Iranian Journal of Otorhinolaryngology
Volume:20 Issue: 4, 2008

ntroduction: Bacteremia following middle ear surgeries occurs in a significant number of patients. The aim of this study is to investigate the incidence of bacteremia following middle ear surgeries. Sixty two patients who where candidates for middle ear operation were enrolled in this study. Blood samples were obtained from each patient immediately before and after operation for bacteriologic analysis. Demographic and middle ear disease characteristics were also recorded for each patient. In 2 culture samples obtained before the operation and in 15 culture samples obtained after the operation, blood cultures were positive. One postoperative sample was excluded from the study due to probability of contamination. Of 14 postoperative cultures, staphylococcus epidermidis and streptococcus pyogenes were positive in 8 and 4 cases, respectively. There were no significant correlations between positive culture and age, otorrhea (duration and odor), surgical approach, type of surgery and pathological condition of patients. Risk of bacteremia following middle ear operations should be considered especially in patients who are high risk for postoperative endocarditis. Considering the serious complications of bacteremia, prophylactic measures are necessary in middle ear operations in this group of patients.

ntroduction: Obstructive sleep apnea syndrome (OSAS) is a serious and life threatening disorder caused by various anatomic and physio-pathologic factors. This study was conducted to clarify some anatomic etiologic factors of OSAS and the role of body mass index (BMI) in expression of its symptoms. In this case-control study 127 patients were included. Sixty patients had OSAS symptoms and 67 patients were considered as controls. Cephalometric parameters from lateral skull view of CT scan and BMI of patients were statistically analyzed and compared between two groups. The position of hyoid bone was significantly lower and soft palate was significantly larger in patients with OSAS symptoms than control group. Moreover, mean BMI measurement was significantly higher in the patient group. Our results suggest that in addition to apparent role of BMI in OSAS symptoms, increased soft tissue compartment of pharyngeal area and position of hyoid bone are significant etiologic factors in this syndrome.

ntroduction: Nasal polyposis is an inflammatory condition of unknown etiology. Recently concerns regarding gastroesophageal reflux or helicobacter pylori as a possible pathologic cause of nasal polyps have been increasing. The present study was planned to investigate the presence of helicobacter pylori in nasal polyps. This case-control study was undertaken enrolling 37 patients with nasal polyps who had undergone nasal endoscopic sinus surgery and 38 control subjects. Biopsy specimens of nasal polyps and inferior turbinates were assessed by rapid urease test. Blood samples of both study and control subjects were evaluated for anti H.pylori IgG by ELISA. H. pylori status was regarded positive, if both tests were positive. Seropositivity was more common in the patients with nasal polyps (66.2%) than control subjects (36.8%) (P<0.001). Rapid urease test was positive in 9 patients with nasal polyps, but was not positive in control group (P<0.01). Only 3 patients with nasal polyps were positive for both rapid urease test and ELISA. Polypoid tissue can be colonized by some bacteria with urease activity other than helicobacter pylori, causing false positive results in rapid urease test. So, other diagnostic tests with more sensitivity and specificity are recommended.

ntroduction: Routine hemithyroidectomy during total laryngectomy in the setting of advanced stage of laryngeal carcinoma without clear thyroid involvement remains a controversial issue. This study was conducted to assess the rate of thyroid gland involvement in the patients without obvious clinical involvement who were candidates for total laryngectomy. In this cross-sectional study, between 1994 and 2007, 186 patients who underwent total laryngectomy with ipsilateral hemithyroidectomy at Imam Khomeini hospital of Ahwaz Jondishapour university, were investigated for thyroid gland involvement. Of 186 patients, 169 cases were men and 17 were women, with mean age of 63 years. Microscopic tissue study revealed tumor invasion to thyroid gland in 7 patients, all of them had clinically advanced disease. Among these patients, 5 cases had transglottic cancer and 2 cases had subglottic cancer. Moreover, 4 patients had thyroid cartilage invasion and in one patient pyriform sinus was involved. There may be no need for thyroidectomy in all total laryngectomy cases. We recommend hemithyroidectomy with isthmectomy during total laryngectomy only in cases with subglottic tumor extension, thyroid cartilage invasion, and pyriform sinus involvement.

ntroduction: Orbital fractures comprise a significant part of facial traumas. The purpose of this study was to evaluate the outcome and epidemiologic features of patients with orbital fractures in Imam Khomeini hospital over a 10-year period. One hundred and three patients with orbital fractures were included in this study. Data obtained from medical records of patients were statistically analyzed. 68% of patients were in the age range of 20-40. The male to female ratio was 5 to 1. Motor vehicle accidents were the main cause of injury and most frequently involved area was the orbital floor. The main clinical finding was echymosis and the most common associated injury was zygomatic bone fracture. Diplopia, enophthalmos and deformity were improved in 94.5%, 86.2% and 87.5% of cases postoperevtively. The frequency of enophthalmos in patients with medial wall fracture was significantly more than patients with fractures of other orbital areas (P<0.05). Patients who underwent Gillies approach had significantly more postoperative complications (P<0.05). There was no significant correlation between the location of orbital fracture and postoperative complications. It seems that young males have the highest risk of orbital fractures in our population and the most common etiology is car accidents. Due to significant injuries in adjacent tissues especially the brain, appropriate evaluation and early management should be considered in these fractures.

ntroduction: Recently, intracranial complications of chronic otitis media (COM) have been significantly decreased due to prompt diagnosis and proper use of antibiotics. The aim of this study was to investigate the etiology and incidence of intracranial complications of chronic otitis media. In this descriptive study, between 1995 and 2007, patients with signs and symptoms indicative of intracranial complications were followed clinically. Among 560 patients admitted with COM, 8 patients had intracranial complication. All of patients were men. The mean age was 30.05 years. Otorrhea exacerbation, fever and headache were the most common presenting symptoms. The most common complications were epidural abscess, brain abscess, cerebellar abscess and meningitis respectively. Although nowadays, intracranial complications after COM rarely occur, they should be strongly considered in patients with symptoms such as fever, headache and otorrhea exacerbation.

ntroduction: Bilateral parotid gland enlargement is commonly caused by viral, metabolic and autoimmune mechanisms. We present a patient with leukemia whose only clinical sign was bilateral enlargement of parotid gland. Case Report: The patient was a 34-year-old male who was admitted with bilateral painless progressive parotid gland enlargement from 3 months ago. Laboratory investigations revealed leukocytosis, anemia, partial thrombocytopenia and increased sedimentation rate. Definite diagnosis was confirmed by bone marrow biopsy indicating acute lymphoblastic leukemia. Although bilateral parotid gland enlargement is a common manifestation of viral and autoimmune diseases, blood malignancies should also be considered for this condition.

ntroduction: With recent advances in medical treatment of tuberculosis, isolated mycobacterial infection of the nasopharynx and tonsil becomes uncommon. The most common presenting symptom is cervical lymphadenopathy and diagnosis can be made by histopathological pattern in the tissue specimens. Case Report: We report a case of tuberculosis involving nasopharynx, tonsil and upper cervical lymph nodes. It is recommended that in all suspicious cases, TB diagnostic tests be considered, specially when the primary pathology exam yields no certain diagnosis