Iranian Journal of Otorhinolaryngology最新文献

Introduction: Cochlear implantation is a surgical procedure which provides the sense of hearing in patients with sensorineural hearing loss, particularly when conventional hearing aids are no longer effective. Although cochlear implantation is mostly used for children, increasing number of adults are also benefiting from this life-changing technology. As cochlear implantation can improve communication in adults, enhance quality of life and socio-emotional well-being, the primary aim of the present study is to investigate the quality-of-life improvement in adult cochlear implant recipients.

Materials and methods: This quasi-experimental single-group pretest-posttest study utilized the Persian standardized version of the World Health Organization Quality of Life questionnaire (WHO-QOL-BREF) to assess quality-of-life improvements in 26 adult cochlear implant recipients with a mean age of 36.19 ± 12.71 years. The questionnaire was administered at two time points: the first month after receiving the speech processor and six months later. Data analysis was conducted using SPSS version 21.

Results: A repeated-measures ANOVA was performed to examine the effects of cochlear implantation and the subsequent rehabilitation program on four quality-of-life dimensions: physical health, psychological health, social relationships, and perception of the living environment. The analysis revealed a significant main effect of time on quality of life, indicating notable improvements across all dimensions from pre- to post-treatment.

Conclusion: The pre- and post-test analysis using the WHO-QOL-BREF questionnaire demonstrated a significant enhancement in the quality of life among adult cochlear implant recipients. Therefore, cochlear implantation is an effective intervention for treating hearing impairment in adults suffering from progressive hearing loss.

Introduction: In patients with unilateral vocal fold paralysis (UVFP), voice therapy (VT), injection laryngoplasty (IL), and medialization thyroplasty (MT) are reported to produce significant improvement in voice quality (VQ). However, their long-term outcomes have not been sufficiently evaluated. We assessed the improvement in VQ with VT, IL, and MT over 12 months.

Materials and methods: This prospective observational study involved 95 adult patients with UVFP, categorized into three groups: VT (n=55), IL (n=36), and MT (n=4). The VQ was assessed with voice handicap index (VHI), maximum phonation time (MPT), phonatory gap (PG), and breathy voice quality (BVQ) on Day 1, 15, 30, 90, 180, and 360.

Results: In the VT group, the decrease in PG, VHI score, and BVQ score was significant from Day 15, 30, and 30, respectively, while MPT increased significantly from Day 15 (p<0.05). In the MT group, similar changes were observed; however, these changes were significant from Day 1 (p<0.05). In both the groups, the lowest PG, VHI score, and BVQ score, and the highest MPT were attained on Day 360. In the IL group, PG, VHI score, and BVQ score decreased significantly, and MPT values increased significantly at every visit (p<0.05). However, PG, VHI score, and BVQ score started increasing and MPT started decreasing from Day 90, 15, 90, and 180, respectively.

Conclusion: All treatment modalities improved the VQ significantly, immediately with IL and MT, and gradually with VT. Moreover, the improvement was long-term with VT and MT, and of intermediate duration with IL.

Introduction: Sickle cell disease (SCD) is a major global health burden with significant clinical, social, and economic impacts. Sensorineural hearing loss (SNHL) is an underreported complication of SCD that is, primarily attributed to vaso-occlusive crises and ischemia. This condition adversely affects the quality of life, education, and social integration, particularly among children in resource-limited settings. Understanding the risk factors for SNHL is crucial for prevention, early detection, and timely intervention. This study evaluated the prevalence of SNHL in children with SCD and identified associated risk factors.

Materials and methods: This prospective comparative study was conducted at a tertiary healthcare facility in Northwest Nigeria. A total of 250 children aged 5-16 years were enrolled, comprising 125 patients with confirmed sickle cell disease (SCD) in a steady state and 125 age- and sex-matched controls with a normal haemoglobin genotype (HbAA).

Results: Bilateral SNHL was identified in 25.6% of SCD cases, whereas no SNHL was observed in the control group. The male-to-female ratio among the affected children was 1.2:1. Multivariate logistic regression revealed significant associations between SNHL and elevated white blood cell count (Odds Ratio {OR} 1.035; 95% Confidence Interval {CI} 1.020-1.050), elevated platelet count (OR 1.209; 95% CI 1.070-1.365), poor clinic attendance (OR 28.668; 95% CI 4.879-168.458; P= < 0.001), non-compliance with SCD medications (OR 9.634; 95% CI 1.830-50.718; P = 0.008), and frequent severe sickle cell crises requiring hospitalization (OR 2.106,; 95% CI 0.019-0.598; P = 0.001).

Conclusion: This study highlights the high prevalence of SNHL in children with SCD and its association with modifiable risk factors. Routine audiological screening, consistent clinic attendance, medication adherence, and regular monitoring of haematological parameters are essential for early identification and management of SNHL. Targeted interventions can significantly improve the outcomes and reduce the burden of this debilitating complication.

Introduction: Endoscopic nasal surgery has numerous potential adverse effects, adhesions are at the top of the list. 5-fluorouracil (5-FU), which is an analogue of pyrimidine, is utilized in a wide variety of areas for the purpose of preventing adhesions. In the present investigation, our purpose was to analyze the impact of intra-operative application of 5-flurouracil in the nasal cavity following FESS, as well as to evaluate both subjective and objective outcomes.

Materials and methods: Following the acquisition of institutional ethical approval, a testing procedure that was randomized, prospective, and double-blinded was carried out. After the FESS, a cotton swab soaked in 1 mL of 5-flurouracil at 5 mg/mL was inserted in one side of the nasal cavity and a saline-soaked one in the other. Both of these swabs were kept in place for a period of five minutes. Postoperatively, patients were assessed over 6 months duration, wherein, adhesions, discharge, crustation, edema and polypoidal changes were analyzed. Subjective symptoms such as nasal block, nasal discharge and loss of smell were also assessed.

Results: At the one-week follow-up, the test group had a significantly higher incidence of adhesions (32% vs. 11.76%, respectively) (p = 0.004) than the control group. Mucosal edema, crusting, polypoidal change and nasal discharge continued to significantly diminish in both groups. Furthermore, improvement in smell perception in the test group at the 20th week post-operatively was statistically significant (p= 0.014).

Conclusions: Adhesions are less common in the early postoperative period in individuals who underwent FESS with or without polypectomy when 5-FU is administered topically. There is also an improvement in smell perception with a reduction of mucosal edema, crusting, polypoidal change and nasal discharge enabling better healing.

Introduction: We aimed to report our clinic's 11-year experience with cochlear implant (CI) revision surgeries.

Materials and methods: This was a retrospective observational study. Patients who underwent CI and revision surgery at the same tertiary institution were enrolled in the study. Patients whose primary surgery was performed at another institution were excluded from the study. The patients' clinical charts, surgical records, and audiological and oral language outcomes were retrospectively examined.

Results: Thirty-three (29 children, 4 adults) of 720 patients (871 CI) at our clinic required revision surgery, representing a revision surgery rate of 4.58%. The most common reason for revision was device failure (10 patients), followed by skin and electrode problems, with electrode tip fold-over in 6 patients, a broken electrode cable in 1 patient, skin flap complications in 6 patients, displacement of the magnet in 1 patient, cholesteatoma in 1 patient, electrode migration in 6 patients, misplacement of the electrode array into the internal acoustic canal in 1 patient, and explantation of the electrode cable in the external auditory canal in 1 patient. We had only one major complication after revision surgery.

Conclusion: We recommend performing routine postoperative imaging, even if intraoperative telemetries are normal, to diagnose electrode misplacement or electrode tip fold-over. Additionally, we recommend long-term regular follow-up of children, in particular, because our study showed that the number of revision surgeries was higher in children who received implants at an early age.

Introduction: Spontaneous pharyngo-laryngeal hematoma in patients receiving oral anticoagulants is rare and potentially fatal because of upper airway obstruction. Many risk factors can cause potential hemorrhagic complications, such as drug interactions.

Case report: We present the case of a 74-year-old man who was on oral anticoagulation by acenocoumarol and presented with acute laryngeal dyspnea. The final diagnosis of pharyngo-laryngeal hematoma secondary to hypercoagulation was made based on the clinical, biological, and radiological features. Therefore, conservative management was initiated. Drug interactions between anticoagulants and macrolides were the probable underlying causes of excessive anticoagulation.

Conclusion: Pharyngo-laryngeal hematoma should be considered in patients receiving anticoagulant therapy with symptoms of upper airway obstruction. Drug interactions may be the underlying cause of hypercoagulation, so medications should be carefully prescribed to these patients.

Introduction: Olfactory dysfunction is prevalent among individuals with chronic kidney disease (CKD), with prevalence escalating alongside disease severity. The uremic toxin we observed in this study is Indoxyl sulfate (IS), a potent uremic toxin that markedly accumulates in the plasma of patients with chronic insufficiency. Olfactory damage may occur in the setting of neuronal damage due to renal failure.

Materials and methods: 27 patients, a total sample in this study with diagnosed chronic kidney disease within stage 5 on regular hemodialysis, were examined for indoxyl sulfate levels in blood plasma and then examined for their olfactory function using the Sniffin' Sticks test. A correlation analysis was conducted between indoxyl sulfate levels and olfactory function test results in patients with CKD.

Results: The Pearson correlation test revealed a strong, significant negative correlation between indoxyl sulfate levels and olfactory function (r = -0.613; p = 0.001). Additionally, correlations were found between indoxyl sulfate levels and each component of olfactory function: threshold value (r = -0.408; p = 0.035), discrimination (r = -0.807; p = 0.001), and identification (r = -0.703; p = 0.001).

Conclusion: Olfactory function is compromised in individuals with chronic renal disease and correlates with the level of accumulation of the uremic toxin indoxyl sulfate.

Introduction: Frontal anterior laryngectomy with epiglottic reconstruction (Tucker's reconstructive surgery) is a technique of partial laryngectomy that has been used by several authors since its introduction in the 80s.The aim of this serie is to specify the indications of this operation and to present the functional and oncological outcomes of our study and those found in the literature.

Materials and methods: We report a retrospective study of 65 cases who underwent Tucker's operation by many surgeons at our educational center over a period of 31 years (1988 - 2020).

Results: This serie included 62 men (95%) and 3 women (5%), with a mean age of 62,8 years. The cases were classified as follows: 42 patients with T1aN0M0 (65%), 21 patients with T1bN0M0 (32%) and 2 patients with T2N0M0 (3%). Following surgery, the mean time for tracheal cannula extraction was 18,4 days and for nasogastric tube was 14,4 days. Five cases developed aspiration pneumonia. Voice quality was then assessed based on its intensity and intelligibility with 11,7% rated as very good, 53,3% as good, 31,7% as average and 3,3% as poor. There were 4 cases of local recurrence, 2 cases of nodal recurrence, and 2 cases of tumour pursuit. The median survival rate was 7,5 years.

Conclusion: The functional and oncological outcomes of Tucker´s reconstructive surgery were generally satisfactory in our patients and are consistent with those reported in the literature. This technique holds an important position of this technique in the therapeutic arsenal for early glottic carcinoma.

Introduction: Sudden hearing loss represents a medical emergency that can potentially have a highly negative impact on an individual's quality of life. In particular it can represent a serious concern in pediatric age, interfering cognitive and language development. Despite the seriousness of the problem, there is currently no consensus on diagnostic and therapeutic management methods, and the debate is still open.

Case report: We present the case of a 15-year-old child with a sudden right-sided hearing loss of profound degree and of idiopathic etiology. Initially he was treated with oral steroid treatment and subsequently to multiple sessions of hyperbaric oxygen therapy without satisfactory results. Several weeks after the onset of symptoms, the patient underwent a cycle of 3 intratympanic methylprednisolone injections with unexpected hearing recovery.

Conclusions: Intratympanic steroid therapy could represent not only a life-saving therapeutic choice as it is currently considered, but also a first therapeutic choice, particularly in pediatric age, thanks to substantial absence of systemic side effects and the potential efficacy even after many weeks from the onset of symptoms.

Introduction: Rhinophyma is a chronic skin pathology that mainly affects the nose. It is featured by thickening of the skin and soft tissue of the nose. Treatment options include topical medication, systemic drugs, electrocautery, cryosurgery, laser therapy, dermabrasion, and in some cases, surgical procedures like rhinoplasty. The aim of this report is to demonstrate the usefulness of the blue laser and its efficacy in the treatment of rhinophyma.

Case report: We report two cases of patients diagnosed with rhinophyma who underwent blue laser treatment.

Conclusions: The use of blue laser to treat rhinophyma has shown to be an effective and safe procedure with very promising results.