Iranian Journal of Otorhinolaryngology最新文献

Introduction: Chronic nasal obstruction, frequent respiratory infections, recurrent ear blocks, earaches, and pediatric obstructive sleep apnea may indicate adenoid enlargement, one of the most common conditions encountered in pediatric otorhinolaryngology practice. Adenoidectomy is a simple procedure with certain limitations, which has led to various innovations in surgical techniques in the recent past. The study aimed to compare two different adenoidectomy techniques: the endoscopy-assisted coblation adenoidectomy and the conventional curettage adenoidectomy.

Materials and methods: In this prospective randomized interventional study involving 40 patients, 20 patients in Group A underwent curettage adenoidectomy, and 20 patients in Group B underwent endoscopic coblation adenoidectomy. Complete adenoid tissue removal, surgical blood loss, operative duration, postoperative pain, and recovery time are the outcome measures.

Results: Endoscopy-assisted coblation adenoidectomy enabled complete adenoid removal better than conventional adenoidectomy, 15 patients (75%) had complete removal versus 3 patients (15%) in the conventional group (p-value of 0.0003). The mean blood loss was 30 ± 5.60 mL in Group A and 10.75 ± 2.93 mL in Group B (p = 0.0001). The pain score assessed using the visual analog scale was 4 ± 0.44 in Group A and 3 ± 0.36 in Group B (p = 0.0001). The mean time taken for recovery in Group A was 3.14 ± 0.62 days and that in Group B was 2.64 ± 0.64 days (p = 0.001).

Conclusions: Coblation adenoidectomy under endoscopic guidance enabled complete adenoid removal, reduction in surgical blood loss and postoperative pain, and shortened recovery time.

Introduction: Lymphadenopathy often causes anxiety due to its association with malignancy or serious infections. This study investigates the role of ultrasound features in distinguishing benign from malignant neck lymphadenopathy and proposes a quantitative scoring system (Node-RADS).

Materials and methods: This cross-sectional study was conducted at Omid Hospital, Mashhad University of Medical Sciences, Iran. Seven hundred ninety-one patients with neck lymphadenopathy underwent gray-scale and Doppler ultrasound, followed by fine needle aspiration (FNA) or core needle biopsy (CNB) for cytopathological confirmation. Key ultrasound features assessed included Short-Axis Diameter (SAD), Cortical/Hilar Echotexture, and Vascular patterns. A scoring system was developed by assigning malignancy coefficients to each variable. Malignancy coefficients (Wi) were assigned based on the prevalence of malignancy for each feature, and a quantitative Node-RADS score was derived. Diagnostic accuracy was evaluated using ROC analysis.

Results: Of 791 patients, 68.5% (542) had malignant lymphadenopathy, predominantly metastases (57.1%, 452). Malignancy coefficients (Wi = 9) were extracted to high-risk features: SAD >16 mm (82% malignancy), Isoechoic cortex with compressed hilum (89%), and non-hilar vascularity (91%). The proposed Node-RADS system achieved an AUC of 0.85 (95% CI: 0.817-0.889), demonstrating strong diagnostic performance.

Conclusion: The proposed ultrasound-based Node-RADS scoring system correlates significantly with pathologic results, offering an appropriate tool for evaluating cervical superficial lymphadenopathy.

Introduction: Chitosan, which is an amino polysaccharide resulting from the deacetylation of chitin, regarding its biomedical features such as antioxidant activity, muco-adhesive and hemostatic properties, antibacterial and anti-inflammatory effects, used for medical purposes. Oral cavity and oropharynx are two important structures that in terms of rich blood supply, hemorrhage might be life threating requiring effective hemostatic management. In present study, we evaluated the effect of chitosan dressing on oral cavity wound healing and hemostasis.

Materials and methods: Nine male dogs were selected simple randomized and divided into three groups. A wound was made in the buccal mucosa bilaterally. We used chitosan powder dressing on the right side, chitosan-free gaze was used on the left side and bleeding time was determined. Three Dogs after5, three dogs after 10, and three dogs after15 days underwent biopsy bilaterally and pathologic assessment performed. Continuous and ordinal variables were reported as a median and IQR, and Wilcoxon test, and Friedman test were used to analyzing. Data were analyzed using SPSS 21.

Results: Statistical analysis (Wilcoxon test) showed that the overall differences between two groups were statistically significant for (Acute inflammation score: P=.025; Collagenization score: P=.046; Neovascularization score: P=.046; Granulation tissue: P=0.046, and Re-epithelialization score: P=0.038). Chitosan powder dressing application significantly reduced acute inflammation and neovascularization, and increased collagenization, granulation tissue and re-epithelialization. Furthermore, the median time of bleeding and percentage change of wound size which were not statistically significant for all 3days in the case and control groups but they were clinically significant.

Conclusion: Chitosan salt powder dressing positively impacts the wound bleeding control and on mucosal wound healing according to histopathologic and gross wound healing indexes.

Introduction: Chronic Kidney Disease (CKD) is considered a public health issue because its frequency is increasing in adults. When a person experiences renal failure, one of the most researched solutes that builds up in plasma is indoxyl sulfate. This toxin can attach to proteins, and it is a byproduct of the tryptophan metabolism in the diet, which provides pro-oxidative and pro-inflammatory activity. In CKD, the redox imbalance associated with oxidative stress is associated with pathophysiological issues brought on by the buildup of uremic toxins. The cochlea is highly susceptible to oxidative stress, which consequently causes permanent cochlear degeneration. To better understand the connection between Indoxyl sulfate levels and hearing loss in CKD patients, we examined the results of pure tone audiometry and OAE examinations.

Materials and methods: This research was conducted on 27 people with stage 5 CKD who had their blood plasma levels of indoxyl sulfate measured before having their hearing ability assessed by OAE and pure tone audiometry. Next, a correlation test was carried out between the results of Indoxyl sulfate levels and the results of hearing function tests in CKD patients.

Results: The indoxyl sulfate value and degree of auditory impairment had a strong positive correlation, according to the Spearman correlation test. (r = 0.881; p = 0.001) and an inverse relationship between the Indoxyl sulfate value and SNR (r = -0.761; p = 0.001).

Conclusion: CKD patients have impaired hearing, which is correlated with the amount of uremic toxin Indoxyl Sulfate that has accumulated.

Introduction: CSOM is inflammation of the mucoperiosteal lining of the ME cleft characterized by ear discharge, permanent perforation of the TM, and hearing impairment. If perforation fails to heal, surgical closure is done by M-plasty (Type-I T-plasty). The graft material used to reconstruct the eardrum is mainly TF. The goal is to reconstruct the TM and sound-conducting mechanism in a long-lasting way. Here, in this study, corneal homograft was considered for closure of TM perforation as part of primary T-plasty. To utilize unused cornea as homograft in T-plasty for closure of TM perforation and obtain acoustic qualities similar to normal TM.

Materials and methods: 63 pts with TTD of ME in a hospital setup over a period of 2 years were considered for the study. All underwent T-plasty with use of Cornea and results were interpreted based on operative graft uptake and effective audible acoustics.

Results: 88% of patients showed successful corneal graft uptake, while 12% of patients with failed corneal graft uptake were planned for revision surgery with other graft materials. A literature review was done with a comparison in terms of various graft materials used to date, success of graft uptake, and audibility achieved following closure of TM perforation.

Conclusion: Corneal graft has shown fairly significant results in terms of efficacious graft uptake and efficient hearing acoustics after T-plasty.

Introduction: Cricoid abscesses are rare, typically occurring in the posterior part of the cricoid and are often life-threatening. In this paper, we describe the first reported case of an anterior cricoid abscess and discuss our management.

Case report: A 60-year-old lady presented with dyspnoea for 2 days and progressive hoarseness for 8 months. A contrast-enhanced computed tomography revealed a posterior soft tissue thickening and an anterior subglottic collection. The patient underwent endoscopic excision of the granuloma and drainage of the abscess. She completed 3 weeks of oral ciprofloxacin. Subsequent follow-up revealed a patent airway.

Conclusion: We were highly suspicious, as stridor is unlikely to be caused solely by a posterior granuloma. Clinicians should remain alert to the possibility of a second pathology, and early imaging should be performed when clinically indicated. The rarity of a cricoid abscess necessitates a high index of suspicion for diagnosis. In this case, progressive laryngeal lumen narrowing caused by posterior granuloma and cricoid abscess facilitated early symptom detection and timely management, thereby averting tracheostomy.

Introduction: Sjögren's syndrome is a systemic autoimmune disorder that gradually impairs exocrine function, primarily affecting lacrimal and salivary glands.

Case report: We describe an unusual presentation involving an elderly female patient diagnosed with late-stage Sjögren's syndrome. Laboratory testing eliminated viral infections including HIV and HCV. Fine-needle aspiration biopsy of parotid swellings revealed inflammatory cystic lesions, excluding malignancy and other common cystic conditions. MRI revealed several fluid-filled nodules in both glands.

Conclusion: This report supports including Sjögren's syndrome in the differential diagnosis for bilateral cystic lesions of the parotid glands. A synthesis of similar literature cases is included.

Introduction: Granulomatosis with Polyangiitis (GPA), also known as Wegener's Granulomatosis, is an ANCA-associated vasculitis that primarily affects small vessels, leading to necrotizing granulomatous reactions in the airways and small vessels. The etiology remains uncertain.

Case report: We report the case of a woman in her 70s, who was previously tracheostomized at another facility and was presented to our attention with glottic-subglottic stenosis. We performed a lysis of glottic synechia and subglottic debulking via transoral laser microsurgery, yielding satisfactory results over the short term. However, a relapse occurred within two months, along with ulcerative lesions on the nasal septum. Biopsies revealed multinucleated giant cells and inflammation suggestive of vasculitis. Based on the histological and clinical features, a diagnosis of vasculitis was considered. Anti-Neutrophil Cytoplasmic Antibodies testing was positive. A rheumatological examination confirmed the hypothesis of Granulomatosis with Polyangiitis. The lack of typical symptoms was the main reason for the delayed diagnosis.

Conclusion: Involvement of the subglottic region and the upper portion of the trachea is a rare but severe complication of GPA. The current literature reports only few cases of laryngeal stenosis, with poor prognosis. Histological examinations of biopsied laryngeal tissue showed significant but non-specific inflammation, contributing to the delay in diagnosis. There are still no precise guidelines for the surgical treatment of subglottic stenosis. This case underscores the importance of considering laryngeal involvement in GPA for early diagnosis and timely intervention to prevent serious complications in order to improve patient outcomes.

Introduction: Adenotonsillectomy is one of the most commonly done surgical procedures in paediatric population. Two main indications for paediatric adenotonsillectomy are recurrent sore throat due to bacterial infection and airway obstruction due to adenotonsillar hypertrophy. This study assessed the impact of adenotonsillectomy on quality of life (QoL) in paediatric patients (3-14 years) with chronic adenotonsillitis using the Paediatric Throat Disorders Outcome Test (T-14), focusing on obstructive and infective symptoms.

Materials and methods: A, prospective, observational study was conducted in a tertiary care hospital from May 2023 for a period of 18 months. Paediatric patients of age 3-14 years with chronic adenotonsillitis who underwent adenotonsillectomy were included in this study. Paediatric Throat Disorders Outcome Test (T-14) questionnaire form was filled by patient caregivers preoperatively at the time of hospital admission and postoperatively at 6^th week. Paired t-test was used to ascertain and compare the values obtained.

Results: 60 paediatric patients of age 3-14 years (mean age 8.7 years) were included in the study, who were diagnosed with chronic adenotonsillitis and underwent adenotonsillectomy. Symptom profile in the study population revealed obstructive issues, manifested as mouth breathing (83.33%) and snoring (45.00%), and infective symptoms presented as throat pain (60%). Following adenotonsillectomy, there was significant T-14 score reductions (p=0.0001) for obstructive (91.17%) and infective (88.10%) symptoms. These outcomes validate adenotonsillectomy's predominant role in addressing combined adenotonsillar pathology in paediatric patients.

Conclusion: Adenotonsillectomy significantly enhances QoL, reduces obstructive and infective symptoms with universal improvement supporting its use in chronic adenotonsillitis.

Introduction: Tuberculosis (TB) is an important contagious disease and a major public health problem globally. It may manifest as pulmonary TB or primary or secondary extrapulmonary TB. Primary oropharyngeal TB is very rare and may mimic presentation of oropharyngeal malignancy especially in the negative initial TB workup.

Case report: We would like to highlight a case of an elderly man presented with ipsilateral oropharyngeal mass and cervical lymph node (LN) enlargement, mimicking oropharyngeal malignancy with regional LN metastasis.

Conclusion: History of TB contact, poor oral hygiene, and poor immunity should alert the possibility of oropharyngeal TB. Involvement of ipsilateral oropharyngeal structure and cervical LN may simulate presentation of oropharyngeal malignancy with regional LN metastasis. Tissue biopsy for histopathological examination and appropriate staining is considered gold standard for diagnosis of TB and excluding malignancy. It is an important communicable disease, thus notification and referral to infectious disease team should be done without delay.