Iranian Journal of Otorhinolaryngology
Volume:26 Issue: 3, Summer 2014

We investigated the effect of intratympanic dexamethasone on control of tinnitus and hearing loss in patients with Menier’s disease. 100 consecutive patients with a diagnosis of Menier''s disease according to the 1995 criteria of The American Academy of Otolaryngology – Head and Neck Surgery (AAO–HNS) who remained symptomatic despite medical therapy were assigned to receive intratympanic dexamethasone. The results were assessed with respect to changes in hearing symptoms and tinnitus. Hearing improvement and improvement in SDS was observed in 52% and 35% of patients, respectively. Tinnitus score was improved in 57% of patients. There was no relationship between age, sex, duration of disease, unilaterality of disease, or response to therapy. Intratympanic dexamethasone may be effective in the symptomatic control of hearing loss and tinnitus in Menier’s disease.

Omega 3 fatty acid especially in the form of fish oil, has structural and biological role in the body''s various systems especially nervous system. Numerous studies have tried to research about it. Auditory is one of the affected systems. Omega 3 deficiency can have devastating effects on the nervous system and auditory. This study aimed to evaluate neural conduction in n-3 fatty acid-deficient rat pups following the supplementation of fish oil consumption during the suckling period In this interventional and experimental study, one sources of omega3 fatty acid (fish oil) were fed to rat pups of n-3 PUFA-deficient dams to compare changes in their auditory neural conduction with that of control and n-3 PUFA-deficient groups, using Auditory Brainstem Response (ABR). The parameters of interest were P1, P3, P4 absolute latency, P1-P3, P1-P4 and P3-P4 IPL, P4/P1 amplitude ratio. The rat pups were given oral fish oil, 5 Ml /g weight for 17 days, between the age of 5 and 21 days. There were no significant group differences in P1 and P3 absolute latency (p > 0.05). but the result in P4 was significant(P ≤ 0.05). The n-3 PUFA deficient +vehicle had the most prolonged (the worst) P1-P4 IPL and P3-P4 IPL compared with control and n-3 PUFA deficient + FO groups. There was no significant difference in P1-P4 IPL and P3-P4 IPL between n-3 PUFA deficient + FO and control groups (p > 0.05).There was a significant effect of diet on P1-P4 IPL and P3-P4 IPL between groups (P ≤ 0.05). The results of present study showed the effect of omega3 deficiency on auditory neural structure during pregnancy and lactation period. Additionally, we observed the reduced devastating effects on neural conduction in n-3 fatty acid-deficient rat pups following the supplementation of fish oil during the suckling period

The use of ossicular graft material in ossicular chain reconstruction has significantly improved hearing results hearing after tympanoplasty and tympanomastoid surgery for chronic otitis media. Today, otologists have a wide array of tools from which to choose, but may find it difficult to know which middle ear implant works best. A prospective study of 80 patients who underwent ossiculoplasty was performed in the ear, nose, and throat (ENT) department at a tertiary health care facility from 2011 to 2013. Patients with chronic suppurative otitis media with an air-bone gap (ABG) of >25 dB with ossicular involvement were included in the study. Total ossicular replacement prosthesis (TORP), partial ossicular replacement prosthesis (PORP), and refashioned incus were used. Success was defined as ABG The majority patients were of middle age with moderate conductive hearing loss. Incus was the most susceptible ossicle. Overall success rate in this study was 80.0% with an average change of 15.76 dB in ABG. With continuing advances in our understanding of middle ear mechanics, the results of ossiculoplasty are improving and results can be very rewarding in experienced hands. Severity of preoperative ear discharge, preoperative mastoid cellularity, presence of disease, and surgical procedure proved to be significant prognostic factors. Autograft incus and PORP fared better when the malleus handle was present while TORP gave better results when the malleus handle was eroded.

Oral Lichen Planus(OLP)is a chronic mucocutaneus disease with an immunological etiology. This study was conducted to evaluate the effect of Cedar honey in treatment of erosive- atrophic OLP. Thirty patients with confirmed clinical and histopathologic of OLP participated in a randomized clinical trial in Mashhad Dental School.Patients were randomly allocated in two groups. Both groups received the standard treatment of OLP (dexamethasone mouthwash 0.5mg 3 times daily and fluconazole capsule 100 mg daily).Intervention group received Cedar honey (20 ml 3 times daily, swish and swallow technique)in addition to standard treatment. The patients were followed for 4 weeks.The pain and severity of the lesions were recorded at the initial visit and follow ups. All recorded data were analyzed with chi- square, T test, ANOVA using SPSS version 11.5and p-value less than 0.05 was considered significant. Thirty patients were included in the study. Both groups had markedly reduction in pain, size of erosive area and atrophic lesions specially in first follow up but there was not a significant different between two groups (p>0.05). Honey was effective in healing of ulcerative lesions.(The average recovery in experimental group was 69% while the average relief of ulcerative lesion in control group was 50%).but this difference was not significant(p=0.896) No significant difference was found in the treatment of atrophic and erosive lesions of OLP by using honey as an alternative treatment, but it may be effective in ulcerative lesions of OLP, although more research with larger sample size is necessary.

Knowledge of the presence of the alveolar antral artery in the lateral maxillary sinus wall is essential for surgeons who operate in this region. The purpose of this study was to investigate the correlation between alveolar antral artery diameter and lateral maxillary bony wall thickness in dentate patients. Thirty five Cone-Beam Computed Tomography (CBCT) scans from 35 dentate patients were selected in coronal sections in three locations; second premolar (P2), first molar (M1), and second molar (M2). The presence of the alveolar antral artery in each situation was determined and the bone thickness in the region of alveolar antral artery was measured perpendicular to the lateral wall of the maxilla. The alveolar antral artery was present in 67.1% CBCTs. The difference between the alveolar antral artery diameter was only significant in the first and second molar area (P=0.039).There were significant differences between bone thickness in three locations, with the thickest bone in the first molar area followed by the second molar and second premolar, respectively. The correlation coefficient showed that there is a positive correlation between bone thickness and alveolar antral artery diameter. This study showed that the thicker the bones in dentate patients, the greater the chance of interference with the large caliber intra-osseous alveolar antral artery.

Laryngeal dysfunction may be divided into three categories; organic, neurologic and functional disorders. Dysphonia and hoarseness are the most common symptoms and, in some cases, the only signs of laryngeal dysfunction. In differential diagnosis of any type of chronic hoarseness, a neoplastic process must be considered and, thus continuous light video laryngoscopy can provide important information on the presence of neoplastic lesions in order to prevent disease progression via early detection and action. This cross-sectional, descriptive-analytical study was carried out on 197 patients with voice disorders admitted to Ayatollah Rouhani Hospital for video laryngoscopy. Available sampling was used and the results achieved were analyzed using SPSS17 statistical software. A total of 197 patients (mean age, 40.72 ±15.17 years) participated in this study, 56.9% of whom were male. From analysis of video laryngoscopy, organic dysphonia was found to be the most common cause of voice disorders, while functional and neurologic dysphonia were observed in 8.6% and 5.6% of patients, respectively. Vocal nodules and Reinke''s edema were among the most common causes of organic dysphonia, with a frequency of 24.4% and 23.4%, respectively; while laryngeal carcinoma accounted for 2.5% of all diagnosed cases with organic causes. Since the presence of voice disorders for more than 3 weeks can be a sign of laryngeal dysfunction, early diagnosis using noninvasive methods such as video laryngoscopy and appropriate medical measures can help prevent the disease progression and eliminate the need for actions such as laryngectomy.

Determination of type of objects, location of trapping objects and endoscopic observation among children with foreign body ingestion. We evaluated 105 endoscopic records of patients due to foreign body ingestion from 2001 to 2011. Button batteries were the most often removed objects (41%). Lower segment of esophagus was the most trapping site. There was significant correlation between type of foreign bodies and their location. Abnormal endoscopic observation were reported in 33% of patients. There was significant correlation between type of foreign body and endoscopic observation. There was also significant correlation between location of the foreign body and endoscopic observation. Foreign body ingestion pattern is somewhat different in our center compared to other studies. Awareness of parents about the prevention of this accident is an important step in decreasing the incidence of foreign body ingestion.

Foreign bodies in the upper airway are one of the most challenging otolaryngology emergencies and have various presentations depending on their physical properties and location. Leeches are blood-sucking hermaphroditic worms that vary in color, length, and shape. They usually reside in fresh-water streams and lakes. When rural untreated water is drunk, leeches may localize in the nose, pharynx, and esophagus, or rarely in the larynx. CaseReport: This case is a man who was referred to our otolaryngology clinic with a complaint of hemoptysis and mild respiratory distress. The patient’s symptoms were all relieved post operatively and he was discharged on the second day following the procedure. Leeches should be suspected as an airway foreign body in patients with a recent history of drinking stream water.

Metastatic lesions of the oral cavity are extremely rare, accounting for approximately 1% of all malignant oral tumors. The most common primary sources of metastatic tumors in the oral region are, from the most to the least common, the breast, lung, kidney, bone, and colon. Renal cell carcinoma accounts for nearly 3% of all adult malignancies. It usually metastasizes to the lungs, bone, adrenal glands, and regional lymph nodes. The incidence of metastasis from renal cell carcinoma to the head and neck region is very low. The tongue is considered a very rare atypical ear, nose, and throat (ENT) location for metastasis of renal cell carcinoma. The present case from Iran reports tongue metastasis of renal cell carcinoma (RCC). Case Report: The following report is based on an 80-year old male patient with a tongue lesion and ambiguous past medical history that ultimately leads to diagnosis of a metastatic RCC. We also updated a previous literature review that was published 2008. A histopathological differential diagnosis for clear-cell tumors is also discussed. Because of the rarity of metastatic tumors of the oral region as well as the presence of other lesions with clear cells, diagnosis of metastatic clear-cell RCC in the oral cavity can be very difficult and challenging.

Desmoid tumors are very rare, benign fibrous neoplasms arise from the musculoaponeurotic structures throughout the body. Case Report: The patient was a seven-year old boy with a large mandibular mass growing over a period of six months. His CT-scan showed a large mass, 13 cm in diameter in the cheek area extending to the neck and trachea. Biopsy was compatible with desmoid fibromatosis. He was given neoadjovant treatment with vinblastin and methotrexate. The patient underwent a tracheostomy. Then a complete hemimandibulectomy and submandibular gland excision was performed. Finally reconstruction with latisimus dorsi free flap was performed. Despite rarity desmoid tumors should be kept in mind of an otorhinolaryngologist as a differential diagnosis in children with head and neck mass.