Iranian Journal of Otorhinolaryngology最新文献

Introduction: Introduction: Junctional Epidermolysis Bullosa (JEB) is a rare subtype of the Epidermolysis Bullosa which itself is a rare genetic disorder. While mucosal involvement of pharynx and oesophagus has been reported, laryngeal involvement is rare.

Case report: A 7-month-old male child who was known to have Junctional Epidermolysis Bullosa presented to the emergency department with respiratory distress associated with a stridor which was eventfully found to have multiple level laryngeal stenosis.

Conclusions: Longitudinal cohort studies are required to determine the long-term outcome and the anticipated behavior of epidermolysis bullosa in patients with laryngeal manifestation to avoid unnecessary surgical interventions.

Introduction: Atypical pleomorphic adenoma (PA) is an uncommon tumor, more frequent in submandibular and parotid glands. PA is classified as atypical when it presents hypercellularity, necrosis or hyalinization, dysplasia, capsular violation or distant metastases.

Case report: We described a case of a 39-year-old female presented with a slowly growing mass involving the soft palate. A life-threatening bleeding from PA with hemorrhagic shock occurred and required ligation of the external carotid artery with tracheotomy. A transoral en-bloc excision of the mass (70 x 50 x 40 mm) was performed. Pathological exam demonstrated an atypical PA, with hypercellular fields and myoepithelial and squamous differentiation.

Conclusion: An appropriate diagnostic evaluation and a prompt intervention are essential to avoid dangerous complications, even for benign neoplasms.

Introduction: Masseteric VEMPs have been effective in evaluating a diverse spectrum of vestibular conditions associated with various brainstem pathologies, but they have rarely been explored among patients with vestibular neuritis.

Case report: The current investigation included a case series highlighting mVEMP responses in addition to cVEMPs and oVEMPs in three patients diagnosed with vestibular neuritis. In the study, all three patients were found to have absent or diminished responses in cVEMPs, oVEMPs, and mVEMPs.

Conclusions: In the present study, the distinctions in cVEMP and oVEMP findings can be attributed to the involvement of inferior and superior vestibular nerve respectively. Furthermore, mVEMP presents a more intricate scenario, both in terms of its genesis and outcomes. This emphasizes the clinical relevance of mVEMP when used in combination with cVEMP and oVEMP, rather than as a substitute for the other VEMPs.

Introduction: Surgical excision forms the principal treatment of oral cavity squamous cell carcinomas. The comprehensive surgical management consists of Wide Local Excision of the tumor and Neck Dissection with removal of Submandibular gland. The submandibular gland accounts for 70-90 % of unstimulated salivary volume. Its excision as a part of neck dissection has been found to cause high Incidence (21% vs 7%) of postoperative xerostomia. Recent studies have highlighted that the preservation of the SMG is possible and oncologically safe in early-grade OCSCC with N0 neck as the involvement of SMG in such cases is low and its preservation decreases the chances of xerostomia.

Materials and methods: 80 subjects were included in the study to estimate the prevalence of metastatic submandibular gland involvement in oral cavity squamous cell carcinomas. The presence of metastasis into the salivary gland was studied and the mechanism/route of involvement was analysed. The comparison was made between the early and advanced tumors for SMG metastasis irrespective of the primary subsite involvement.

Results: In the current study low prevalence (6.2 %) of metastasis to SMG was seen. It was seen in high-grade tumors only. None of the early-grade tumors showed any evidence of SMG metastasis. The most common pattern (80%) of glandular involvement was a direct extension from the primary tumor.

Conclusions: Our study concludes that SMG preservation neck dissections can be carried out in early-grade OCSCC irrespective of primary tumor site involvement. The advantages of preserving the SMG are multiple. Furthermore, the morbidity is markedly decreased with its preservation without any compromise on oncological safety.

Introduction: Staphylococcus aureus is an identified pathogen involved in the recurrence of symptoms in patients with chronic rhinosinusitis with nasal polyps. We investigated the effectiveness of a topical ointment of mupirocin applied in the nasal vestibule in lessening symptom recurrence and improving the efficiency of functional endoscopic sinus surgery.

Materials and methods: Patients with chronic rhinosinusitis, nasal polyps, and a positive nostril culture for Staphylococcus aureus were included in a clinical trial. The right nostril was determined as the intervention group (applying mupirocin ointment) and the left as the control group (applying vitamin A ointment). Lund-Mackay radiological scores and Lund-Kennedy endoscopic scores were examined at the time of diagnosis and six months later.

Results: Among 60 patients with chronic rhinosinusitis with nasal polyps, 91.6% were positive for nostril Staphylococcus aureus. Comparing the average of the diagnostic radiological and endoscopic scores with the follow-up values in both groups indicated a significant improvement after surgery (P-value=0.001, 0.001). However, there was no significant difference in the radiological and endoscopic score improvements between the study and control groups (P-value > 0.56, 0.74).

Conclusion: Nasal mupirocin administration following endoscopic sinus surgery cannot significantly prevent symptom recurrence in chronic rhinosinusitis with nasal polyps.

Introduction: Hypertrophy of adenoids is a common condition in childhood, resulting in obstructive symptoms such as sleep apnea, snoring, and rhinosinusitis. Adenotonsillectomy is recommended to improve prognosis and quality of life. This case-control study compared facial angles and lip position related to dentofacial and mouth growth in symptomatic children with adenoid hypertrophy and asymptomatic control groups.

Materials and methods: The study included children aged 5 to 7 who presented with obstructive symptoms and confirmed severe adenoid hypertrophy in lateral neck radiography. Standard lateral photography was taken. The Nasofacial and Nasomental angles, and upper and lower lip positions and their distance behind the Ricketts line, were measured and compared with the normal control group.

Results: This study included 54 children with severe adenoid hypertrophy and 66 normal children. Facial angles were not significantly different between the two groups, but the mean horizontal position of the upper and lower lip in children with adenoid hypertrophy was significantly lower than in the control group (P value = 0.05). The lips were too close to the Ricketts line compared with the control group.

Conclusions: This research demonstrates that children with severe adenoid hypertrophy have more dentofacial disorders than others. Adenotonsillectomy surgery is necessary for children with obstructive symptoms caused by tonsil enlargement, and if symptoms like snoring persist post-surgery, complementary orthodontic treatments should be considered.

Introduction: Adductor Spasmodic Dysphonia (ADSD) is the most common form of spasmodic dysphonia. It encompasses various symptoms affecting voice and speech. The objective of this study is to report the management of patients with ADSD using the transnasal endoscopic approach for laryngeal Botulinum Toxin (Botox) injection.

Materials and methods: A retrospective chart review of patients with ADSD who underwent transnasal endoscopic laryngeal Botox injection was conducted. Voice outcome measures included the Voice Handicap Index-10 (VHI-10) score and the degree of speech fluency.

Results: Eight patients with ADSD who underwent 20 office-based transnasal endoscopic laryngeal Botox injections were included. The most commonly injected sites were the thyroarytenoid muscle (TA) and the false vocal fold in 95% and 55% of the cases, respectively. The mean dose of injected Botox was 2.48 ± 0.55 IU in the TA muscle, and 2.14 ± 0.53 IU in the false vocal fold. The mean amount of Botox injected in the larynx was 7.16 ± 2.42 IU. The mean follow-up period was 17.7 ± 13.3 months. There was marked improvement in speech fluency in 64.7% of the cases and mild improvement in one third of the cases. Marked improvement in speech fluency was recorded in 64.7% of the cases and mild improvement in one third of the cases. The mean VHI-10 score of patients dropped significantly from 22.47±4.08 to 15±4.69 following treatment (p<0.001).

Conclusions: The transnasal endoscopic approach is an effective and well-tolerated approach for laryngeal Botox injection in patients with ADSD.

Introduction: A sleep apnea monitor (BM2000A) is a wrist-worn device that measures oxygen saturation and pulse rate during sleep. This study aimed to evaluate the efficacy of the watch-like BM2000A for screening obstructive sleep apnea (OSA).

Materials and methods: 102 patients complaining of sleep breathing disorders were included; 81% were men and 19% were women. All participants underwent overnight simultaneous polysomnography (PSG) and BM2000A sleep monitoring. The number of apneas and hypopneas, apnea-hypopnea index (AHI), percentage of time spent with oxygen saturation under 90%, average oxygen saturation, lowest oxygen saturation, and duration of sleep were computed by the BM2000A and PSG. Then, these parameters were compared to validate the BM2000A.

Results: All parameters, measured with BM2000A, had a good correlation (r ≥ 0.6, p < 0.0001) with PSG-derived indexes, except for sleep time (r = 0.19, p = 0.061) and hypopnea index (r = 0.4, p < 0.0001). AHI had the strongest correlation (r = 0.87, p < 0.0001). The mean difference between AHI values calculated with PSG and wrist-worn pulse oximeter (WPO) was -17.66 events/h (95% CI: -50.39 to 15.06). In AHI ≥ 5, BM2000A had 90.7% sensitivity, 100% specificity, 91.2% accuracy, and 0.994 area under the curve. Using AHI ≥ 5, ≥ 15, and ≥30 as the screening criteria, optimal WPO-AHI cutoffs to improve the screening accuracy were 3.10, 8.92, and 13.05.

Conclusions: BM2000A-derived results properly correlate with PSG and can provide OSA screening with good sensitivity and specificity.

Introduction: Head and neck sarcomas are uncommon tumors that account for less than 1% of head and neck malignancies and fewer than 5% of all sarcomas. This study aims to assess the head and neck sarcomas pattern in Isfahan, Iran, compare its results with previous findings, and investigate treatment methods and the recurrence and survival rate.

Materials and methods: This study was done on 160 patients diagnosed with head and neck sarcomas between 2001 and 2020 in four medical centers in Isfahan, Iran. The patients with head and neck sarcoma confirmed by biopsy were included. Patient information included sex, age at diagnosis, and full characteristics of the mass. Disease recurrence and 2-year and 5-year overall survival (OS) were investigated by phone.

Results: Among 160 patients, 94 (58.8%) were male. The mean age was 36.9 ± 23.2 years. The neck was the most reported location for sarcomas (N=34, 21.3%). Undifferentiated pleomorphic sarcoma was the most frequent histopathologic pattern (N=48, 30.0%). The brain and lungs were the most common destinations for metastasis. "Surgery and adjuvant therapy together" was the most common type of treatment (N=108, 68.8%). The 2-year and 5-year recurrence rates were N=100, 62.5%, and N=110, 68.8%, respectively. The 2-year and 5-year OS was N=103, 64.4%, and N=58, 36.6%, respectively. Eighty-nine patients have had metastasis (55.6%).

Conclusions: Both 2-year and 5-year recurrence rates and OS were significantly correlated with metastasis. The OS within two years and five years were significantly higher in those treated only by "Surgery".

Introduction: To develop and validate a click-based mobile "Audiclick" app employing click noises for hearing assessments.

Materials and methods: This prospective comparative study compares the "AudiClick" app as a hearing screening tool to pure tone audiometry. Participants listened to sounds through wired earbud headphones that were connected to an Android or iOS device.

Results: The study involved 110 participants aged between 18 to 80 years old. All degrees of hearing loss severity corresponds to pure tone average (p < 0.01) results. The app was also found to be effective at identifying hearing loss (80-99% sensitivity, specificity, positive predictive value, and accuracy). Test-retest reliability had also shown excellent ICC scores of 0.93.

Conclusions: This study demonstrates that a mobile app using click sounds can be as efficient as pure tone audiometry for field screenings, while being more cost-effective and easier to develop.