Iranian Journal of Otorhinolaryngology最新文献

Introduction: Scleroma is a chronic, specific granulomatous disease that affects the head and neck mucosa. Its common sites are the nose and larynx; however, it might affect other areas. One of the rare sites to be affected is the middle ear and mastoid cavity, for which the term otoscleroma was coined. We present such a rare case in this report.

Case report: A 47-year-old patient with a history of both old laryngoscleroma and recent Rhinoscleroma. He presented with symptoms of ear discharge and facial palsy. Examination revealed complete facial nerve palsy and an external auditory canal polyp. A decision was made to perform subtotal petrosectomy with facial nerve decompression and maximum debulking to be sent for histopathology. The result came typical of otoscleroma.

Conclusion: Otoscleroma is a fairly rare occurrence. It might be primary, with no evidence of Scleroma in other sites or following rhino and/or laryngoscleroma. It might be unilateral or bilateral. It might mimic the clinical picture of chronic suppurative otitis media and its complications. Tympano-mastoidectomy is recommended to stop the discharge, obtain a proper biopsy and decompress the facial nerve if needed. Otoscleroma should be suspected in the case of previous Scleroma in other sites, and otitis media or complications like manifestations.

Introduction: The internal jugular vein (IJV) is one of the major vessels in the neck and serves as an important landmark for surgeons during head and neck surgery. Anomalies of the IJV are rare and seldom encountered by the surgeons. However, a comprehensive knowledge of these variations is essential for better surgical dissection and to prevent intra-operative mishaps. The variations can be in the forms of bifurcation, trifurcation, duplication, fenestration and posterior tributaries of the IJV. Here we describe three cases of bifurcation and fenestration of the IJV that we encountered in our surgical practice.

Case report: In the first patient, we found an empty fenestration of the right internal jugular vein during a selective neck dissection for tongue carcinoma. The spinal accessory nerve was passing lateral to the IJV above the level of the fenestration. The second patient was operated for a left vagal schwannoma in the neck. During the surgery, we found a bifurcation of the left IJV, and the two tributaries fused just above the left omohyoid muscle. The third patient, a sixty-year-old lady also had a bifurcation of the left IJV. It was found during a modified radical neck dissection for carcinoma ex pleomorphic adenoma of the left parotid gland.

Conclusion: An in-depth knowledge of the anomalies of the internal jugular vein and meticulous evaluation of the pre-operative imaging may help the surgeons in preventing any intra-operative catastrophe during head and neck surgery.

Introduction: Internal Jugular Vein (IJV) is an important landmark for Head and Neck surgeons during oncological clearance of disease from neck and microvascular reconstruction as well as for the intensivist during central line insertion. Detailed knowledge of the IJV anatomy and its variations is important to avert any catastrophic complications during surgery.

Materials and methods: Data of 350 patients was recorded prospectively and analysed over a period of two years and presence of IJV duplication was documented as percentages.

Results: A total of 350 patients with diagnosed oral cavity carcinoma were included who underwent neck dissection out of which seven patients were identified with Internal Jugular Vein duplication making it an institutional clinical prevalence of around 2%.

Conclusion: IJV duplication is inadvertently found intra operatively on maximum number of occasions therefore to avoid the risk of iatrogenic injury and undesired complications, preoperative imaging should be carefully assessed while planning the patient for surgery.

Introduction: Recurrent Laryngeal Nerve (RLN) injury remains one of the significant complications associated with thyroidectomy, occurring in approximately 1% to 9% of cases. Vocal Cord (VC) function is typically assessed before surgery using laryngoscopy. However, Transcutaneous Laryngeal Ultrasonography (TLUS) has become a non-invasive alternative for evaluating VC mobility. This study was performed to compare the diagnostic accuracy of TLUS with traditional laryngoscopy in assessing vocal cord function in patients undergoing thyroid surgery.

Materials and methods: A total of 105 patients undergoing hemi- or total thyroidectomy were enrolled in a prospective observational study at a tertiary healthcare facility from October 2022 to June 2024. TLUS was conducted by endocrine surgeons using a Mindray UGW 11 device. VC mobility was categorised as usual (spontaneous, rhythmic, symmetrical movement) or unilateral VC paralysis (asymmetrical or absent movement on the affected side).

Results: In the preoperative setting, TLUS achieved 100% sensitivity, Positive Predictive Value (PPV), and overall diagnostic accuracy. Postoperatively, it maintained a high sensitivity of 99.02%, with specificity reaching 100% and an area under the curve (AUC) of 0.99. The PPV remained at 100%, while the Negative Predictive Value (NPV) was 75%, and the diagnostic accuracy declined slightly to 99.05%. These findings highlight TLUS as a reliable, economical, and patient-friendly modality for evaluating vocal cord mobility in thyroid surgery.

Conclusion: TLUS is an effective non-invasive method for assessing VC function, with high diagnostic accuracy. With further advancements in ultrasound technology and standardized protocols, TLUS can be incorporated into routine clinical practice as a supplement to traditional laryngoscopy techniques. This study supports the use of TLUS as a viable alternative for preoperative and postoperative VC assessment in thyroid surgery patients.

Introduction: Angina Bullosa Hemorrhagica (ABH) is a rare condition characterized by hemorrhagic blisters and is often asymptomatic. These lesions appear more commonly in the oral cavity and oropharynx and are often misdiagnosed. A retrospective cross-sectional study was performed in clinically confirmed cases of ABH to study its epidemiology, etiology and presentation in a tertiary care hospital in Southern Asia.

Materials and methods: Total of 8 patients of ABH were evaluated and included in the present study. All clinical data and track records were assessed by the medical records department. Cases were studied and results were interpreted. Results: Total of 8 cases were enrolled with male-to-female ratio of 0.6:1 and middle age as the most common age of presentation. Buccal mucosa was the most common site involved with average lesion size of 1.6 cm. Masticating trauma was the most common etiological risk factor. Majority patients were asymptomatic with spontaneous resolution of lesions in all the cases.

Conclusion: Due to smaller number of studies reported, the lesions of ABH remained poorly understood with uncertain etiology. The knowledge of characteristic clinical features of the lesion and pattern of spontaneous healing is of utmost importance as a lesion of ABH can share some features with other serious disorders, thereby delaying the diagnosis. A thorough clinical history and examination of the lesion should always be done to establish an accurate diagnosis. Due to its completely benign nature, proper counseling of the patients must be ensured for better patient compliance.

Introduction: Otitis media with effusion (OME) is a widespread condition affecting children globally. This study aimed to assess the relationship between obesity in pediatric populations and the risk of developing OME.

Materials and methods: This retrospective observational study was performed in 2020 at Khalili and Dastgheib hospitals, affiliated with Shiraz University of Medical Sciences in Shiraz, Iran. The study included all children aged 2 to 15 years with a confirmed OME diagnosis. Participants in the non-OME group were chosen from children who did not have OME.

Results: A total of 148 healthy individuals were included in the non-OME group, while the OME group comprised 110 patients. Statistical analysis revealed that the mean age (p=0.040), weight (p<0.001), height (p=0.024), BMI (p=0.023), and BMI percentile (p=0.023) were significantly greater in the OME group compared to the non-OME group. Additionally, there was a higher proportion of males in the OME group (63.6%) compared to the non-OME group (44.0%), with this difference being statistically significant (p=0.001). Logistic regression analysis indicated that factors such as older age (p=0.023), male gender (p=0.001), and elevated BMI percentile (p=0.004) were significantly associated with the presence of OME.

Conclusion: This research indicates that there is a correlation between obesity and a heightened risk of OME.

Introduction: The COVID19 pandemic has posed one of the greatest challenges to healthcare systems worldwide. Tracheostomy is often required in critically ill patients with COVID19 who require prolonged mechanical ventilation and frequent airway clearance. Determining the optimal timing of tracheostomy in these patients, particularly after endotracheal intubation, remains clinically complex and controversial.

Materials and methods: This retrospective study included COVID19-positive patients (confirmed by PCR) admitted to a referral hospital in Northwest Iran who underwent tracheostomy during their ICU stay. Patients were stratified into early and late tracheostomy groups based on the interval between intubation and tracheostomy (<14 days vs. ≥14 days). Demographic data, duration of mechanical ventilation before and after tracheostomy, and survival rates were analyzed.

Results: A total of 62 patients were evaluated. Fourteen patients (22.6%) underwent early tracheostomy, while fortyeight patients (77.4%) underwent late tracheostomy. The mean duration of mechanical ventilation after tracheostomy was 28.57 days in the early group and 30 days in the late group. The overall duration of mechanical ventilation was significantly shorter in the early group compared with the late group (39.36 vs. 58.42 days). Survival rates were 57.1% in the early group and 39.6% in the late group.

Conclusion: Early tracheostomy-performed within the first 14 days following intubation-significantly decreases the total duration of mechanical ventilation in critically ill COVID19 patients. However, tracheostomy timing does not influence the duration of ventilation after tracheostomy or overall patient survival.

Introduction: Deviated nasal septum (DNS) is common in the population and at times can warrant a need for septal surgeries. It has been hypothesised that DNS increases the post-nasal discharge, leading to increased sino-bronchial reflexes. This leads to lower respiratory tract inflammation and infections. The current study has been done to confirm the above hypothesis and to evaluate the improvement after septal surgeries among the patients.

Materials and methods: 72 patients, above 18 years of age, who had undergone a septal correction surgery were included in our study. Pulmonary function tests (PFT) like FVC, FEV1, FEV1/FVC, FEF25%-75%, and PEF were used to evaluate the patients pre-operatively, 1 month post-operatively, and 2 months post-operatively. Additionally, the Nasal Obstruction Evaluation Scale (NOSE) was used to assess the improvement in PFT, comparing the pre-operative and 2 months post-operative PFT. The study was conducted from November 2022 to May 2023. All data were recorded and analysed using SPSS version 21.0.

Results: All PFT indices showed improvement on both the 1^st month (p>0.05) and 2^nd month (p<0.05) post-operatively. All patients had an improvement in the NOSE score 2 months post-operatively (p<0.001). Among all the patients, only the overweight and obese patients had a lower degree of improvement in PFT.

Conclusion: Our study thus concludes that septal surgeries have a positive impact on the Lower Respiratory Tract, thus confirming our hypothesis.

Introduction: Balance integrates sensory and motor functions through the visual, somatosensory, and vestibular systems. Auditory inputs also contribute to spatial orientation, aiding postural control and stability. Exploring the effects of auditory stimuli on postural stability may reveal their therapeutic potential. So, current study is undertaken to study effect of auditory stimuli in maintaining postural stability in healthy young and older adults with age-related hearing loss.

Materials and methods: A total of 70 participants were divided into two groups: Group I consisted of 35 individuals aged 18-35 years with normal hearing, and Group II comprised 35 older adults aged 50-80 years with mild to moderate sensorineural hearing loss. Pure Tone Audiometry was performed, followed by a Modified Clinical Test of Sensory Interaction and Balance (mCTSIB) protocol and tandem gait on static postural stability, under four conditions (quiet, speech, natural environmental sounds, white noise), both with and without auditory stimuli.

Results: Postural stability improved with natural sounds compared to quiet and other auditory stimuli in both young and older adults with age-related hearing loss. Healthy young adults consistently showed better postural stability than older adults in both quiet and auditory conditions.

Conclusion: Auditory stimuli can effectively enhance postural stability in both young adults and older adults with age-related hearing loss, with more pronounced effect observed in older adults. Therefore, auditory stimuli can be effectively used to enhance postural stability, suggesting their potential utility in therapeutic interventions aimed at improving balance in individuals with age-related hearing impairments.

Introduction: Myxomas are rare, benign mesenchymal tumors predominantly found in connective tissues, rarely occurring in the head and neck. Composed of stellate cells in a mucoid matrix, their incidence in intramuscular locations is about 1 in 1,000,000, with fewer than 200 cases reported since 1948. This report discusses the surgical treatment and pathology of a subcutaneous myxoma in the infraauricular region.

Case report: A middle-aged male presented with a painful, discharging polypoidal mass in the infraauricular area, initially misdiagnosed as a dermoid cyst from imaging and biopsy. Surgical excision and reconstruction using a bilobed flap were performed. Histopathological analysis confirmed myxoma. At the six-month follow-up, the patient demonstrated excellent wound healing and functional recovery, emphasizing the effectiveness of the bilobed flap in infraauricular reconstruction.

Conclusion: This case highlights the diagnostic challenge of myxomas, especially in unusual locations. Effective management relies on surgical removal with histological confirmation, demonstrating the importance of considering myxomas in differential diagnoses of neck masses. The successful use of a bilobed flap for reconstruction emphasizes the necessity for appropriate surgical planning to manage aesthetic and functional outcomes.