Iranian Journal of Otorhinolaryngology最新文献

Introduction: Thyroid nodules are a common diagnosis in adults. However, in children, they are rare, occurring in only 1-5% of cases. Early diagnosis and prompt management are crucial due to the higher likelihood of malignancy. The aim of this study was to describe the characteristics of thyroid nodules in children and plan their therapeutic management.

Materials and methods: A retrospective study was conducted on 29 children who underwent surgery for thyroid nodules at our ENT department between 2000 and 2022.

Results: The average age of the patients was 14.4 years, with a clear predominance of females (sex ratio of 0.16). The primary complaint was the appearance of an anterior cervical swelling in 82.7% of cases. The surgical procedures performed on the thyroid gland included isthmectomy in one patient, lobectomy in 16 patients, and total thyroidectomy in 12 patients. Total thyroidectomy was performed in one step in 10 cases and in two steps in 2 cases where papillary carcinoma was found in the final histological examination of the lobectomy parts. Papillary carcinoma was confirmed in four cases (13.8%) after definitive histological examination. All patients had favourable outcomes. The mean follow-up was 31 months for benign cases and 15 months after the last course of radioactive iodine therapy for malignant cases.

Conclusion: Thyroid nodules are uncommon in children. To evaluate the risk of malignancy in children with thyroid nodules, ultrasound and cytology should be performed. This will help determine the appropriate surgical management.

Introduction: The notable increase in cases of rhino-orbito-cerebral Mucormycosis during the COVID pandemic is alarming. Both share a common route of entry, the nasal mucosa, leading to speculation about whether similar receptors play a role in both diseases. We aim to compare the expression of ACE2 and TMPRSS2 in the nasal and paranasal sinus tissues among patients with COVID-19-associated Mucormycosis (CAM), COVID-19-negative mucormycosis (CNM), and healthy individuals.

Materials and methods: This prospective study included patients with CAM, CNM, and healthy individuals who underwent surgical management. Immunohistochemistry was performed in the sino-nasal tissue to detect the presence of ACE2 and TMPRSS2 receptors. The level was compared among the three groups.

Results: The study encompassed 44 patients with CAN, 20 with CNM, and ten healthy individuals. ACE2 positivity was seen only in the apical cilia, with no significant difference among the groups (p=0.6). In contrast, TMPRSS2 positivity was seen in the cytoplasm and nucleus of epithelium and submucosal glands in addition to apical cilia. TMPRSS2 was increasingly expressed in patients with CAM compared to CNM (p=0.009) and the healthy group (p=0.002).

Conclusion: The expression of TMPRSS2 receptors is elevated in patients with COVID-19-associated mucormycosis with no significant change in the expression of ACE2 receptors. This finding could account for the heightened susceptibility to infection by SARS-CoV-2 and the subsequent immune dysregulation, providing a fertile ground for Mucorales co-infection.

Introduction: Endotracheal intubation is a standard procedure for securing and maintaining the airway during general anesthesia. Cuff pressure must be within the correct range to avoid serious airway complications. This study aimed to assess how the pressure in the endotracheal tube cuff changes when the patient's position is altered.

Materials and methods: This prospective, observational study was conducted on 85 patients aged 18 to 75 undergoing general anesthesia for surgery. Endotracheal intubation was performed with an appropriately sized tube, and the tube cuff was inflated with air using a syringe. The cuff pressure of the endotracheal tube was then assessed using a cuff manometer immediately after intubation and position change, 5 minutes after each, and every 15 minutes until the end of the surgery. Based on the formula for testing the difference between two means for a quantitative trait in two populations, and considering an alpha of 0.05 and a beta of 0.2, the sample size was calculated as 20 individuals in each group of patients with different positions.

Results: The endotracheal cuff pressure increased in all three positions, including prone, right lateral, and left lateral. A significant relationship was also observed between the sore throat one hour after extubation and the prone position.

Conclusion: The ETT cuff pressure increased or decreased outside the normal range in most patients undergoing surgeries that require changing positions. Therefore, we recommend close and continuous monitoring of cuff pressure during anesthesia.

Introduction: Electric shock occurs when electricity passes through the body, causing a range of symptoms from mild tingling to potentially life-threatening injuries such as burns, seizures, and cardiac arrest. In rare cases, Sudden Sensorineural Hearing Loss (SSNHL) has also been associated with an electric shock.

Case report: A 35-year-old male presented with left-sided hearing loss following an electric shock. The audiometric evaluation revealed left Sensorineural hearing loss (SNHL). The patient was prescribed oral corticosteroids showing some improvement in hearing thresholds and was advised hearing aid for the residual SNHL.

Conclusion: Limited literature exists on the association between high-voltage electric shocks and hearing loss. This case report highlights the importance of prompt evaluation and management of (SSNHL) in individuals affected by electric shock.

Introduction: Pharyngocutaneous fistula (PCF) is the most common complication following total laryngectomy (TL). The factors contributing to its occurrence are still a matter of debate. The impact of suture type has been relatively underexplored. This study aimed to analyze the risk factors associated with PCF and understand how the type of suture influences PCF characteristics.

Materials and methods: An observational study encompassing all TL procedures was performed between 2005 and 2022 at a secondary care hospital. Sociodemographic and clinical variables widely studied in the literature to identify PCF risk factors were considered. Additionally, the characteristics of fistulas were examined to assess the influence of the suture type.

Results: Seventy TL cases were included. The incidence of PCF was 56.0%. Identified risk factors for PCF included pharyngeal closure type (p=0.001) (RR=13.09), nutritional support type (p=0.001) (RR=13.54), the need for reintervention due to postoperative bleeding (p=0.001) (RR=1.13), and the need for blood transfusion after surgery (p=0.015) (RR=1.20). Regarding the suture type, Modified Connell Suture (MCS) was associated with a later onset of fistula (p=0.014), shorter hospital stay (p=0.001), and early initiation of oral feeding (p=0.009).

Conclusion: PCF occurrence is associated with nasogastric tube use, Lambert closure, postoperative bleeding, and reintervention for bleeding after TL. Moreover, MCS sutures are linked to a shorter hospital stays and early initiation of oral feeding.

Introduction: The available evidence about hearing loss in Coronavirus disease (COVID-19) patients mostly show sensorineural hearing loss, and the long-term effects of COVID-19 on auditory thresholds are unknown. This study aimed to compare the auditory threshold results in COVID-19 patients (several months after infection) with a control group.

Materials and methods: The clinical diagnosis of COVID-19 was confirmed with positive polymerase chain reaction findings and radiology images. Hearing evaluation was performed with an audiometry test and a calibrated audiometer in a sound-treated room. The results of 177 patients were compared with those of the 589 matched control group. In both groups, subjects over 50 years old or with any history of ear disease were excluded from the study.

Results: The time interval between infection with COVID-19 and hearing tests was 170.51±98.38 days. There was no significant difference between the auditory thresholds in different frequencies in both groups. Also, no significant difference was observed between the auditory thresholds of the two groups in the first, second, and third trimesters after being infected.

Conclusion: This study did not show the long-term effects of COVID-19 on auditory thresholds, and the findings do not support hearing loss as a long-term COVID symptom.

Introduction: True vocal cord failure (glottis) refers to the inability or failure of the larynx structure and vocal cords to produce sound. One of the optimal techniques for repairing this lesion is medialization laryngoplasty, which restores sound strength, continuity, and quality. Another technique is to create a Mini window in the periphery of false vocal cords. This study compared the effectiveness of medialization laryngoplasty with Gore-tex in two classic medialization laryngoplasty techniques and the Mini window method in the periphery of false vocal cords.

Materials and methods: A total of 30 participants who had unilateral vocal cord paralysis due to various causes, such as surgery, metastasis, and intubation, were studied. After obtaining informed consent from patients, 15 participants were assigned to each group (classic or mini-window medialization laryngoplasty). Voice parameters, such as pitch, jitter, shimmer, and hoarseness, were evaluated before and after surgery. The duration of the surgery was also compared.

Results: The Mini-Window method significantly improved sound quality, resulting in lower voice shimmer and shorter surgery duration.

Conclusion: While both methods are effective, the Mini-Window technique offers a more efficient surgery with reduced voice shimmer.

Introduction: This study aimed to evaluate the accuracy of preoperative high-resolution computed tomography (HRCT) imaging in measuring the distance from the long process of the incus to the footplate and its potential for predicting the optimal prosthesis length required for stapedotomy in patients with otosclerosis.

Materials and methods: This cross-sectional study included fifty patients scheduled for primary stapedotomy. A radiologist obtained and reconstructed preoperative HRCT scans of the temporal bone to measure the distance from the long process of the incus to the oval window in both axial and coronal views. These HRCT-derived measurements were then compared with intraoperative measurements performed by an otolaryngologist. The agreement between the two methods was assessed using correlation and Bland-Altman analysis.

Results: The mean distances measured by HRCT and intraoperatively were 4.15mm and 4.27mm, respectively. A strong and statistically significant correlation (r=0.928, P<0.001) was observed between the two approaches, indicating a robust association. The Bland-Altman analysis revealed a mean bias of 0.11±0.07mm, with limits of agreement (LoAs) ranging from -0.02 to 0.26 mm, and no points exceeding the 95% LoAs. The maximum potential error between the two measurement methods was 0.28mm, suggesting that HRCT imaging can reliably predict prosthesis length. In a stratified analysis based on the surgical distance (≤4 mm [N=11], 4.25mm [N=25], ≥4.5mm [N=13]), good agreement was maintained in the Bland-Altman analysis.

Conclusion: Preoperative HRCT imaging may be a valuable tool for accurately predicting the required prosthesis length prior to stapedotomy in otosclerosis patients.

Introduction: Uvulopalatopharyngoplasty (UPPP) surgery, though helpful, may not always achieve optimal results for obstructive sleep apnea (OSA). This prospective, uncontrolled trial investigates the potential of nortriptyline in improving symptoms and sleep parameters in OSA patients who have previously undergone UPPP.

Materials and methods: This single-center study evaluated the effects of nortriptyline in 24 OSA patients who had undergone UPPP surgery one year prior. Participants underwent a type IV sleep study one night before starting nortriptyline, and one month after treatment. The study employed the Stanford Subjective Snoring Scale (SSSS) and the Epworth Sleepiness Scale (ESS) to evaluate subjective reports of snoring and daytime sleepiness.

Results: The Apnea-Hypopnea Index (AHI) significantly decreased from 16.8 to 11.4 events/hour (p-value = 0.02, effect size = 0.5). Mean oxygen saturation significantly increased from 94.1% to 95.4% (p-value = 0.016, effect size = 0.6). Time spent below 90% oxygen saturation significantly decreased from 7.2% to 4.8% (p-value = 0.007, effect size = 0.73). ESS significantly decreased from 9.6 to 7.2 (p-value < 0.001, effect size = 0.89). SSSS significantly decreased from 7.1 to 3.1 (p-value = 0.002, effect size = 0.90). Minor side effects were monitored; one participant developed excessive sleepiness, and another participant reported heart palpitations.

Conclusion: This trial suggests that nortriptyline may be a promising treatment option for improving residual sleep apnea in patients who have already undergone UPPP but still experience symptoms. Further research is needed to confirm these initial results. Trial registration number: IRCT20230614058482N1.

Introduction: Epistaxis is a common Otorhinolaryngological condition that is usually self-limiting and rarely requires imaging and intervention. Intrasinus Internal Carotid Artery aneurysm presenting with epistaxis is extremely rare.

Case report: We report a case of a 57- year old male presenting with recurrent episodes of epistaxis. Contrast-enhanced Computed Tomography of the Paranasal Sinuses and Magnetic Resonance Imaging were performed, which showed a focal defect in the posterolateral wall of the sphenoid sinus through which an aneurysm from the cavernous segment of the Internal Carotid artery was seen herniating into the sinus with an associated hematoma.

Conclusion: Non-traumatic Internal carotid artery Intrasphenoidal aneurysms are infrequent causes of recurrent epistaxis. They can mimic malignant or inflammatory sinus masses, which can lead to inadvertent biopsy; hence, they should be ruled out by radiological investigation to ensure timely diagnosis and management.