Iranian Journal of Otorhinolaryngology
Volume:25 Issue: 4, Autumn 2013

Hearing loss occurs when there is a problem with one or more parts of the ear or ears and causes children to have a delay in the language-learning process. Hearing loss affects children''s lives and their development. Several approaches have been developed over recent decades to help hearing-impaired children develop language skills. Auditory-verbal therapy (AVT) is one such approach. Recently, researchers have found that music and play have a considerable effect on the communication skills of children, leading to the development of music therapy (MT) and play therapy (PT). There have been several studies which focus on the impact of music on hearing-impaired children. The aim of this article is to review studies conducted in AVT, MT, and PT and their efficacy in hearing-impaired children. Furthermore, the authors aim to introduce an integrated approach of AVT, MT, and PT which facilitates language and communication skills in hearing-impaired children. In this article we review studies of AVT, MT, and PT and their impact on hearing-impaired children. To achieve this goal, we searched databases and journals including Elsevier, Chor Teach, and Military Psychology, for example. We also used reliable websites such as American Choral Directors Association and Joint Committee on Infant Hearing websites. The websites were reviewed and key words in this article used to find appropriate references. Those articles which are related to ours in content were selected. Recent technologies have brought about great advancement in the field of hearing disorders. Now these impairments can be detected at birth, and in the majority of cases, hearing impaired children can develop fluent spoken language through audition. According to researches on the relationship between hearing impaired children’s communication and language skills and different approaches of therapy, it is known that learning through listening and musical plays have great impact on children''s communication skills, so that they can successfully join the mainstream society. VT, MT, and PT enhance children’s communication and language skills from an early age. Each method has a meaningful impact on hearing loss, so by integrating them we have a comprehensive method in order to facilitate communication and language learning. To achieve this goal, the article offers methods and techniques to perform AVT and MT integrated with PT leading to an approach which offers all advantages of these three types of therapy.

Tonsillectomy is one of the most common surgeries in the world and the most common problem is post-tonsillectomy pain and bleeding. The relief of postoperative pain helps increase early food intake and prevent secondary dehydration. One method for relieving pain is peritonsillar injection of epinephrine along with an anesthetic, which has been shown to produce variable results in previous studies. Study Deign: Prospective case-control study. Setting: A tertiary referral centers with accredited otorhinolaryngology-head & neck surgery and anesthesiology department. Patients under 15 years old, who were tonsillectomy candidates, were assigned into one of three groups: placebo injection, drug injection before tonsillectomy, and drug injection after tonsillectomy. The amount of bleeding, intensity of pain, and time of first post-operative food intake were evaluated during the first 18 hours post operation. The intensity of pain in the first 30 minutes after the operation was lower in the patients who received injections, but the difference was not significant during the first 18 hours. The intensity of pain on swallowing during the first 6 hours was also lower in the intervention groups as compared with the placebo group. The amount of bleeding during the first 30 minutes post operation was lower in the two groups who received injections, but after 30 minutes there was no difference. Injection of epinephrine and bupivacaine pre- or post- tonsillectomy is effective in reducing pain and bleeding. The treatment also decreases swallowing pain in the hours immediately after surgery.

Postoperative sore throat is a common complaint in patients with endotracheal intubation and has potentially dangerous complications. This randomized controlled trial study investigated the incidence of postoperative sore throat after general anesthesia when betamethasone gel is applied to a tracheal tube compared with when IV dexamethasone is prescribed. Two hundred and twenty five American Society of Anesthesiologist (ASA)-class I and II patients undergoing elective abdominal surgery with tracheal intubation were randomly divided into three groups: betamethasone gel, intravenous (IV) dexamethasone, and control groups. In the post-anesthesia care unit, a blinded anesthesiologist interviewed all patients regarding postoperative sore throat at 1,6, and 24 hours after surgery. The incidence of sore throat was significantly lower in the betamethasone gel group compared with the IV dexamethasone and control groups, 1, 6, and 24 hours after surgery. In the first day after surgery 10.7% of the betamethasone group had sore throat whereas 26.7% of the IV dexamethasone group and 30.7% of the control group had sore throat. Bucking before extubation was observed in 14(18.4%), 8(10.4%), and 9(12.2%) patients, in the IV dexamethasone, betamethasone gel, and control group, respectively. We concluded that wide spread application of betamethasone gel over tracheal tubes effectively mitigates postoperative sore throat, compared with IV dexamethasone application.

Tinnitus is a perception of sound without external source. For complete assessment of tinnitus, central auditory processing abilities should be considered in addition to the routine psychological evaluation of tinnitus characteristics. Temporal processing is one of the important auditory skills that are necessary for complex higher level auditory processing. 20 tinnitus patients and 20 healthy volunteers without tinnitus, all with normal auditory thresholds (≤20 dBnHL), were enrolled in present study. Pure Tone Audiometry (PTA), Tinnitus evaluation, Gap in Noise (GIN) test and Duration Pattern Test (DPT) were applied to all participants. Analysis of GIN test revealed statistically significant increases in an approximate threshold value of gap detection in the patients group, both in right and left sides (P=0.007 and P= 0.011, respectively). Comparison of percentage of correct responses in between two groups was also statistically meaningful in right and left ears (P= 0.019 and P=0.026, respectively). The comparison of different parameters of DPT in two study groups revealed no significant differences in percentage of correct responses between two groups (P>0.05). GIN test results identified auditory temporal resolution difficulties in patients with tinnitus, meaning that in spite of normal auditory thresholds there may be some possibility of abnormality in central auditory processing functions.

Auditory temporal resolution and auditory temporal ordering are two major components of the auditory temporal processing abilities that contribute to speech perception and language development. Auditory temporal resolution and auditory temporal ordering can be evaluated by gap-in-noise (GIN) and pitch-pattern-sequence (PPS) tests, respectively. In this survey, the effect of bilingualism as a potential confounding factor on auditory temporal processing abilities was investigated in early Azari-Persian bilinguals. In this cross-sectional non-interventional study, GIN and PPS tests were performed on 24 (12 men and 12 women) early Azari-Persian bilingual persons and 24 (12 men and 12 women) Persian monolingual subjects in the age range of 18–30 years, with a mean age of 24.57 years in bilingual and 24.68 years in monolingual subjects. Data were analyzed with t-test using SPSS software version 16. There was no statistically significant difference between mean gap threshold and mean percentages of the correct response of the GIN test and average percentage of correct responses in the PPS test between early Azari-Persian bilinguals and Persian monolinguals (P≥0.05). According to the findings of this study, bilingualism did not have notable effect on auditory temporal processing abilities.

To report the experience of the Jordan University Hospital with respect to the surgical treatment of otosclerosis and to compare results and complications with published studies. The medical records of all patients who underwent stapes surgery for otosclerosis at the Jordan University Hospital during the period January 2003 to December 2010 were reviewed. Out of 130 patients who underwent stapes surgery, 104 (80%) fulfilled the criteria and were enrolled in this study. There were 68 (65.4%) females and 36 (34.6%) males (female-to-male ratio, 1.9: 1). The disease was bilateral in 86 (82.7%) patients. Family history for otosclerosis was positive in 37(35.6%) patients. Tinnitus was observed at presentation in 82 (78.8%) patients and spontaneously resolved or improved in 51(62.2%) patients after surgery. Air bone gap after surgery was ≤ 10 dB in 79 (76.0%) patients, between 10 and 20 dB in 10 (9.6%) patients, and between 20 and 30 dB in four (3.8%) patients. Complications occurred in 17(16.3%) patients, which included: one (1.0%) deaf ear, two (2.0%) sensorineural hearing loss, two (2.0%) facial nerve palsy, six (5.8%) vertigo lasting more than 7 days, three (2.9%) chorda tympani damage, one (1.0%) floating of footplate, and two (2.0%) perforation of the tympanic membrane. The results of this study are comparable with those reported in the literature by surgeons with the same level of experience, but below than those with large series experience. Therefore, we believe that an experienced general ear, nose, and throat (ENT) surgeon can perform stapes surgery safely and successfully in the absence of an otologist.

The aim of this study was to evaluate the role of teeth and lips in the perception of smile esthetics. Thirty women, ranging between 20 and 30 years of age, all with Class I canine and molar relationships and no history of orthodontic treatment, were chosen. Five black and white photographs were taken of each participant in a natural head position while smiling. The most natural photo, demonstrating a social smile, was selected. Two other photographs were also taken from a dental frontal view of each subject using a retractor, as well as a lip-together smile. Three groups of judges including 20 orthodontists, 20 restorative specialists, and 20 laypersons were selected. The judges were then asked to confirm the esthetics of each picture on a visual analogue scale. An analysis of variance (ANOVA) and the Pearson correlation test were used for statistical analysis. For the orthodontists group, correlation between the scores given to the full smile and each of its components was significant (α=0.05), with equal correlation of each component with the full smile. In contrast to laypersons, the correlation between the scores given to the full smile and each of its components among restorative specialists was significant. For orthodontists and restorative specialists, esthetic details and the components of the smile (teeth and perioral soft tissues) were important in esthetics perception. In contrast, laypersons perceived no effect of esthetics detail or smile components.

A keratocystic odontogenic tumor is a benign intra-bone mass originating from dental lamina or its residue. It represents 2–11% of jaw cysts, and has a slow but aggressive growth. The evaluation of molecular characteristics, immunohistochemistry, and genetic expression currently have no established classification regarding the evolution and pathophysiologic pattern of these lesions.

This is a clinical retrospective study with a full analysis of patient history regarding physical evaluation, radiologic images, pathology results, and surgical resection. We performed a major literature review concerning current concepts relating to its biological characterization.

Three cases of keratocystic odontogenic tumor were identified. Two of the cases were large, with aggressive behavior and significant bone destruction and recurrence, which had been overlooked for more than a decade. The third case had an early diagnosis, and the treatment led to full recovery and complete healing.

The keratocystic odontogenic tumor is a benign lesion with slow growth, which lends itself to a more conservative treatment, even in cases of large lesions. A better understanding of these tumors, both at the biological and molecular level, could lead to guidelines for treatment and prognosis of such patients.

Laryngeal leiomysarcoma is an extremely rare malignancy originating from smooth muscle cells. Its rarity is due to the fact that only less than 50 cases of pure laryngeal leiomyosarcoma and less than 10 cases of hypopharyngeal leiomyosarcaoma have been reported in modern medical literature. Even though the clinical presentation mimics that of a laryngeal carcinoma forming the major bulk of the laryngeal malignancies, the difference in management, warrants an accurate diagnosis. An accurate histological diagnosis may be difficult; but supplementing by electron microscopy and immunohistochemical staining, the diagnosis can be reached certainly. We reported a case of this very rare malignancy presenting in the supraglottic region by highlighting the clinical features, histological and radiological diagnosis and management of this extremely rare malignant entity.

Tessier facial cleft is among the rarest facial clefts reported in literatures and there are many issues arguing about its multidisciplinary repairing techniques. Tessier number 4 and 5 are extremely rare facial anomalies. There are few literatures describing these clefts and their surgical modalities. Number 5 Tessier cleft begins medial to oral commissure in the upper lip and extends superiorly as a groove through the cheek and ends at the middle third of lower eyelid. Bonny involvement consists of alveolar ridge, maxillary bone lateral to infra orbital foramen and orbits lower rim and floor. Number 4 Tessier facial cleft begins between cupid bow and oral commissure; skirting the nose and pass through cheek and lateral to lacrimal duct. Bonny involvement consists of alveolar ridge, maxillary bone medial to infra orbital foramen and orbital rim and floor. Case Report: This paper represents a patient with bilateral number 4 and 5 Tessier cleft lip with unilateral complete cleft palate and surgical approach on her. We recommended early repair using autogenously tissues and minimal discarding healthy tissues as possible.