Iranian Journal of Otorhinolaryngology
Volume:20 Issue: 2, 2008

1Assistant Professor, Pulmonary department, Ghaem hospital,2Assistant Professor, Otorhinolaryngology– head and neck surgery department, Imam Reza hospital, 3 Internist, Emergency ward, Ghaem hospital, 4Medical Student, Mashhad University of Medical Sciences, Iran ntroduction: Asthma is characterized by airway inflammation, airway hyper responsiveness, and reversible airflow limitation. The prevalence of this disease has increased over the past two decades to approximately 5 to 10% of the population. The presence of nasal polyposis in asthma patients is associated with an increase in asthma severity. We studied the efficacy of endoscopic sinus surgery of nasal polyposis in improvement of asthma. We performed a prospective, cross-sectional study from 2001 until 2006. Fifty patients with severe persistent asthma and nasal polyposis were included. The severity of asthma (with NHLBI and NAPP criteria) and FEV1 before and after endoscopic nasal polypectomy were recorded. We used paired simple T test for comparison of means using SPSS software. The mean age of our patients was 32.5 ± 14.3 years and male to female ratio was 2/3. From 50 patients with asthma and nasal polyposis, 38 cases showed significant improvement in asthma severity and FEV1. Mean values of FEV1 before and after endoscopic sinus polypectomy were 1.68 L and 2.52 L respectively. Opening of the upper airway with resulting improvement of breathing following endoscopy sinus polypectomy can decrease the severity of asthma. We recommend to seek for nasal polyposis in patients with severe asthma and to consider endoscopic sinus surgery in these cases.

ntroduction: In the conventional technique of tympanoplasty almost all of the ENT surgeons use gelfoam in the middle ear for supporting graft against margin of tympanic membrane perforation. In this study we didn’t use gelfoam in the middle ear and compared the results of graft success rate with two techniques. In this clinical trial, during 2 years 181 patients with chronic otitis media (COM) underwent tympanoplasty with underlay grafting. In 83 patients gelfoam was used in the middle ear for tympanoplasty or tympanomastoidectomy (CCTM, OCTM). In 98 patientswe did not use gelfoam in the middle ear. In the first group 59 and 24 patients underwent CCTM and OCTM respectively and in the second group 61 and 37 patients underwent CCTM and OCTM respectively. In the patients with using gelfoam, graft success rate was 91% for tympanoplasty and CCTM group and 83% for OCTM group. In patients without gelfoam, graft success rate was 89% in tympanoplasty and CCTM group and 84% in OCTM group. In this study, the graft success rate was similar in 2 groups. The advantage of this technique is rapid improvement of patients’ hearing after removal of the external ear canalrosebud. In addition, the reaction of immune system is less than usual technique. We conclude that this technique could be routinely used in tympanoplasty and tympanomastoidectoy.

ntroduction: Endoscopic surgery is a new standard method of treatment for chronic sinusitis. During this operation even small amount of bleeding may reduce the visual field of surgeon significantly and make the procedure troublesome. In this study we compared the operative conditions between patients who receive either remifentanil or halothane for general anesthesia. Endoscopic sinus surgery was performed in 60 patients. Pre- medication was done by fentanil and midazolam and induction was done by propofol and atracurium. The patients were divided into two groups and received either halothane or remifentanil for anesthesia maintenance. Monitoring was performed during anesthesia. Bleeding volume was measured and operation field condition was assessed by the surgeon. Patients’ characteristics such as age and gender were the same in both groups. Intra- operative systolic blood pressure was significantly lower in the remifentanil group but diastolic and mean blood pressure and heart rate didn’t change after induction and during maintenance in either group. Recovery time in the remifentanil group was also significantly shorter than the halothane group. Bleeding volume was also lower and the operation field condition was better in the remifentanil group. Remifentanil is a good choice to maintain an ideal anesthesia for endoscopic sinus surgery.

ntroduction: Papillary thyroid cancer (PTC) usually has an excellent prognosis with more than 90% survival rate at 10 years. Papillary thyroid cancer may be diagnosed with histological examination in patients underwent lobectomy. The necessity of performing a completion thyroidectomy (CT) is still a controversial issue. This study investigated the rate of contraralateral PTC in patients, who had completion thyroidectomy We retrospectively reviewed the medical and pathologic data of 82 patients with PTC. These patients underwent thyroid lobectomy, followed by completion thyroidectomy during 1997-2007. Thirty tree patients (40%) had PTC in the contralateral lobe. There was no significant difference between patients with or with out contralateral tumor regarding gender, age, primary tumor size or time to completion thyroidectomy.The presence of lymph node metastases and multifocality of cancer in the ipsilateral lobe increased the risk of residual disease in the contralateral lobe. The postoperative complication were infrequent and included: 6 (3.7%) patients with transient recurrent laryngeal nerve palsy, 2 (2.5%) patients with permanent recurrent laryngeal nerve palsy, 9 (11%) patients with transient hypocalcemia and 1 (1.2%) patient with permanent hypoparathyroidism. Five patients (6%) developed hematoma in 2 of whom re-exploration was required. The prevalence of residual disease in the contralateral lobe of patients with PTC is significant. We recommend that a completion thyroidectomy should be considered for PTC treatment. Completion thyroidectomy can be done safely with acceptable low morbidity.

ntroduction: Nasal septal deviation and hypertrophy of the adenoids and palatine tonsils are the two common causes of nasopharyngeal obstruction and resulting mouth breathing in children. It is accepted that chronic mouth breathing influences craniofacial growth and development. The aim of this study was to evaluate the differences of craniofacial morphology in children with two different etiological factors of mouth breathing. In this cross sectional study we studied 47 patients aged 6-10 years with predominant mouth breathing during 2005-2007. After otorhinolaryngologic examination, patients were divided into two groups based on the etiology of nasopharyngeal obstruction: group 1 with adenoid hypertrophy and group 2 with nasal septal deviation. Lateral cephalometric radiographs were obtained to assess craniofacial development. For statistical analysis Mann-Whitney and T-student tests were used. With respect to the inclination of the mandibular and palatal planes, anteroposterior relationship of maxilla and mandible to the cranial base, and indexes of facial height proportions, no significant difference was observed between two groups of children with mouth breathing. Only the gonial and craniocervical angle measurements were significantly larger in children with adenoid hypertrophy (P<0.05). The present study did not show any significant morphological differences between children with adenoid hypertrophy and those with nasal septal deviation. Mouth breathing seems to have a similar effect on craniofacial morphology irrespective of its etiology. Prospective studies with larger samples including older children are suggested.

ntroduction: The purpose of this study is to evaluate the distribution, clinical features, and treatment modalities of arachnoid cyst in our department. The study was carried out between April 1, 1996 and October 1, 2006 in the neurosurgery department, Ghaem hospital, Mashhad University of Medical Sciences. Twenty patients with arachnoid cyst underwent surgery between April 1, 1996 until October 1, 2006, consisting of 12 males and 8 females aged 5 to 68 years (mean age 32.4 years). Twelve patients underwent surgery and one patient underwent endoscopic fenestration, and cystoperitoneal shunting (medium pressure) was performed in 7 patients. All patients were followed for minimum of 6 months after surgery. During the study period, 20 patients were investigated. The cysts location was the middle cranial fossa in 12 patients (60%), suprasellar region in 1 patient (5%), the cerebral convexity in 1 patient (5%), posterior cranial fossa in 2 patients (10%), cerebellopontine angle in 3 patients (15%), and quadrigeminal cisterns in 1 patient (5%). All cysts had clearly unilateral distribution, 12 (60%) were located on the left side and 8 (40%) on the right side. The most common symptoms on presentation were epileptic seizures (46%), increased intracranial pressure (34%), visual impairment (5%), headache (10%), and cerebellar signs (5%). Arachnoid cysts have a strong predilection for the middle cranial fossa which may be explained by a meningeal mal-development theory. We also conclude that the major indication for surgery in patients with arachnoid cyst is the presence of intractable seizures, increased intracranial pressure, and compression of nervous tissues. Headache is not a surgical indication on its own.

ntroduction: Lymphoid papillary hyperplasia is a rare benign lesion of the palatine tonsils with a papillary surface configuration so atypical which could clinically be mistaken for a carcinoma or papilloma. Case report: The following report describes a 7 year old girl with papillomatous lesions of both palatine tonsils.

ntroduction: Intraparotid facial nerve schowannoma is a rare tumor. We reported two cases of this tumor. Case report: We presented two cases of intraparotid facial nerve schowannoma. Both patients were presented with asymptomatic parotid mass which mimicked pleomorphic adenoma. No preoperative facial nerve dysfunction was detected. Diagnostic results and surgical management are also discussed.