Iranian Journal of Otorhinolaryngology
Volume:37 Issue: 1, Jan-Feb 2025

Frontal anterior laryngectomy with epiglottic reconstruction (Tucker’s reconstructive surgery) is a technique of partial laryngectomy that has been used by several authors since its introduction in the 80s.The aim of this serie is to specify the indications of this operation and to present the functional and oncological outcomes of our study and those found in the literature.  We report a retrospective study of 65 cases who underwent Tucker’s operation by many surgeons at our educational center over a period of 31 years (1988 - 2020). This serie included 62 men (95%) and 3 women (5%), with a mean age of 62,8 years. The cases were classified as follows: 42 patients with T1aN0M0 (65%), 21 patients with T1bN0M0 (32%) and 2 patients with T2N0M0 (3%). Following surgery, the mean time for tracheal cannula extraction was 18,4 days and for nasogastric tube was 14,4 days. Five cases developed aspiration pneumonia. Voice quality was then assessed based on its intensity and intelligibility with 11,7% rated as very good, 53,3% as good, 31,7% as average and 3,3% as poor. There were 4 cases of local recurrence, 2 cases of nodal recurrence, and 2 cases of tumour pursuit. The median survival rate was 7,5 years. The functional and oncological outcomes of Tucker´s reconstructive surgery were generally satisfactory in our patients and are consistent with those reported in the literature. This technique holds an important position of this technique in the therapeutic arsenal for early glottic carcinoma.

Pharyngocutaneous fistula (PCF) is the most common complication following total laryngectomy (TL). The factors contributing to its occurrence are still a matter of debate. The impact of suture type has been relatively underexplored. This study aimed to analyze the risk factors associated with PCF and understand how the type of suture influences PCF characteristics.  An observational study encompassing all TL procedures was performed between 2005 and 2022 at a secondary care hospital. Sociodemographic and clinical variables widely studied in the literature to identify PCF risk factors were considered. Additionally, the characteristics of fistulas were examined to assess the influence of the suture type.  Seventy TL cases were included. The incidence of PCF was 56.0%. Identified risk factors for PCF included pharyngeal closure type (p=0.001) (RR=13.09), nutritional support type (p=0.001) (RR=13.54), the need for reintervention due to postoperative bleeding (p=0.001) (RR=1.13), and the need for blood transfusion after surgery (p=0.015) (RR=1.20). Regarding the suture type, Modified Connell Suture (MCS) was associated with a later onset of fistula (p=0.014), shorter hospital stay (p=0.001), and early initiation of oral feeding (p=0.009).  PCF occurrence is associated with nasogastric tube use, Lambert closure, postoperative bleeding, and reintervention for bleeding after TL. Moreover, MCS sutures are linked to a shorter hospital stays and early initiation of oral feeding.

Olfactory dysfunction is prevalent among individuals with chronic kidney disease (CKD), with prevalence escalating alongside disease severity. The uremic toxin we observed in this study is Indoxyl sulfate (IS), a potent uremic toxin that markedly accumulates in the plasma of patients with chronic insufficiency. Olfactory damage may occur in the setting of neuronal damage due to renal failure.  27 patients, a total sample in this study with diagnosed chronic kidney disease within stage 5 on regular hemodialysis, were examined for indoxyl sulfate levels in blood plasma and then examined for their olfactory function using the Sniffin’ Sticks test. A correlation analysis was conducted between indoxyl sulfate levels and olfactory function test results in patients with CKD.  The Pearson correlation test revealed a strong, significant negative correlation between indoxyl sulfate levels and olfactory function (r = -0.613; p = 0.001). Additionally, correlations were found between indoxyl sulfate levels and each component of olfactory function: threshold value (r = -0.408; p = 0.035), discrimination (r = -0.807; p = 0.001), and identification (r = -0.703; p = 0.001). Olfactory function is compromised in individuals with chronic renal disease and correlates with the level of accumulation of the uremic toxin indoxyl sulfate.

The notable increase in cases of rhino-orbito-cerebral Mucormycosis during the COVID pandemic is alarming. Both share a common route of entry, the nasal mucosa, leading to speculation about whether similar receptors play a role in both diseases. We aim to compare the expression of ACE2 and TMPRSS2 in the nasal and paranasal sinus tissues among patients with COVID-19-associated Mucormycosis (CAM), COVID-19-negative mucormycosis (CNM), and healthy individuals.  This prospective study included patients with CAM, CNM, and healthy individuals who underwent surgical management. Immunohistochemistry was performed in the sino-nasal tissue to detect the presence of ACE2 and TMPRSS2 receptors. The level was compared among the three groups.  The study encompassed 44 patients with CAN, 20 with CNM, and ten healthy individuals. ACE2 positivity was seen only in the apical cilia, with no significant difference among the groups (p=0.6). In contrast, TMPRSS2 positivity was seen in the cytoplasm and nucleus of epithelium and submucosal glands in addition to apical cilia. TMPRSS2 was increasingly expressed in patients with CAM compared to CNM (p=0.009) and the healthy group (p=0.002).  The expression of TMPRSS2 receptors is elevated in patients with COVID-19-associated mucormycosis with no significant change in the expression of ACE2 receptors. This finding could account for the heightened susceptibility to infection by SARS-CoV-2 and the subsequent immune dysregulation, providing a fertile ground for Mucorales co-infection.

Tinnitus is one of the symptoms of presbycusis that affects patients' sleep and social life. This study aimed to determine the effect of coenzyme Q10 (CoQ10) on treating tinnitus due to presbycusis.  In this double-blind, randomized clinical trial, 50 patients with tinnitus due to presbycusis were randomly divided into groups A and B, with 25 patients in each group. In addition to routine treatments, group A received 100 mg of CoQ10 daily, while group B received a placebo. Both groups were evaluated for tinnitus severity, loudness of tinnitus, quality of life, and sleep disturbance before and 6 weeks after starting the treatment.  In the intervention and control groups, the mean changes in score compared to before the treatment were as follows: quality of life (3.1 ± 1.67) and (1.28 ± 0.76) (P = 0.298), sleep disorder (-7.60 ± 1.38) and (-1.0 ± 8.55) (P<0.001), tinnitus disability (-17.2 ± 52.93) and (-4.56 ± 1.37) (P<0.001), tinnitus loudness of right ear (-1.68 ± 0.41) and (-0.95 ± 0.23) (P=0.11) and left ear (-2.2 ± 0.35) and (-0.54 ± 0.21) (P<0.001).  This study indicated that adding CoQ10 to the routine regimen for patients with tinnitus due to presbycusis significantly decreases tinnitus disability, improves sleep disturbance, and reduces tinnitus loudness. However, more studies should be conducted in this regard.

Angina Bullosa Hemorrhagica (ABH) is a rare condition characterized by hemorrhagic blisters and is often asymptomatic. These lesions appear more commonly in the oral cavity and oropharynx and are often misdiagnosed. A retrospective cross-sectional study was performed in clinically confirmed cases of ABH to study its epidemiology, etiology and presentation in a tertiary care hospital in Southern Asia.  Total of 8 patients of ABH were evaluated and included in the present study. All clinical data and track records were assessed by the medical records department. Cases were studied and results were interpreted. Total of 8 cases were enrolled with male-to-female ratio of 0.6:1 and middle age as the most common age of presentation. Buccal mucosa was the most common site involved with average lesion size of 1.6 cm. Masticating trauma was the most common etiological risk factor. Majority patients were asymptomatic with spontaneous resolution of lesions in all the cases.  Due to smaller number of studies reported, the lesions of ABH remained poorly understood with uncertain etiology. The knowledge of characteristic clinical features of the lesion and pattern of spontaneous healing is of utmost importance as a lesion of ABH can share some features with other serious disorders, thereby delaying the diagnosis. A thorough clinical history and examination of the lesion should always be done to establish an accurate diagnosis. Due to its completely benign nature, proper counseling of the patients must be ensured for better patient compliance.

Electric shock occurs when electricity passes through the body, causing a range of symptoms from mild tingling to potentially life-threatening injuries such as burns, seizures, and cardiac arrest. In rare cases, Sudden Sensorineural Hearing Loss (SSNHL) has also been associated with an electric shock. 

Case Report:

A 35-year-old male presented with left-sided hearing loss following an electric shock. The audiometric evaluation revealed left Sensorineural hearing loss (SNHL). The patient was prescribed oral corticosteroids showing some improvement in hearing thresholds and was advised hearing aid for the residual SNHL. 

Limited literature exists on the association between high-voltage electric shocks and hearing loss. This case report highlights the importance of prompt evaluation and management of (SSNHL) in individuals affected by electric shock.

Scleroma is a chronic, specific granulomatous disease that affects the head and neck mucosa. Its common sites are the nose and larynx; however, it might affect other areas. One of the rare sites to be affected is the middle ear and mastoid cavity, for which the term otoscleroma was coined. We present such a rare case in this report. 

Case Report: 

A 47-year-old patient with a history of both old laryngoscleroma and recent Rhinoscleroma. He presented with symptoms of ear discharge and facial palsy. Examination revealed complete facial nerve palsy and an external auditory canal polyp. A decision was made to perform subtotal petrosectomy with facial nerve decompression and maximum debulking to be sent for histopathology. The result came typical of otoscleroma 

Otoscleroma is a fairly rare occurrence. It might be primary, with no evidence of Scleroma in other sites or following rhino and/or laryngoscleroma. It might be unilateral or bilateral. It might mimic the clinical picture of chronic suppurative otitis media and its complications. Tympano-mastoidectomy is recommended to stop the discharge, obtain a proper biopsy and decompress the facial nerve if needed. Otoscleroma should be suspected in the case of previous Scleroma in other sites, and otitis media or complications like manifestations.