Iranian Journal of Otorhinolaryngology
Volume:32 Issue: 6, Nov Dec 2020

Tympanoplasty is a surgical treatment of tympanic membrane perforation. Many efforts have been made to increase the success rate of tympanoplasty. Some studies confirmed the positive role of estrogen in wound healing. The current study was conducted to evaluate the effect of topical estrogen on the success rate of tympanoplasty.   A total of 85 patients were randomly assigned to the case and control groups. Otomicroscopic examination was performed before and 3 months following the operation. At the final stage of tympanoplasty, gelfoam was placed on the lateral side of the graft. It was soaked in dexamethasone in the control group and combination of dexamethasone and estradiol valerate solution in the case group. Hearing thresholds were measured by audiometric tests pre- and postoperatively. Hearing levels were assessed as the mean air conduction (AC) at 500, 1000, and 2000 Hz. The graft status was evaluated using otomicroscopic examination 3 months following the operation.   Otomicroscopic examination revealed successful graft healing in 23 of 37 and 29 of 36 patients in the control and case groups, respectively. A higher rate (80.55%) of graft repair was observed in the estradiol group, compared to that (62.16%) reported for the control group; however, the difference was not statistically significant (P=0.08). The average improvement values of the AC levels were 20.45 and 24.7 dB in the control and case groups, respectively (P=0.3). Statistical analysis among the subgroup of patients with small perforations showed that the success rate of tympanoplasty was significantly higher in the estradiol group, compared to that reported for the control group (P=0.03).   Although topical estrogen was generally ineffective in increasing the success rate of tympanoplasty, it improved the success rate among patients with small tympanic membrane perforations.

During functional neck dissection, the surgeon tries to preserve the internal jugular vein (IJV); however, the incidence of its narrowing or obstruction following modified radical neck dissection (MRND) or selective neck dissection (SND) varies between 0% and 29.6%. The most distressing complication of IJV thrombosis (IJVT) is pulmonary embolism. This study aimed to evaluate the incidence of IJVT following selective or modified radical neck dissection.   

In this study, 109 neck dissections were performed with the preservation of the IJV on 89 patients from March 2011 to December 2012 in the Cancer Institute of Imam Khomeini Hospital Complex, Tehran, Iran. Ultrasound evaluation of the IJV was performed in the early postoperative period and three months after the surgery.  

The study population consisted of 62 male and 27 female patients with a mean age of 57+17.57 years. Ultrasound evaluation of the IJV among the participants (109 veins) indicated thrombosis in nine veins (8.25%) in the early postoperative period, four of which remained thrombotic and without flow three months after the surgery. Moreover, 96.33% of the IJVs were patent with a normal blood flow three months after the neck dissection. Among the evaluated IJVs, the only factor that showed a significant association with IJVT was the incidence of postoperative complications, including hematoma and seroma (P=0.01).
 

It seems that the most important factor for the prevention of the IJVT is a meticulous surgery and surgical complication avoidance during neck dissection.

Introduction :

Simple Snoring is low frequency sound without obstructive sleep apnea, produced mainly from vibration of the upper airway wall in the soft palate; it can be bothersome and may causes social problems. So the aim of this study is an attempt for relieving simple snoring though, stiffening the soft palate via transoral diode laser palatoplasty.                                                                     

Materials and Methods  :

 Forty six adult patients with socially troublesome snoring were recruited in this stuy. Adequately history was taken to rule out witnessed evidence of obstructive sleep apnea. Then full otolaryngological examination, with soft palate vibration grading assessment by Muller maneuver were followed, consequently the eligible patients were underwent transoral 810 nm diode laser palatoplasty under local anesthesia and followed-up 6 months post-operatively.

Results:

  Theloudness of subjective snoring assessed by visual analogue score (VAS) was relieved from 6.6 to 2.4 and by Muller maneuver was improved from 2.7  to 1.9, and for the frequency from 2.1 Hz to 0.3 Hz, and from 2.4 Hz to 0.55 Hz for the duration pre to post-operative with P value of 0.75 to 0.023 respectively,  So the overall frequencies of improvement of snoring loudness results had revealed a total improvement (no snoring) were detected in 4 patients,  and moderate improvement had been found in 30 patients,  while mild improvement of snoring had been seen in 10 patients, however about  2 patents got no benefit from the surgery.

Conclusion:

 Stiffening of the soft palate by diode laser had shown to be significantly beneficial in relieving the snoring intensity as it had a positive impact on its subjective loudness, frequency and duration.

Attention deficit hyperactivity disorder (ADHD) has the highest prevalence among psychiatric disorders in children. The present study investigated the effect of adenotonsillectomy on the symptoms of ADHD in a 6-month follow-up.
 
This cross-sectional study was performed on 100 patients referred for respiratory problems during sleep due to adenotonsillar hypertrophy (ATH). The patients’ parents were asked to complete the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition checklist as a standard benchmark for ADHD before, 2 weeks, and 6 months after the surgery. The data were analyzed by SPSS software (version 20) through paired t-tests and McNemar’s test.
 
The age averages of male and female children were 7.15 and 8.4 years, respectively. The frequency of ADHD in the studied population was 30%, which is much higher than the prevalence of this disorder in the normal population. In the second week after the surgery, the mean score of ADHD decreased from 4.97±2.97 (attention deficit [AD]) and 6.77±1.61 (hyperactivity disorder [HD]) before the surgery to 3.86±2.25 (AD) and 4.28±2.02 (HD) 2 weeks after the surgery (P=0.001). After a 6-month follow-up, these figures further decreased (AD=2.34±2.32; HD=1.97±2.44; P<0.001).
 
Adenotonsillectomy had a significant effect on the improvement of ADHD symptoms. There is a necessity for checking patients with ADHD for ATH, especially in case of sleep disorders, sleep apnea, snoring, or mouth breathing.

The aim of this paper is to present our experience with combined endoscopic-transcutaneous approach in terms of effectiveness and safety in patients with large or impacted parotid stones.   This is a prospective study carried out from August, 2012 to February, 2017 analyzing 21 patients with parotid sialolithiasis. The indication of combined approach was either failed attempt to remove the stone endoscopically, large size (>4mm), or impacted stone. The exact location of the stone was pointed out by endoscopic transillumination and the stone was removed via transcutaneous incision which could be linear incision or a preauricular incision followed by stenting for 3 weeks. We were successfully able to remove the stone in all 21 cases using modified Blair’s incision in 18 cases, while a linear incision was used in remaining 3 cases. Two patients developed stricture in the post-operative period at 5 and 3 months, respectively. The strictures were successfully dilated endoscopically and the patients are asymptomatic ever since.   Combined endoscopic-transcutaneous approach is a highly successful approach with few complications for removal of parotid stones and thus resulting in high gland preservation rates in patients of parotid sialolithiasis.

Office-based laryngeal biopsy (OBLB) may provide a histological examination of laryngeal lesions in patients who cannot undergo a direct laryngoscopy. Nonetheless, only scarce information regarding its clinical applicability in these patients are available. The study’s aim is to report the feasibility of OBLB in patients ineligible for direct laryngoscopy.   A total of 55 patients presenting with laryngeal lesions requiring biopsy but ineligible for direct laryngoscopy because at risk for general anesthesia were consecutively enrolled. OBLB was performed using a flexible endoscope with a 2 mm instrument channel under local anesthesia on an outpatient basis. The biopsied lesions were categorized according to their location, morphology, and histology (benign, premalignant, and malignant). In case of malignancy the patients started non-surgical treatment; otherwise, the patients were scheduled for a close follow-up.   OBLB was well tolerated and no complications occurred. Laryngeal lesions were more frequently located in the glottic region (28 out of 55 patients), while the most frequent morphology was ulcerative (35 out of 55 patients). The histological examination revealed 34 cases of malignancy, 9 cases of premalignancy, and 12 cases of benign lesions. In none of the patients without malignancy the laryngeal lesion showed significant changes during the follow-up period and a re-biopsy was not performed.   In patients ineligible for direct laryngoscopy under general anesthesia OBLB could be considered as a sound-alternative method to assess the histology of suspected laryngeal lesions.

Introduction:

 Tracheostomy is done to bypass the obstructed upper airway. Rare complication of this procedure is the fracture of the tube. Early identification and management of this condition is a great challenge to an otolaryngologist. To study the factors associated with the fracture and migration of tracheostomy tube into tracheobronchial tree in paediatric age group.  

This study is a case series study conducted on children with a diagnosis of fractured tracheostomy tube presenting as a foreign body airway over five years duration. Data regarding the possible patient and tube factors responsible for the condition were collected and analysed.  

Total 11 patients (males-5 and females-6, average age-10.18 years, range 1-15 years) wearing tracheostomy tube for an average period of 2 years (range 3 months-8 years) were included in the study. Aspirated tubes were Jackson’s metallic inner tube, Romson polyvinyl chloride plastic tube and Fuller’s outer tube flange in 5 (45.5%), 4 (36.4%) and 2 (18.1%) patients respectively. The most common fracture site was at the junction between tube and neck plate (90.9%). The most common causes for fracture tube were prolonged use in 10 cases (90.9%), stomal narrowing in 9 cases (81.8%), and infection with peri-stomal granulation tissue in 9 cases (81.8%).   

A fractured tracheostomy tube is a rare but preventable late complication of tracheostomy. Appropriate training about proper tracheostomy care, timely check-up of tracheostomy tube for signs of wear and tear, scheduled replacement, regular follow up and awareness may prevention this complication.

Ancient schwannoma of infratemporal fossa arising from the trigeminal nerve is very rare in clinical practice.  

A 65-year old male presented to the outpatient department with a progressive swelling over the left parotid for 5 years and pain during chewing for 6 months which was diagnosed as benign spindle cell tumour on cytology. The tumor was excised with a combined transparotid and transmandibular cervical approach and the final pathology was confirmed to an Ancient Schwannoma.  

A giant infratemporal fossa Schwannoma extending to the parapharyngeal space masquerading as a parotid swelling is very unusual. Transparotid transmandibular excision of the infratemporal fossa tumor is an effective approach ensuring complete removal of the tumor with minimal postoperative complications and acceptable cosmoses.

Ectopic thymus is an uncommon cause of neck masses in children that frequently present as lateral cervical swelling especially on the right side.

Case Report:

 We report two cases with atypical clinical presentation of ectopic thymus and superior herniation of normal thymus. Both of the patients manifested as intermittent midline mass at the suprasternal region during Valsalva manuevre. Unique ultrasound features with the location along the thymic descent together with dynamic assessment of the organ movement were essential to reach the correct diagnosis. Conservative approach was considered in these patients considering the necessity of thymus in the process of puberty.  

High index of suspicion is of utmost importance when encounter patient with similar clinical manifestation to avoid unnecessary diagnostic modalities and surgeries. Accurate diagnosis will also alleviate parents’ anxiety.

Chronic sclerosing sialadenitis (Küttner tumor) is a relatively uncommon and often under-recognized cause of salivary gland enlargement, characterised by sclerosing IgG4-related inflammation, producing a hard swelling of the gland that mimics malignancy. The name tumor is tricky and misleading, in fact the disease has no histological features of malignancy, but still it cannot easily be distinguished from cancer because of its hard consistency to touch.

Case Reports:

We aim to report three cases of Küttner tumor and to review morphological MRI features (homogeneous T1- and T2-hypointensity, homogeneous contrast enhancement) and diffusion weighted imaging findings (low ADC values) which can help radiologists to reach the correct diagnosis.

Definite diagnosis of Küttner tumor is histopathological. However imaging features are straightforward and can address radiologists toward the correct diagnosis.