated the permanent pathologic margins of the resected laryngeal specimen which were considered negative by judgment of surgeons. Patients consisted of 61 pathologic proven T1-T2 laryngeal squamous cell carcinoma (SCC) cases. In all patients, tumor resection was performed via a transoral route with CO2 laser, and no residual laryngeal tumor was observed according to judgment of the surgeon. The patients with positive margin (s) underwent another resection. Patients were followed up for 18 months for tumor recurrence.  
    Results
    The obtained results demonstrated that pathologic margins were reported in 6 patients, with the deep margin being the most common positive margin. During the 18-month follow-up, 8 cases of recurrence were detected.  
    Conclusion
    Judgment of the surgeon was in agreement with permanent pathologic evaluation in transoral laryngeal laser resection at the early stages of laryngeal SCC in most cases. Nevertheless, it is suggested that further direct studies be conducted to evaluate the frozen section on oncologic outcomes in transoral laser surgery for laryngeal cancer.
    Keywords: Laryngeal Squamous Cell Carcinoma, Laser microsurgery, Pathological study
  • Atta Heidari *, Abdollah Moossavi, Fariba Yadegari, Enayatollah Bakhshi, Mohsen Ahadi Pages 229-236
    Introduction
    Aging reduces the ability to understand speech in noise. Hearing rehabilitation is one of the ways to help older people communicate effectively. This study aimed to investigate the effect of vowel auditory training on the improvement of speech-in-noise (SIN) perception among elderly listeners.  
    Materials and Methods
    This study was conducted on 36 elderly listeners (17 males and 15 females) with the mean±SD of 67.6±6.33. They had the normal peripheral auditory ability but had difficulties in SIN perception. The samples were randomly divided into two groups of intervention and control. The intervention group underwent vowel auditory training; however, the control group received no training.  
    Results
    After vowel auditory training, the intervention group showed significant changes in the results of the SIN test at two signal-to-noise ratios of 0 and -10 and the Iranian version of the Speech, Spatial, and Qualities of Hearing Scale, compared to the control group (P<0.001). Regarding the Speech Auditory Brainstem Response test, the F0 magnitude was higher in the intervention group (8.42±2.26), compared to the control group (6.68±1.87) (P<0.011).  
    Conclusion
    This study investigated the effect of vowel auditory training on the improvement of SIN perception which could be probably due to better F0 encoding and receiving. This ability enhancement resulted in the easier perception of speech and its more proper separation from background noise which in turn enhanced the ability of the old people to follow the speech of a specific person and track the discussion.
    Keywords: Aging, Fundamental Frequency (F0), Speech-in-Noise Perception, Vowel Auditory Training
  • Ali Kouhi, Sasan Dabiri, Alireza Mohseni *, Mohammadtaha Kouchakinezhad Eramsadati Pages 237-241
    Introduction
    More and more patients are using the Internet to achieve information these days. Most patients (85%) use search engines to look for information about health. The quality of this information that patients encounter is highly different. This study aimed to assess the quality of information that an ear, nose, and throat patient would encounter when searching for information about their problem.  
    Materials and Methods
    The Persian keywords of most common otolaryngology problems were searched in Google. Moreover, the first 10 websites were selected by each search for the analysis using the DISCERN instrument. This instrument is made to evaluate the comprehensiveness and quality of health-related websites.  
    Results
    A total of 100 websites were evaluated in this study. However, 12 (12%) websites were excluded from further analysis due to copyright problems, advertisements, traditional treatments, and other reasons. The total DISCERN score for all 88 evaluated websites was obtained at 1.89 (SD=0.49). Moreover, the highest and lowest scores were 3.66 and 1.21, respectively. The search for “otitis treatment” had the highest results (mean DISCERN score=2.20, SD=0.38). The statistical analysis showed that the mean score for the Wikipedia.com Persian website was significantly higher, compared to the other Persian websites (P< 0.001).  
    Conclusion
    Persian websites have information with variable quality for the treatment of otolaryngology problems. Repeated websites, such as Wikipedia.com provided better information; however, the total quality of information was not satisfying.
    Keywords: Google, health, internet, Quality
  • Shruti Ranjan *, Nikhil Arora, Deepika Sethi, Daljeet Kaur, Gyanesh Sethi Pages 243-247
    Introduction

    Brachial plexus schwannomas are extremely rare tumours of the head and neck region accounting for less than 5 % overall. Due to its rarity and anatomic complexity of the brachial plexus, schwannomas in this region present a diagnostic and surgical challenge to the surgeon. 

    Case Report

    We present a case of a 56-year-old female who presented with a slow growing right sided neck swelling associated with pain and tingling in the distal end of the right forearm. According to FNAC, imaging studies results, a diagnosis of benign neurogenic tumour possibly schwannoma was made. After taking proper consent patient underwent surgical excision of the tumour. Postoperatively, patient developed numbness and tingling in right arm and stiffness at elbow joint, which is showing improvement after regular physiotherapy sessions.  

    Conclusion

    Although brachial plexus schwannomas, extremely rare head and neck tumours, should be kept as a differential diagnosis in patients presenting with supraclavicular neck swellings. These are potentially curable lesions. As such, detailed history and examination together with imaging studies is important is establishing a preoperative diagnosis for proper management.

    Keywords: Brachial Plexus, Neurofibroma, Schwannomas
  • Abdoreza Naser Moghadasi, Maryam Poursadeghfard *, Tayebeh Kazemi, Samaneh Hosseini Pages 249-253
    Introduction

    Multiple sclerosis (MS) is a lifelong disease of the brain and spinal cord. Fingolimod is an oral drug which modulates the S1P receptor and is used for relapsing remitting form of MS and can causes rebound activity if it is ceased even in a short period of washout time. 

    Case Report

    Here, we introduce a young girl, a known case of MS, who developed reversible isolated unilateral sensory-neural hearing loss along imaging activity two weeks after stopping fingolimod. The patient responded well to the intravenous corticosteroid therapy which is the first line treatment of new MS attack.  

    Conclusion

    fingolimod cessation can cause rebound activity in a short period of the time. It is important to consider any new neurological sign and symptom as a rebound activity during washout time. Although SNHL is not common in MS, it could be presented as an unusual manifestation of rebound relapse after stopping fingolimod.

    Keywords: Fingolimod, Multiple Sclerosis, Rebound activity
  • Rakesh Bambore Suryanarayan Rao, Bharathi Murundi Basavarajaiah *, Sreenivas Kamath Kasaragod, Thanzeem Unisa Pages 255-258
    Introduction

    Extra-pulmonary tuberculosis (EPTB) arising in extra-oral region in head and neck are rare, and when swellings arise from other sites such as infraorbital region, cheek, etc, tuberculosis is not usually considered for the differential diagnosis (DD) and often the diagnosis is missed and appropriate treatment is delayed.

    Case Report

    We report a rare entity of primary tuberculosis, which presented as infraorbital swelling and our technique of performing sublabial approach to the swelling with endoscopic guided excision of the swelling and also we have review of literature of similar cases of primary tuberculosis presenting as swelling over the face over the past 5 year.

    Conclusion

    Primary EPTB should be considered as DD in cases of chronic facial swelling.

    Keywords: Extra pulmonary primary tuberculosis, Infraorbital tuberculosis, Sublabial endoscopic approach
  • Ashwin Chandra Veni *, Kannan Asokan, Krithika Chndrasekar Sekar, D. Parimala, Kanmani Shanmuga Sundaram, Yesoda Aniyan Pages 259-262
    Introduction

    Choristoma is a non-neoplastic growth of normal tissues in non-indigenous site of origin. Osseous Choristoma is an ectopic bone formation which is a rare entity with 72 cases has been reported in the tongue, 15 cases in the buccal mucosa, 1 case in the lower lip.  

    Case Report

    A 43 year old male patient experienced a mild, intermittent, dull aching type in the upper lip. An excisional biopsy was done by placing a single incision under local anesthesia. To our knowledge case is first to be reported in the upper lip as a result of reactive pathogenesis.  

    Conclusion

    As per literature, surgical excision is the treatment of choice for osseous Choristoma. Malignant transformation has not been reported yet.

    Keywords: Choriostoma, Mature bone, Osseous choriostoma, Osteocytes