Iranian Journal of Otorhinolaryngology
Volume:21 Issue: 2, 2009

ntroduction: Concurrent cisplatin-based chemoradiation is currently considered the treatment of choice for locoregional nasopharyngeal carcinoma. Celecoxib is a selective cyclooxygenase-2 (COX-2) inhibitor which can potentially enhance the effect of radiotherapy. The aim of this study was to determine the efficacy and safety of celecoxib in nasopharyngeal carcinoma. Patients with newly diagnosed locoregional nasopharyngeal carcinoma were included in this clinical trial study. The patients were assigned to receive 7 weeks concurrent chemoradiation with weekly cisplatin and either celecoxib 100 mg twice daily or placebo. After completion of chemoradiation, all patients received combined chemotherapy with cisplatin plus 5-Fu every 3 weeks for 3 cycles. Clinical response rates and treatment-related toxicity were the primary and secondary end-point of the study. Total of 50 eligible patients with the median age of 43 years were enrolled in the trial. Overall (complete and partial) clinical response rate was 100% in both groups. Complete and partial clinical response rates were 64% and 36% in study group and 44% and 56% in control group respectively (P>0.25). There was no difference in terms of treatment-related toxicity rates between two groups. This clinical trial showed that addition of celecoxib 100 mg twice daily to concurrent chemoradiation does not increase the response rates and treatment-related toxicities in patients with locoregional nasopharyngeal carcinoma.

ntroduction: The use of cartilage in reconstruction of the tympanic membrane has been established especially in cases such as tubal dysfunction and adhesive processes. Cartilage offers the advantage of higher mechanical stability compared with membranous materials but may alter the acoustic transfer characteristics of the graft. The purpose of this study was to investigate the hearing results after thin cartilage – perichondrium tympanoplasty, versus temporalis facia tympanoplasty. In this clinical trial, tympanic membrane reconstruction was operated with thin perichondrium-cartilage slices in one group of patients and temporalis facia in another group. Post operation Speech reception threshold (SRT) and graft take rate were compared statistically between two groups. After one-year follow up, the graft take rate was 98% in the temporalis fascia group and 96.8% in the cartilage perichondrium group. The mean improvement of SRT was 17.9db for cartilage-perichondrium group and 21.6db for temporalis fascia group. The difference was not statistically significant. Considering the results of this study, cartilage-perichondrium tympanoplasty offers the possibility of a rigorous tympanic membrane (TM) reconstruction with no statistically significant differences in post operative hearing results.

ntroduction: Nasal and paranasal sinuses malignant neoplasms are usually diagnosed in advanced stages because of non-specific and benign symptoms. In this study we evaluated the symptoms، pathology and treatment of paranasal sinuses malignancies in patients admitted to Tehran University of Medical Sciences affiliated hospitals. In this descriptive study، medical files of patients diagnosed with paranasal sinus malignancies and admitted to Imam Khomeini and Amir Aalam hospitals between 2000-2007 were evaluated. Of 75 patients، 47 were male and 28 were female. The mean age was 55±14. 1 years. The most common sinus involvement was seen in Maxillary sinuses (86. 7%) and 18 patients had concurrent involvement of other sinuses. The most common pathology was squamous cell carcinoma (40%) and the most common clinical symptom was nasal obstruction (%28). Distant metastasis was found in 46 patients and 42 patients presented with eye involvement Eleven patients underwent endoscopic resection. The presence of eye involvement and distant metastasis in a large number of the patients showed that diagnosis of paranasal cancers is delayed because of their nonspecific symptoms. Therefore further education of clinical manifestations of paranasal sinus cancers is emphasized.

ntroduction: Ossicular chain injury is one of the most common causes of hearing loss in chronic otitis media (COM). Although definite diagnosis of ossicular discontinuity is made intraoperatively, preoperative determination of ossicular chain injury will help the surgeon decide about reconstruction options and hearing prognosis of the patient. In this study we compared preoperative pure tone audiometry (PTA) findings of COM patients with the ossicular condition determined during surgery. 97 Patients with COM who underwent ear surgery for the first time were included in the study. A checklist of preoperative clinical findings, audiometric parameters and intraoperative findings was filled out for all patients. Mean amount of Air-Bone Gap (ABG), Bone Conduction threshold (BC) and Air Conduction threshold (AC) of 97 Patients were 35.17, 13.13 and 48.30 respectively. In ears with or without cholesteatoma, granulation tissue, or otorrhea, mean of AC, BC, and ABG were not significantly different. In ossicular erosion and discontinuity (OD), mean of AC and BC thresholds increased significantly but ABG didn’t change significantly. According to the results of this study, in preoperative assessment of COM patients to predict ossicular condition we recommend considering AC, BC and ABG levels together instead of using ABG alone as is routine in our daily practice.

ntroduction: Allergic fungal Rhinosinusitis (AFRS) is the most common form of fungal sinusitis in patients with refractory chronic rhinosinusitis (CRS). According to high occurrence of AFRS in warm regions with high humidity, in this study we evaluated the prevalence of AFRS in patients with refractory chronic rhinosinusitis from Sari city, Iran. During one year, 134 surgical sinus specimens were retrieved from 50 cases with refractory CRS. Specimens were analyzed by histopathological and mycological methods including Hematoxylin & Eosin, Periodic Acid- Schiff, and CalcoFlour White staining and also mounted by KOH. These samples were also processed for fungal culture. Total serum IgE was evaluated for all patients. Of 50 patients, 12 cases (24%) showed AFRS based on clinical, histopathological, mycological and radiological findings. Although collected samples from these patients were all microscopically positive for fungi, only 58.34% of these patient's specimens yielded fungi in culture. Aspergillus flavus was the most prevalent isolated fungi (33.34 %). 16/66% of these patients had elevated total IgE levels. Nasal polyps, history of atopy and Eosinophilic mucin were seen in all patients with AFRS. The results of our study showed AFRS is a common disorder in patients with CRS. Sinonasal polyposis and history of atopy were found in all patients with AFRS, therefore considering these important criteria in diagnosis of AFRS is emphasized.

ntroduction: Oral ulcers are one of the most common oral lesions and chief complaints of the patients referred to the Oral Medicine department. This study was conducted to determine the prevalence of different etiologies of oral ulcers in oral medicine ward of Mashhad university of medical sciences This retrospective and descriptive study was conducted on 294 patients referred to the oral medicine ward of Mashhad dental school between 2002 and 2007 due to oral ulcers. Required data were collected from medical records of patients and analyzed by descriptive statistics. Aphthous ulcers were the most common oral ulcers (27.9%). Oral ulcers were more prevalent in females. Tongue was the most common site involved (44.21) and oral ulcers were most prevalent between the ages 21-40. Multiple ulcers were more common (76%). Oral ulcers are among the most common complaints of patients referred to the Oral Medicine department. Due to geographic variations, epidemiologic studies can be helpful in diagnosis of these lesions.

ntroduction: Staphylococcus aureus is one of the most important common factors of nosocomial infections which can lead to considerable fatality. Preventing patients from suffering infections resulting from S. aureus has a special place in controlling nosocomial infections, in which the first step is to determine and study the sources of bacteria in hospitals. Clinical staff is one of the sources of this bacterium. In the first step the samples were taken randomly from staffs, hands in different wards of Imam Reza Hospital. Then nasal samples were taken from the personnel whose culture was positive for S. aureus before and after washing, and S. aureus was determined by biochemical tests. Of 90 people chosen for the first step, 35 had contaminated hands in both sampling steps and 28 of them were nasal carries of S. aureus.Although there was a significant relationship between nasal carriage of Staphylococcus aureus and hand contamination, the relationships between these variables and sex, work shift and hospital ward were not statistically significant. This study showed that nasal carriage of Staphylococcus aureus can enhance hand contamination with these bacteria which helps bacteria circulation in the hospital environment.

ntroduction: Ancient schwannoma is a rare variant of schwannoma that rarely occurs in the oral cavity. Histologically it can be confused with a malignant mesenchymal tumor. Therefore it is important to differentiate them from each other. Case report: The patient was a 40 – year – old male with the complaint of a painless gradual swelling in the left side of the mandibular lingual gingiva for about 5 years. No sign of bone resorption was found in periapical radiographs. After the excision of lesion, histopathologic examination showed proliferation of Schwann cells, degenerative changes including nuclear atypia, hyalinization and myxoid areas and calcification. Immunohistochemical analysis revealed strong positive staining for S-100 protein. All these features were consistent with diagnosis of ancient schwannoma.