Iranian Journal of Otorhinolaryngology
Volume:34 Issue: 5, Sep-Oct 2022

Noise-induced hearing loss (NIHL) is defined as the sensorineural hearing loss caused by acute acoustic trauma or chronic exposure to high-intensity noises. Exposure to noises can lead to irreversible damage to the inner ear and, consequently, to a permanent shift of the hearing threshold. Police officers are particularly at risk of acute or chronic hearing damages. The aim of this study is to evaluate the hearing loss of police officers in relation to the occupational risk factors and clinical-anamnestic characteristics by collecting and analyzing existing data and evidence available in public databases.

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses group (PRISMA). Studies were included if they met inclusion and exclusion criteria. Study selection, data extraction, and quality assessment were conducted independently by two researchers.

Our initial literature search yielded 29 peer-reviewed articles. Out of 29 papers, only 10 were included in the review, after inclusion and exclusion criteria were applied the.

Hypertension, smoking and alcohol intake significantly affect hearing performance. In addition, a history of acoustic trauma, use of ototoxic drugs, exposure to noise in leisure-time activities and failure to use ear protectors are often found in a fair number of subjects. NIHL is also related to the age of the subjects as well as the extent and duration of noise exposure. Furthermore, NIHL is also influenced by shooting practice sessions police officers are required to undertake as well as by the chronic exposure to traffic noise, especially in motorcycle police officers.

Bleeding during endoscopic sinus surgery has an unfavorable effect on the surgical field and prolongs the time of surgery. In this study, we assessed the efficacy of topical furosemide on bleeding and the quality of the surgical field during endoscopic sinus surgery.In this clinical trial, 76 patients with chronic rhinosinusitis were selected for endoscopic sinus surgery and randomly assigned to two groups, topical furosemide (intervention) and normal saline (control). The intervention group received 20 micrograms of intranasal spray twice daily, and the control group received regular intranasal saline spray, similar to the intervention group. In addition, the quality of the surgical field (scoring by the BOEZAART grading system) and the amount of bleeding during surgeries were measured. All data were analyzed.In the intervention and control groups, the mean surgical bleeding volume was 187.70± 24.79 and 229.21± 28.18 ml (P <0.001), the mean of Boezaart scale 2 and 3 (P <0.001) and the mean of surgical time were 106.53±14.67 and 126.63 ± 15.42 minutes (P <0.001), respectively. In patients of the intervention group with and without polyps, the mean surgery time was 99.56± 12.15 and 118.84 ±10.03 minutes (P <0.001), and the mean bleeding volume during endoscopic sinus surgery was 176.46 ± 22.58, 208.46 ±12.14 ml (P <0.001) respectively.Our findings showed that nasal, topical furosemide spray significantly reduced the amount of bleeding during endoscopic sinus surgery and time of the surgery and improved the quality of the surgical field.

We aimed to compare the effectiveness of wideband absorbance in detecting ossicular chain discontinuity with intraoperative findings.In this study, 58 ears from 38 patients with chronic otitis media (COM) were included. Twenty-six ears with perforation and intact ossicular chain were determined as Group 1, 12 ears with perforation and ossicular chain defects were determined as Group 2, and 20 ears with normal hearing and intact tympanic membrane were determined as Group 3. The comparison of the groups was made considering the static (non-pressure) absorbance analysis performed using wideband tympanometry.When perforation sites were evaluated in Group 1 and Group 2; there were 12 anterior perforations, 7 posterior perforations, and 19 subtotal perforations. Air conduction thresholds in Group 2 were significantly (P<0.05) higher than in Group 1, as expected in pure tone audiometry. When wideband absorbance (WBA) measurements were evaluated in all 3 groups, no significant difference (P>0.05) was found between the frequencies 226 to 1000 Hz. WBA measurements at 8 frequencies between 1888-2311 Hz in Group 1 were significantly lower than Group 3 (P<0.05). WBA measurements at 4 frequencies between 3462-3886 Hz frequencies in Group 2 were significantly lower than Group 1 (P<0.05).Our findings concluded that a significant decrease in absorbance values in the narrow frequency range may be valuable in predicting ossicular chain defects.

According to the prevalence of sexual enjoyment reduction in total or partial laryngectomy patients, the present study aimed to evaluate sexual disorders among men who had undergone total laryngectomy.In this cross-sectional case-control study, purposive sampling was carried out to select all the samples that had experienced total laryngectomy. The control group was selected among the male patients who were referred for a routine checkup. In order to compare the groups, the international index of erectile function (IIEF) was performed, and the data were statistically analyzed in SPSS software (version 21).Based on the obtained results, laryngectomy patients had experienced problems with sexual problems, especially in the field of erectile function, sexual desire, and intercourse satisfaction (P<001).According to various studies, sexual dissatisfaction negatively impacts the Quality of life. This problem, commonly observed in total laryngectomy patients, needs to be considered.

Bilateral facial nerve (FN) palsy due to temporal bone fracture is a rare clinical entity, with few cases reported.  The choice between conservative and surgical treatment is more complex than in unilateral cases.A thorough search of the available literature on trauma-related bilateral FN palsy revealed 22 reports. Our own experience is also described.All bilateral delayed- and unknown-onset cases were treated conservatively, with a good recovery rate (70.5%). Surgery was performed on 6 sides within the immediate-onset group, with a good recovery rate (83.3%).In the management of traumatic FN palsy, the main controversial issue focusses on indications for surgery as well as timing and type of approach. In bilateral cases, it is more challenging to make the right choice, due to lack of facial asymmetry and/or state of unconsciousness following severe trauma. Electro-diagnostic tests and high-resolution computed tomography are essential for decision-making.

The best strategy to treat otitis media with effusion in cleft lip/palate patients is still under debate. This research aimed to evaluate the otologic outcomes in children at least five years post-repair.A retrospective study was conducted on 40 children who underwent palatoplasty between January 1, 2012, and January 1, 2014, at Children’s Medical Center (Tehran, Iran). Patients had intervelar veloplasty under magnification (Sommerlad’s Technique). Based on patients’ charts, their age, gender, cleft type, date of palatoplasty, as well as the date and the frequency of ventilation tube (VT) insertion, were recorded. Furthermore, otomicroscopy, middle ear status, and tympanometry were assessed five years postoperatively. There was no significant difference in middle ear status between children with complete and incomplete cleft palates. The mean age at the time of study and the mean follow-up duration were significantly higher in the normal middle ear group, compared to the abnormal middle ear group (7.7±1.6 vs. 6.8±0.9, P=0.03 and 6±1.15 vs. 5.42±0.9, P=0.04, respectively). Middle ear status was not significantly different between early or late palatoplasty patients. In addition, the frequency and timing of VT insertion were not significantly different between the two groups.Middle ear status improved as patients grew older; however, the age of palatoplasty and the frequency of VT insertion were not significant prognostic factors in patients who underwent intervelar veloplasty under magnification.

Thyroglossal duct cysts are a common congenital anomaly in the neck which usually present in adulthood as a midline neck swelling the location of which can vary from lingual, suprahyoid, infrahyoid and suprasternal.

Here we have described the case of a thirty-year-old male who presented with a history of recent onset dysphonia and an unnoticed neck swelling. Clinical examination revealed a midline 2 x 2 cm cystic lesion in the neck. On further evaluation using laryngoscopy and computed tomography the patient was found to have a smooth mucosa-covered cyst in the subglottic location. Surgical excision of the cyst was done via laryngofissure and the postoperative course was uneventful. The postoperative biopsy revealed a subglottic thyroglossal cyst.

Though there have been reports of intralaryngeal extension of thyroglossal duct cysts, the subglottic location is extremely rare. Through this case report, we would like to highlight the atypical presentation of thyroglossal duct cysts and how an innocuous pathology can turn potentially life-threatening. We would also recommend avoiding a fine needle aspiration cytology in such cases due to the critical location.

Thymoma is a rare malignancy with usual location in the antero-superior mediastinum. Occurrence of an extra-mediastinal thymic malignancy in the neck with lung metastasis and without involvement of the mediastinum is an extremely rare condition. Staging systems and treatment guidelines are defined for mediastinal thymomas but not for ectopically located thymomas.

38-year-old female presented with the chief complaint of a progressive neck swelling, located predominantly in the right lateral neck, extending to the midline. Computed Tomography showed a heterogenous peripherally enhancing mass with likely origin from the thyroid gland. The mass measured 12 x 6 x 3.5 cm in size and extended from the hyoid bone superiorly to the suprasternal location inferiorly. Additionally, there were multiple, variable sized subpleural nodules scattered in both lungs, suggestive of lung metastases. Histopathology and immunohistochemistry findings from neck mass confirmed the diagnosis of Thymoma Type A. 

Thymoma is a rare tumor that typically does not show aggressive behaviour. Extra-mediastinal neck thymoma with bilateral lung metastasis is an extremely rare presentation. Thymoma presenting as neck swelling without mediastinal extension on radiology, poses a diagnostic dilemma. Histopathology with immunohistochemistry helps to confirm the final diagnosis. Surgery is the mainstay for the management of localized tumors with adjuvant treatment reserved for incompletely resected tumors or advanced stage. Systemic metastasis are rare in this indolent tumor and chemotherapy regimens are investigational. Clinical presentation, prognostic factors, staging and management guidelines are still not well defined for this rare tumor with atypical location.

Oral metastases are rare; nevertheless, they must be considered in the differential diagnosis of lesions in patients with a previous history of malignancy or older adults. The clinical signs of oral metastasis typically comprise pain, dysphagia, ulceration, bleeding, and paresthesia. Soft tissue sarcomas tend to affect the extremities and retroperitoneum. The most common metastases in the oral cavity are carcinomas, and sarcomas rarely metastasize to this area. Undifferentiated pleomorphic sarcoma (UPS) is a mesenchymal malignancy that infrequently affects the head and neck site. It shows a male predilection and occurs in all age groups. The lung is the most common area of distant metastasis in undifferentiated pleomorphic sarcoma.

This report presents a 61-year-old female patient with a painful bluish-purple mass of the posterior right mandibular alveolar mucosa. She had a history of thigh UPS about four years ago. An incisional biopsy was performed, and the specimen was stained with hematoxylin and eosin. Immunohistochemical antibodies for CK, S100, desmin, myogenin, MDM2, SOX10, and caldesmon were negative and focally positive for CD68. Ki-67 index was about 70%.

This report aimed to increase awareness of a rare lesion by describing the clinical, histopathologic, and immunohistochemical findings of metastatic undifferentiated pleomorphic sarcoma of the oral cavity.

Chronic otitis media is a significant health problem, but middle ear and mastoid neoplasms, either benign or malignant, are extremely rare.

Here is a report from a 51-year-old female who presented persistent otorrhea with an aural polyp. The patient was operated on with the probable diagnosis of cholesteatoma. During surgery, a fragile mass was discovered, and histopathologic examination reported the diagnosis of a primary oncocytic Schneiderian papilloma. Microscopically it has pseudostratified epithelium of columnar cell epithelium with eosinophilic granular cytoplasm and hyperchromatic nuclei. The treatment of choice for Schneiderian papillomas is complete surgical removal.

Although very rare, oncocytic Schneiderian papilloma should be considered a differential diagnosis of ear neoplasms such as auditory canal polyps.