Iranian Journal of Otorhinolaryngology最新文献

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.

Introduction: Epirubicin and mitomycin-C share similar mechanisms of action, with both exhibiting antiproliferative effects by inhibiting DNA and protein synthesis. While the efficacy of mitomycin-C in laryngology is well established, this study aims to investigate whether epirubicin can produce comparable clinical outcomes in this field.

Materials and methods: Ten rabbits were included in this experimental study. A thermal injury was created at the posterior commissure using a conchal probe. Following the injury, one group was treated with mitomycin-C, while the other received epirubicin. After a six-week post-treatment period, the rabbits were euthanized, and both macroscopic and microscopic evaluations were performed to assess stenosis, scarring, granulation tissue, necrosis, and ulceration. Two pathologists, blinded to the treatment groups, independently examined the histological samples.

Results: Macroscopically, no significant differences were observed between the two groups in terms of scarring, synechiae, or granulation tissue formation at the posterior commissure. However, the mitomycin-C group demonstrated a relatively milder tissue response. Microscopic analysis revealed grade 3 collagen deposition in one rabbit and grade 1 in two rabbits from the epirubicin group. In comparison, the mitomycin-C group showed grade 1 deposition in two rabbits and grade 2 in another two. The average fibroblast count was 83.3 in the epirubicin group versus 59 in the mitomycin-C group.

Conclusions: Although this pioneering study does not provide conclusive evidence that epirubicin is as effective as or superior to mitomycin-C in laryngology, it highlights epirubicin's potential as a promising candidate for further investigation in the treatment of laryngeal conditions.

Introduction: Tinnitus is one of the symptoms of presbycusis that affects patients' sleep and social life. This study aimed to determine the effect of coenzyme Q10 (CoQ10) on treating tinnitus due to presbycusis.

Materials and methods: In this double-blind, randomized clinical trial, 50 patients with tinnitus due to presbycusis were randomly divided into groups A and B, with 25 patients in each group. In addition to routine treatments, group A received 100 mg of CoQ10 daily, while group B received a placebo. Both groups were evaluated for tinnitus severity, loudness of tinnitus, quality of life, and sleep disturbance before and 6 weeks after starting the treatment.

Results: In the intervention and control groups, the mean changes in score compared to before the treatment were as follows: quality of life (3.1 ± 1.67) and (1.28 ± 0.76) (P = 0.298), sleep disorder (-7.60 ± 1.38) and (-1.0 ± 8.55) (P<0.001), tinnitus disability (-17.2 ± 52.93) and (-4.56 ± 1.37) (P<0.001), tinnitus loudness of right ear (-1.68 ± 0.41) and (-0.95 ± 0.23) (P=0.11) and left ear (-2.2 ± 0.35) and (-0.54 ± 0.21) (P<0.001).

Conclusion: This study indicated that adding CoQ10 to the routine regimen for patients with tinnitus due to presbycusis significantly decreases tinnitus disability, improves sleep disturbance, and reduces tinnitus loudness. However, more studies should be conducted in this regard.

Introduction: The current study sought to assess the predictive value of inflammatory markers, namely the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR), in relation to central lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC).

Materials and methods: A total of 79 participants with confirmed PTC diagnosis following surgery were included in the study. Demographic data, clinical characteristics, and laboratory variables were collected. CLNM was evaluated based on pathological findings. NLR and PLR were calculated to assess their associations with clinicopathological features and metastasis.

Results: The study included 26 males (25.9%) and 53 females (74.1%), with a mean age of 42.26 years (range 15-74). Significant findings included a higher incidence of CLNM in males (p=0.047) and larger tumor sizes in patients with CLNM (p=0.047). Tumor multifocality was also more common in the CLNM group (62.5% vs. 28.9%, p=0.003). Although no significant relationship was found between the inflammatory markers NLR, PLR, and CLNM, a meaningful association was observed between PLR and age in patients with CLNM (r= 0.414, p=0.011).

Conclusion: This study demonstrates significant associations between clinicopathological features and CLNM in PTC. Male gender, larger tumor size, and multifocality correlated with higher CLNM rates. While inflammatory markers such as NLR and PLR did not show significant differences, PLR's positive correlation with age in CLNM patients suggests potential prognostic value, warranting further investigation.

Introduction: Surgical bleeding is one of the most critical complications in various surgical procedures. In middle ear surgery, managing bleeding is a significant challenge for anesthesiologists because even minor bleeding can obstruct the surgeon's vision and prolong the surgery. Our objective is to compare the impact of preoperative oral clonidine versus labetalol infusion on bleeding volume during tympanoplasty surgery.

Materials and methods: In this double-blind randomized controlled trial, tympanoplasty candidates were randomly assigned to three groups: the clonidine group (received 300 micrograms of clonidine tablets one hour before surgery with normal saline infusion during the operation), the control group (given a placebo tablet one hour before surgery with normal saline infusion during surgery), and the labetalol group (administered a placebo tablet one hour before surgery with labetalol infusion at a rate of 0.2 mg/kg of body weight per hour during surgery). We then evaluated the extent of intraoperative bleeding, systolic and diastolic blood pressure, mean arterial pressure, and heart rate at various time points until the end of the surgery.

Results: Clonidine and labetalol were effective in reducing intraoperative bleeding compared to the control group. Grade 2 bleeding (minimal bleeding requiring intermittent suction) was the highest grade observed across all three groups and was consistently noted in all patients. Clonidine demonstrated greater efficiency in reducing systolic and diastolic blood pressure, mean arterial pressure, and heart rate compared to both labetalol and the control group.

Conclusion: Premedication with clonidine or labetalol is associated with reduced intraoperative bleeding, improved surgical field visibility, and shorter duration of tympanoplasty procedures. This may potentially lead to increased satisfaction and success rates of the operation.

Introduction: Kikuchi-Fujimoto disease is a self-limited disease which is also known as histiocytic necrotizing lymphadenitis. The Kikuchi-Fujimoto disease is a rare cause of cervical lymphadenopathy, with or without systemic signs, such as fever, leukopenia, and skin rashes.

Case report: We presented a case of Kikuchi-Fujimoto disease in a 29-year-old female mimicking sepsis after a COVID-19 infection. Clinical examination revealed stable vitals and multiple diffuse non-tender bilateral cervical and axillary lymph adenopathy with hepatosplenomegaly. The patient's blood parameters showed leukopenia, raised erythrocyte sedimentation rate, lactate dehydrogenase, microcytic hypochromic anemia with normal renal and liver function tests. The patient was treated with broad spectrum intravenous antibiotics and subcutaneous neupogen with a clinical suspicion of sepsis. The patient then underwent a CT scan which validated the clinical findings. Although the fever subsided, a persistent cervical lymphadenopathy was observed and the biopsy confirmed it to be necrotising lymph adenitis secondary to Kikuchi-Fujimoto disease. This patient has been regularly monitored and has shown resolution of cervical lymphadenopathy.

Conclusion: Clinicians should suspect Kikuchi-Fujimoto disease when patients present with persistent cervical lymphadenopathy unresponsive to initial medical treatment. Lymph node biopsy should be undertaken to rule out Kikuchi-Fujimoto disease and prevent these patients from extensive diagnostic procedures and inappropriate treatment modalities.

Introduction: Recently use of endoscopes for ear surgeries is being popular among the surgeons as it gives a wide view of the middle ear. Also, tympanoplasty by transcanal approach can be done as a day care procedure and so it reduces the cost of hospitalization. The study was aimed to evaluate the results of type 1 tympanoplasty done by endoscopic transcanal approach with cartilage perichondrium graft, in relation to successful graft take-up rate and improvement in hearing.

Materials and methods: Total 50 patients were included in the study and all of them underwent type 1 tympanoplasty by endoscopic transcanal approach. Tragal cartilage with its attached perichondrium on one side facing laterally was placed as graft lateral to handle of malleus with v shaped notch at 12 o clock by underlay technique in all the cases. Patients were called for regular follow-up, and they were observed for successful graft take-up and improvement in hearing at 3 months after procedure.

Results: Out of 50 cases complete closure was achieved in 46 cases which makes a success rate of 92%. The average improvement in hearing of 15.3 dB was noted.

Conclusion: Endoscopic Transcanal approach with cartilage-perichondrium graft for tympanoplasty (type 1) is effective in terms of successful graft take-up rate and improvement in hearing, very cost effective, faster in terms of surgical time, and has less postoperative morbidity so gives better quality of life to the patient.

Introduction: Canaloplasty is challenging because of the high rate of postoperative restenosis. The aim of this study was to evaluate the outcomes of using a U-Linear split-thickness skin graft (U-Linear STSG), a novel modified graft placement technique for canaloplasty.

Materials and methods: A retrospective cross-sectional study was conducted on patients who underwent canaloplasty between January 2013 and December 2023. The medical records of external auditory canal stenosis patients who underwent canaloplasty were reviewed. The data collected included patient demographics, surgical approaches, postoperative outcomes, and audiometric findings. The outcomes of reconstruction for ear canal stenosis using a U-Linear STSG were compared with those using a reconstructed local flap. Statistical analyses included chi-square tests for categorical data and independent t tests for continuous data.

Results: Thirty-six patients with external auditory canal stenosis underwent reconstruction; 17 patients underwent reconstruction with a U-Linear STSG, and 19 patients underwent reconstruction with a local flap. A review of the clinical outcomes revealed that postoperative restenosis was significantly less common in the U-Linear STSG group than in the local flap group (p < 0.05). In terms of audiometry, the postoperative air‒bone gap in the U-STSG group was slightly greater than that in the local group. No serious complications were observed in either group.

Conclusion: A U-Linear STSG can be simply and feasibly applied in reconstruction for ear canal stenosis, with no major complications.