Iranian Journal of Otorhinolaryngology
Volume:37 Issue: 2, Mar-Apr 2025

Endoscopic nasal surgery has numerous potential adverse effects, adhesions are at the top of the list. 5-fluorouracil (5-FU), which is an analogue of pyrimidine, is utilized in a wide variety of areas for the purpose of preventing adhesions. In the present investigation, our purpose was to analyze the impact of intra-operative application of 5-flurouracil in the nasal cavity following FESS, as well as to evaluate both subjective and objective outcomes. Following the acquisition of institutional ethical approval, a testing procedure that was randomized, prospective, and double-blinded was carried out. After the FESS, a cotton swab soaked in 1 mL of 5-flurouracil at 5 mg/mL was inserted in one side of the nasal cavity and a saline-soaked one in the other. Both of these swabs were kept in place for a period of five minutes. Postoperatively, patients were assessed over 6 months duration, wherein, adhesions, discharge, crustation, edema and polypoidal changes were analyzed. Subjective symptoms such as nasal block, nasal discharge and loss of smell were also assessed.At the one-week follow-up, the test group had a significantly higher incidence of adhesions (32% vs. 11.76%, respectively) (p = 0.004) than the control group. Mucosal edema, crusting, polypoidal change and nasal discharge continued to significantly diminish in both groups. Furthermore, improvement in smell perception in the test group at the 20th week post-operatively was statistically significant (p= 0.014).Adhesions are less common in the early postoperative period in individuals who underwent FESS with or without polypectomy when 5-FU is administered topically. There is also an improvement in smell perception with a reduction of mucosal edema, crusting, polypoidal change and nasal discharge enabling better healing.

Thyroid nodules are a common diagnosis in adults. However, in children, they are rare, occurring in only 1-5% of cases. Early diagnosis and prompt management are crucial due to the higher likelihood of malignancy. The aim of this study was to describe the characteristics of thyroid nodules in children and plan their therapeutic management. A retrospective study was conducted on 29 children who underwent surgery for thyroid nodules at our ENT department between 2000 and 2022.The average age of the patients was 14.4 years, with a clear predominance of females (sex ratio of 0.16). The primary complaint was the appearance of an anterior cervical swelling in 82.7% of cases. The surgical procedures performed on the thyroid gland included isthmectomy in one patient, lobectomy in 16 patients, and total thyroidectomy in 12 patients. Total thyroidectomy was performed in one step in 10 cases and in two steps in 2 cases where papillary carcinoma was found in the final histological examination of the lobectomy parts.Papillary carcinoma was confirmed in four cases (13.8%) after definitive histological examination. All patients had favourable outcomes. The mean follow-up was 31 months for benign cases and 15 months after the last course of radioactive iodine therapy for malignant cases.Thyroid nodules are uncommon in children. To evaluate the risk of malignancy in children with thyroid nodules, ultrasound and cytology should be performed. This will help determine the appropriate surgical management.

True vocal cord failure (glottis) refers to the inability or failure of the larynx structure and vocal cords to produce sound. One of the optimal techniques for repairing this lesion is medialization laryngoplasty, which restores sound strength, continuity, and quality. Another technique is to create a Mini window in the periphery of false vocal cords. This study compared the effectiveness of medialization laryngoplasty with Gore-tex in two classic medialization laryngoplasty techniques and the Mini window method in the periphery of false vocal cords.

A total of 30 participants who had unilateral vocal cord paralysis due to various causes, such as surgery, metastasis, and intubation, were studied. After obtaining informed consent from patients, 15 participants were assigned to each group (classic or mini-window medialization laryngoplasty). Voice parameters, such as pitch, jitter, shimmer, and hoarseness, were evaluated before and after surgery. The duration of the surgery was also compared.

The Mini-Window method significantly improved sound quality, resulting in lower voice shimmer and shorter surgery duration.

While both methods are effective, the Mini-Window technique offers a more efficient surgery with reduced voice shimmer.

Otitis media with effusion (OME) is a widespread condition affecting children globally. This study aimed to assess the relationship between obesity in pediatric populations and the risk of developing OME.This retrospective observational study was performed in 2020 at Khalili and Dastgheib hospitals, affiliated with Shiraz University of Medical Sciences in Shiraz, Iran. The study included all children aged 2 to 15 years with a confirmed OME diagnosis. Participants in the non-OME group were chosen from children who did not have OME.A total of 148 healthy individuals were included in the non-OME group, while the OME group comprised 110 patients. Statistical analysis revealed that the mean age (p=0.040), weight (p<0.001), height (p=0.024), BMI (p=0.023), and BMI percentile (p=0.023) were significantly greater in the OME group compared to the non-OME group. Additionally, there was a higher proportion of males in the OME group (63.6%) compared to the non-OME group (44.0%), with this difference being statistically significant (p=0.001). Logistic regression analysis indicated that factors such as older age (p=0.023), male gender (p=0.001), and elevated BMI percentile (p=0.004) were significantly associated with the presence of OME.This research indicates that there is a correlation between obesity and a heightened risk of OME.

The available evidence about hearing loss in Coronavirus disease (COVID-19) patients mostly show sensorineural hearing loss, and the long-term effects of COVID-19 on auditory thresholds are unknown. This study aimed to compare the auditory threshold results in COVID-19 patients (several months after infection) with a control group. The clinical diagnosis of COVID-19 was confirmed with positive polymerase chain reaction findings and radiology images. Hearing evaluation was performed with an audiometry test and a calibrated audiometer in a sound-treated room. The results of 177 patients were compared with those of the 589 matched control group. In both groups, subjects over 50 years old or with any history of ear disease were excluded from the study. The time interval between infection with COVID-19 and hearing tests was 170.51±98.38 days. There was no significant difference between the auditory thresholds in different frequencies in both groups. Also, no significant difference was observed between the auditory thresholds of the two groups in the first, second, and third trimesters after being infected. This study did not show the long-term effects of COVID-19 on auditory thresholds, and the findings do not support hearing loss as a long-term COVID symptom.

Internal Jugular Vein (IJV) is an important landmark for Head and Neck surgeons during oncological clearance of disease from neck and microvascular reconstruction as well as for the intensivist during central line insertion. Detailed knowledge of the IJV anatomy and its variations is important to avert any catastrophic complications during surgery.Data of 350 patients was recorded prospectively and analysed over a period of two years and presence of IJV duplication was documented as percentages.  A total of 350 patients with diagnosed oral cavity carcinoma were included who underwent neck dissection out of which seven patients were identified with Internal Jugular Vein duplication making it an institutional clinical prevalence of around 2%. IJV duplication is inadvertently found intra operatively on maximum number of occasions therefore to avoid the risk of iatrogenic injury and undesired complications, preoperative imaging should be carefully assessed while planning the patient for surgery.

Granulomatosis with Polyangiitis (GPA), also known as Wegener’s Granulomatosis, is an ANCA-associated vasculitis that primarily affects small vessels, leading to necrotizing granulomatous reactions in the airways and small vessels. The etiology remains uncertain.

We report the case of a woman in her 70s, who was previously tracheostomized at another facility and was presented to our attention with glottic-subglottic stenosis. We performed a lysis of glottic synechia and subglottic debulking via transoral laser microsurgery, yielding satisfactory results over the short term. However, a relapse occurred within two months, along with ulcerative lesions on the nasal septum. Biopsies revealed multinucleated giant cells and inflammation suggestive of vasculitis. Based on the histological and clinical features, a diagnosis of vasculitis was considered. Anti-Neutrophil Cytoplasmic Antibodies testing was positive. A rheumatological examination confirmed the hypothesis of Granulomatosis with Polyangiitis. The lack of typical symptoms was the main reason for the delayed diagnosis.

Involvement of the subglottic region and the upper portion of the trachea is a rare but severe complication of GPA. The current literature reports only few cases of laryngeal stenosis, with poor prognosis. Histological examinations of biopsied laryngeal tissue showed significant but non-specific inflammation, contributing to the delay in diagnosis. There are still no precise guidelines for the surgical treatment of subglottic stenosis. This case underscores the importance of considering laryngeal involvement in GPA for early diagnosis and timely intervention to prevent serious complications in order to improve patient outcomes.

The internal jugular vein (IJV) is one of the major vessels in the neck and serves as an important landmark for surgeons during head and neck surgery. Anomalies of the IJV are rare and seldom encountered by the surgeons. However, a comprehensive knowledge of these variations is essential for better surgical dissection and to prevent intra-operative mishaps. The variations can be in the forms of bifurcation, trifurcation, duplication, fenestration and posterior tributaries of the IJV. Here we describe three cases of bifurcation and fenestration of the IJV that we encountered in our surgical practice.

Case Report:

 In the first patient, we found an empty fenestration of the right internal jugular vein during a selective neck dissection for tongue carcinoma. The spinal accessory nerve was passing lateral to the IJV above the level of the fenestration. The second patient was operated for a left vagal schwannoma in the neck. During the surgery, we found a bifurcation of the left IJV, and the two tributaries fused just above the left omohyoid muscle. The third patient, a sixty-year-old lady also had a bifurcation of the left IJV. It was found during a modified radical neck dissection for carcinoma ex pleomorphic adenoma of the left parotid gland. 

An in-depth knowledge of the anomalies of the internal jugular vein and meticulous evaluation of the pre-operative imaging may help the surgeons in preventing any intra-operative catastrophe during head and neck surgery.