Iranian Journal of Otorhinolaryngology
Volume:34 Issue: 3, May-Jun 2022

Tympanoplasty is a common surgery for chronic otitis media and has conventionally been performed with a microscope for decades. The trend of endoscopic minimally invasive surgeries has been increasing worldwide for the last few decades. Few studies have discussed the outcomes of microscopic and endoscopic tympanoplasty. This study aims to compare results of tympanoplasty done with microscope vs endoscope in terms of graft take rate and improvement in conductive hearing loss.
We did a retrospective review of 120 patients (54 male and 66 female) who underwent Type I tym panoplasty at Liaquat National Postgraduate Medical Center from January 2019 to January 2020. We included 60 patients who underwent microscopic tympanoplasty and 60 patients who underwent endoscopic tympanoplasty. Postoperative graft uptake and hearing improvement were studied.
 
Overall mean preoperative hearing loss was 30.24 (±9.61) dB as compared to mean postoperative hearing loss, which was reduced to 19.36 ( ±8.54) dB, and the difference was significant (P-value <0.001. No statistically significant difference was found for air-bone gap closure between the two groups (P-value 0.78). Out of 120 patients, overall successful graft uptake was seen in 109 (90.8%). In microscopic tympanoplasty, graft take was 90.0%, compared to 91.6% in endoscopic patients. There was no significant difference in graft take in the two groups.
The endoscopic tympanoplasty is comparable to microscopic in terms of graft uptake and hearing improvement.

One of the most important complications of OSAHS in children is growth delay. The aim of this study was to investigate changes in clinical body growth, and laboratory growth in children with OSAHS after adeno-tonsillar surgery. In our study, among 102 children suffering from sleep-disordered breathing, 70 met the inclusion criteria because they were affected by OSAHS and adenotonsillar hypertrophy. In total, 96 children affected by adeno-tonsillar hypertrophy (55 males and 41 females) underwent nocturnal cardiorespiratory monitoring with Embletta MPR, monitoring for post-operative 24 hours. Patients underwent blood sampling to evaluate preoperative GH and IGF-1 serum levels, “placement” in Cacciari’s growth charts and adenotonsillectomy and saturation monitoring for post-operative 24 hours. According to auxological parameters, 82.86% of the patients were below the fiftieth percentile of BMI Cacciari’s growth charts and IGF-1 preoperative serum levels were below the normal range. All patients underwent adenotonsillectomy.All 70 patients recovered from OSAHS according to the results of nocturnal cardiorespiratory monitoring after six months. IGF-1 serum levels significantly increased after three months and one year after. All the auxological parameters showed a significant increase after surgery. We calculated the average annual growth in height of the patients before and after adenotonsillectomy (AT): the growth rate was impaired by OSAHS (5.4±1.3 cm/year), while in the following year post-surgery we found a significant growth speed acceleration (9.9±1.7 cm/year, P=0.001).In conclusion, growth delay in children can be caused by OSAHS, and when it is due to adenotonsillar hypertrophy, adenotonsillectomy is to be considered as the therapy of choice.

The ability to perceive speech is a key sign of language development and normal speech. The current study was designed to measure the speech perception abilities in children with cochlear implant both in subjective and objective mannersThe research has been reviewed and approved by Medical ethical Committee and Thai Clinical Trials registry Committee. Sixty children age range from five to eight years with a pre-lingual bilateral profound sensori-neural hearing loss, fitted with a cochlear implant for two years or more were included. They were divided into two equal groups {thirty children in each group}; group I with good progress in auditory training and language acquisition and group II with poor progress in auditory training and language acquisition. Speech perception abilities were evaluated subjectively via Speech perception tests and objectively by measuring cortical evoked potentials. The results of speech perception tests and cortical evoked potential were analyzed and correlated. There was a statically significant difference in the mean & SD of speech perception test results and the aided P1 latency, amplitude of cortical evoked potential between the two groups. There was negative correlation between P1 latency and speech perception tests and a positive correlation between P1 amplitude and speech perception tests in both groups.The cortical evoked potential is correlated with the speech perception ability which can help in objective prediction of speech perception abilities in CI children.

Validated questionnaires are a valuable tool in medical practice. The role of septoplasty in improving patients’ non-nasal symptoms and their quality of life is still controversial. The aim of this study was to determine the differences in outcome after septoplasty measured by a disease-specific questionnaire vs a general QoL questionnaire.A total of 50 patients underwent septoplasty and completed the SNOT-22 and the SF-36v2 questionnaires preoperatively and at 6 months post-op. Pre-op, post-op and variation for each domain in both questionnaires were calculated and compared with a measure of self-reported health transition (Question 2 of SF-36v2) and with the Minimal important difference (MID) for our sample.SNOT-22 scores significantly improved for each specific question and for the total score. SF-36v2 showed a significant improvement in scores for mental domains (Mental Health, Role Emotional, and Vitality) but less so for the physical domains. MID for our sample was 4.2 points. Patients with variations greater than 4.2 in SNOT-22 total score (74%) revealed significantly better variations in Physical Function, General Health, Social Function and Vitality.Validated questionnaires are a fundamental tool for assessing outcomes of commonly performed surgeries in ENT. Disease-specific questionnaire showed improvement in scores for the majority of patients. The general QoL showed improvement only in Mental Domains. This may suggest that the impact of septoplasty in patient’s general health might not be significant.

Cochlear implants (CI) provides speech perception for patients with sensorineural hearing impairment; nonetheless, listening to music is a daunting challenge for them. The present study aimed to compare Iranian CI users and normal hearing (NH) controls in terms of musical habits and appreciation and investigate the possible effect of background variables.A total of  37 CI users who underwent surgery at least 18 months before the study and 59 NH listeners were enrolled in this study. The participants were assigned to two age groups: group A (patients ≥15 years old) and group B (patients <15 years old). They were asked to complete the questionnaires to assess their music engagement.In group A, the mean score of music importance was significantly higher in CI users (8.7±2.1), as compared to that in NH subjects (5.8±2.3) (P=0.005). Participation in professional musical training and singing with music was not significantly different between the groups. In group B, the mean score of desire for music was not significantly different between CI users (8.2±1.8) and NH subjects (7.7±2.0). They participated in professional musical training and had a reaction to music almost equally. Singing with music was significantly less common in the CI group (CI 16[61.5%], NH (40[85.1%]) (P=0.023). Selected background variables had no significant effect on the music tendency and habits of CI users.Iranian CI users tended to have a high level of music appreciation in both adult and children groups. Moreover, CI users and NH controls did not significantly differ in the importance of music, devoted time, participation in musical activities, and musical habits.

An aberrant carotid artery has distinct terms and may exhibit a submucosal mass in the posterior pharyngeal wall.  While it is primarily asymptomatic, an extreme aberrancy doubles the risk of dissection, a cerebrovascular accident (CVA) and an injury intraoperatively.Case Report:We report a case of ‘kissing carotid artery’ in a 65-year-old lady who presented with a foreign body sensation felt in the throat for one week.  A finding of flexible nasopharyngolaryngoscopy (FNPLS) showed a bilateral paramedian retropharyngeal pulsating mass.  Radiological examinations, including Computed Tomography (CT) of the neck and an angiogram, revealed an aberrant course of bilateral carotid arteries.  In view of no malignancy and vascular malformations, there was no further intervention done, and the patient was subjected to yearly surveillance.

Retropharyngeal carotid arteries are clinically significant anatomic variants.  Such anomalies are potentially life-threatening and a risk factor for a severe hemorrhage during the simplest and commonly performed transoral surgeries. Thus, thorough perioperative assessment with accurate imaging techniques and studies are required to evaluate these anomalies and may avoid any disastrous complications.

An aberrant or anomalous subarcuate artery and its canal is an extremely rare and clinically significant finding. If accidentally nicked or injured, it can cause inadvertent hemorrhage and obscure the surgical field.Case Report:We present a case of 21 year old made with Chronic Otitis Media of the right ear who was incidentally diagnosed with a dilated subarcuate canal and an aberrant subarcuate artery atypically associated with lateral semicircular canal and facial nerve.

Prior knowledge of this symptomatically dormant variation is important, particularly in retrofacial tympanomastoidectomy and cerebello-pontine angle tumor surgeries. Pre-operative temporal bone scans are advisable in such cases.

Mammary Analogue Secretory Carcinoma of salivary glands (MASC) is a low-grade carcinoma of salivary glands of the head-neck region. It bears histological resemblance to Secretory Carcinoma of the breast and Acinic Cell Carcinoma (ACC) of the parotid gland. Its clinical behaviour and aggressiveness vary amongst individuals and experience in MASC of the submandibular gland are limited. Case Report:We report a 16-year-old female with binary neck swelling in the submandibular region. The hard swelling in the submandibular region was a MASC and the soft cystic mass was a synchronous congenital lymphatic cyst in the neck. We report two unusual features, an extremely rare involvement of MASC of submandibular salivary gland and the presence of a congenital lymphatic cyst in the area adjacent to the main tumour mass. Treatment was done by surgical excision of both the neck masses in-toto and ipsilateral selective neck dissection (Level I-IV).

While MASC's histological pattern has been described in previous studies, its clinical picture is rarely documented. This report aims to shed light on the clinical presentation of this under-diagnosed entity and the aggressive management protocol required during preoperative workup, intraoperative disease clearance and post-operative follow up of such patients. MASC of the submandibular salivary gland is an uncommon cause of neck swelling in the adolescent age group, but due to its occasional aggressive nature, should be borne in mind as a possible differential diagnosis of salivary gland tumours.

Elimination of extensive defects of the larynx and trachea by using musculoskeletal plastics without the use of supporting materials is not always sufficient. Laser modeling of cartilage tissue is a promising technique in modern medicine.Case Report: This article presents a new method for plastic closure of an extensive defect in the larynx and trachea with the help of costal auto-cartilage modeled by an erbium fiber laser with wavelength of 1.56 μm.

The presented method allows us to restore the anatomical integrity of the respiratory tract at the final stage of surgical treatment of patients with chronic combined laryngeal and tracheal stenosis. Presented own clinical observation.

Nasopharyngeal carcinoma (NPC) is a nasopharyngeal epithelial neoplasm that has distinct aetiological, epidemiological and biological characteristics compared to other head and neck malignancies. Patients usually present late due to non-specific symptoms and deep location of the tumour in the nasopharynx.Case ReportWe would like to highlight a case of advanced NPC presenting with generalised lymphadenopathy, without the presence of an obvious nasopharyngeal mass that masqueraded as lymphoma in the initial stage.

NPC may share clinical features with other sinonasal pathologies or other malignant lymphoproliferative disorders that lead to a delay in diagnosis. NPC should be one of the differential diagnoses for any cases presenting with cervical lymphadenopathy, especially in adult male patients originating from East or Southeast Asia. Early diagnosis and treatment are crucial because early-stage NPC has an excellent chemoradiotherapy response and high survival rate.