Iranian Journal of Otorhinolaryngology
Volume:32 Issue: 5, Sep-Oct 2020

Operations on the tympanic membrane of the middle ear, myringoplasty, and tympanoplasty are now widely accepted, and attempts are underway all over the world to standardize the surgical techniques. This study aimed to compare postoperative outcomes of endoscopic and microscopic cartilage myringoplasty in patients suffering from chronic otitis media (COM).   This clinical trial study compared 130 patients with COM who underwent transcanal endoscopic myringoplasty by repairing perforation using auricular concha cartilage under general anesthesia (n=75) and conventional repairing method by postauricular incision and tympanomeatal flap elevation under microscopic surgery (n=55).   According to the results, there was no significant difference between the two groups in terms of hearing gain 1, 6, and 12 months after surgery (P=0.063); however, higher hearing gain scores were observed in the endoscopic group. Moreover, lower recovery time and post-operative pain were reported in patients who underwent the endoscopic approach, compared to those who treated with the conventional repairing method (P<0.001).   Endoscopic myringoplasty technique is a safe and effective way to improve hearing loss as much as the conventional method. However, due to the lower recovery time and post-operative pain, it seems to be the method of choice in myringoplasty surgery.

The performance in most smell identification tests is subjected to cultural variations. This study aimed to evaluate age, gender, and smoking-related effects on the test performance in the North of Iran.

The olfactory function of 1470 eligible subjects was assessed in this study. Moreover, this study evaluated the influence of age, gender, and education on the test scores.

According to the results, females obtained higher mean test scores, compared to males (18.4 vs. 17.6). In general, the elderly obtained lower scores, and about 30% of the subjects who were ≥65 years of age had severe hyposmia or anosmia. Furthermore, the olfactory impairment frequency in smoker subjects was significantly more than non-smokers (P<0.001). Test scores were generally higher in subjects with higher education levels. Logistic regression analysis revealed that the total number of cigarette doses in smokers and age had a significant association with olfactory dysfunction (P value <0.001 and 0.004, respectively). Cronbach’s α of Iran-SIT was obtained at 0.78 which was more than an acceptable value of 0.7.

The findings of this study revealed that a low score in the Iran-SIT correlated with smoking, older age, low education level, and gender (male).

Kashima operation, also known as endoscopic laser cordotomy is used for the treatment of bilateral abductor vocal cord palsy where the glottis chink is made posteriorly, sufficient enough for patient to breathe comfortably without any strider.

This Clinical Trial Was Performed On 12 Patients[1] with Bilateral Abductor Vocal Cord Paralysis. All Patients Underwent Kashimas Procedure and Post-Operative Voice, Respiratory and Deglutition Function Were Evaluated.

75% of patients were females and the mean age of patients was 40.9 ±9.13 years. In our patients, the most common etiology of bilateral vocal cord palsy was thyroid surgery (n=10, 83.33%).There was a significant improvement in breathing after surgery (P=0.001). After the procedure, 70% of patient had mild voice handicap score, and MPT was in normal range in 91.6% of cases.

Kashimas procedure is a satisfactory surgical treatment for treating bilateral vocal cord palsy in regards to strider. No aspiration was seen in any of the patients post-surgery and voice outcome of these patients was also satisfactory.

Eustachian tube (ET) dysfunction is a common clinical entity but its treatment is still challenging to Otorhinolaryngologists. This study is done to know the effectiveness of transnasal endoscopic balloon dilatation of eustachian tube for treatment of chronic eustachian tube dysfunction.
 
It is a retrospective observational study conducted between May 2018 to June 2019 at IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India. Twenty one patients were identified with diagnosis of ET dysfunction and assigned to this study. The transnasal endoscopic procedure was done to dilate the cartilaginous part of the eustachian tube with a balloon catheter. Preoperative computed tomography was done in all cases. All patients were post-operatively assessed in 1st, 2nd and 8th weeks after the procedure.
 
Balloon dilatation of the eustachian tube was easily performed in all cases of this study. No abnormality including carotid canal was seen before this procedure. All except 2 cases revealed significant improvement in the ET functions. There was no damage to any vital structures like internal carotid artery in this study.
 
The majority of the patients participated in this study showed positive outcome after balloon dilation of eustachian tube. It is a feasible and safe procedure for dilating the eustachian tube. This treatment is a very promising and requires more research on this aspect.

Rhinoplasty is one of the most common surgical procedures performed among Iranians. An important issue to be considered by nasal surgeons is anatomical variations between different ethnic groups. Working on Iranians with the existing ethnic variety encourages the need for an analysis of this particular population.  

The present cross-sectional observational study was conducted on Iranian patients who underwent primary open rhinoplasty at a university hospital in Tehran, Iran. The preoperative evaluations included routine aesthetic analysis as well as the measurement of the subcutaneous fat thickness (using ultrasound imaging) and the angle between the anterior nasal spine and the alveolar process of the maxilla. Intraoperative assessments were performed on the alar rim-inferior border of lateral crus distance, maximal width of lateral crus, connection pattern of upper lateral cartilage, and lower lateral cartilage. Alar cartilage thickness was measured with microscopic evaluation. Moreover, the similar studies conducted on other ethnic groups were reviewed as well.  

In total, 66 cases were included in the study (41 females and 25 males) who were within the age range of 18-38 years old (27.82±5.51). According to the results, nasolabial angles were 93.68°±7.82° and 92.25°±6.98° in females and males, respectively. In addition, a significant correlation was found between the anterior nasal spine-maxilla angle and nasolabial angle (p <0.05). Moreover, the findings revealed a significant but weak negative correlation between alar subcutaneous fat thickness and alar cartilage thickness (0.0002). Maximal width of lateral crus was found to be 11.44mm±2.02 and 10.41 mm±1.72 in males and females, respectively.  

Despite the differences observed between various ethnic groups, drawing a definite conclusion about these variations needs comparative studies with similar samples (cadaver vs. patients) and measurement techniques.

The Study Aimed To Compare The Results of Cryosurgery With Trichloroacetic Acid Chemical (TCA) Cautery For The Treatment of Hypertrophied Nasal Turbinates.

This was a prospective study of 70 patients with nasal obstruction due to hypertrophied nasal turbinates who were randomly divided in 2 groups of 35 each. In group 1, patients underwent inferior nasal turbinate reduction by cryosurgery and in group 2 patients with cautery by 50 % TCA. The patients were evaluated using SNOT-20 score pre and postoperatively on 6th month.

Significant improvement in symptoms was seen in 28 patients (80 %) in group 1 and in 10 patients (28.57%) in group 2..Improvement in average SNOT Score after cauterization of hypertrophied nasal turbinates by cryosurgery was from 55(severe) to 16(mild) and by TCA was from 54(severe) to 32(mod) in 6 months and this was statistically significant (p <0.001). Complications like bleeding, scarring, infection and adhesion formation were more with TCA than that of cryosurgery group and among these complications scarring was statistically significant (P =0.003).

The use of cryosurgical treatment for hypertrophied nasal turbinates is a safe, curative method as compared to that of TCA cautery which is less curative and with more complications.

The majority of the daily life activities involve the concurrent performance of simultaneously challenging motor and cognitive activities, such as talking while walking, which requires the vestibular system for balance. Functional balance allows the brain to interpret and integrate the sensory information from our physical and social environment. This study aimed to investigate the effect of cognitive activities on the vestibular system function.  

This study investigated the otolith system as a sensory organ that is responsible for linear acceleration by recording ocular vestibular evoked myogenic potential (oVEMP) in 28 healthy participants (11 males and 17 females) with the age range of 18-26 years under a cognitive condition. The rest and intervention states were compared in terms of oVEMP n1-p1 amplitude, n1-p1 latencies, and gender.  

The results showed that the oVEMP n1-p1 amplitude in both ears significantly decreased, and the asymmetry increased after cognitive tasks, compared to the rest state in females (P≤0.02). Moreover, there was no significant difference between the rest state and numeric subtraction task in terms of oVEMP n1-p1 latencies in males and females (P>0.05).  

These results suggest that an augmented cognitive load causes an alteration in the oVEMPs; therefore, it is suggested that the structures associated with the cognitive processing are connected with the vestibular system in the brain. These findings demonstrate the importance of non-vestibular factors in balance, especially in females.

Acne is a common complain among post rhinoplasty patients. While rhinoplasty is done for aesthetic reasons and acne expressively affects the individual’s appearance, we aimed to study its incidence and role players.

A descriptive cross-sectional study was performed on 152 (143 females and 9 males) patients admitted for rhinoplasty during January 2016 to March 2017. Patients were examined by a dermatologist prior to surgery and 7, 30 and 90 days after rhinoplasty using the Global Acne Grading System and responded to a list of questions on the probable risk factors of acne. Psychological status was examined by the perceived stress scale-14 and the Hospital Anxiety and Depression Scale.

The patients' mean age was 28.9±3.82 yrs. Mild and moderate acne were observed in 21.7% (n=33) of the cases in the preoperative visit. The incidence of mild and moderate acne was 36.1%, 42.8% and 23% after 7, 30 and 90 days of surgery, respectively. One week after rhinoplasty, acne manifested in 14.9% of cases with no history of acne. Mean age significantly differed between those with and without post-surgical acne at all post-surgical visits (P> 0.001 and P=0.001 and P=0.015, respectively). Hospital anxiety and depression and perceived stress levels were significantly higher in patients who presented with acne on the first post-surgical visit compared to those with no acne presentations (P=0.04 and P=0.02, respectively).

External psychological stress may be the main role player in post-rhinoplasty acne. Consultation or referral of patients to an experienced psychologist

Colon adenocarcinoma is one of the foremost causes of cancer mortality. Oral metastasis of colon adenocarcinoma is, however, rare and indicates an end-stage disease process.  

We report a case of a 69-year-old female with a gingival mass diagnosed with colon adenocarcinoma and liver metastasis after one year. A swelling was found in the maxillary right buccal and lingual gingiva during physical examination. Tissue biopsy revealed an intestinal metastatic adenocarcinoma. The patient underwent chemotherapy for treatment. We also reviewed all reported cases of gingival metastasis due to colon adenocarcinoma.  

Careful examination of the oral cavity in patients with the adenocarcinomas of various organs is beneficial in the early diagnosis of metastasis since the most frequent metastatic lesion of the oral cavity is adenocarcinoma.

Arteria lusoria is an aberrant right subclavian artery. In symptomatic cases, patients report dysphagia and only in few cases dyspnea, due to external compression of the trachea and esophagus. Symptoms occur in advanced age and diagnosis is made with chest HRCT, when other causes of dysphagia have been excluded.   

An 83-year-old woman presented with dyspnea and mechanical dysphagia for solids. Therefore, she did a chest high-resolution computed tomography (HRCT) that showed areas of consolidation of the lung parenchyma, pleural effusion and presence of arteria lusoria, with a retroesophageal course. After 18 days, dysphagia and dyspnea worsened. The new chest HRCT revealed bilateral atelectasis of the lower lung lobes and severe compression of esophagus and trachea along the course of the arteria lusoria.  

Considering its dangerousness, this vascular anomaly should be considered in advanced aged patients with dysphagia and dyspnea, once other causes have been excluded.