Iranian Journal of Otorhinolaryngology最新文献

Introduction: Pediatric sudden sensorineural hearing loss (SSNHL) is a rare otological emergency. With the emergence of the Coronavirus 19 pandemic, alcohol-based hand sanitizers are among the essential household items. Many hand sanitizers are frequently coupled with scents that young children may find pleasant.

Case report: A 5-year-old girl presented to our clinic with hearing loss after the consumption of alcohol-based hand sanitizer. A pure tone audiogram showed bilateral SSNHL. The child was prescribed systemic corticosteroids resulted in a slight improvement in hearing thresholds. The child was followed up at 6 and 18 months showing no further improvement in hearing thresholds.

Conclusion: Although various infective, vascular, and immune responses have been proposed, alcohol-based hand sanitizer consumption has not been reported to present with SSNHL to the best of our knowledge. In the current scenario of the Coronavirus pandemic, otorhinolaryngologists must keep in mind that SSNHL may occur as a result of hazardous alcohol-based hand disinfectant consumption.

Introduction: In morphologically normal-appearing inner ears, measurements of the distance between the round window and carotid canal (RCD), the maximum diameter of the basal turn of the cochlea next to the round window (BD), and the thickness of the promontory (PT) just lateral to the basal turn may be used as guide for safe cochleostomy and implant placement.

Materials and methods: From January to March 2022, a cross-sectional observational study was carried out in a tertiary care hospital. The round window to carotid canal distance (RCD), the largest diameter of the cochlea's basal turn next to the round window (BD), and the thickness of the promontory immediately lateral to the basal turn (PT) were measured using CT temporal bone images of 150 persons without cochlear abnormalities. The values obtained were compared using Paired T-test for significance of difference between both genders and sides.

Results: A total of 150 participants-75 men and 75 women-with a mean age of 37.5 years were enrolled in the study. With a range of 7.18 mm to 10.52 mm, the mean RCD was 8.84 mm (SD 0.8 mm). The mean BD was 2.27 mm (SD 0.4 mm), while the mean PT was 1.15 mm (SD 0. mm). The values obtained did not differ significantly in both the genders and the right and left sides (p = 0.37 and 0.24, respectively).

Conclusion: The present study has defined and calculated pertinent measures at cochleostomy site that will aid safe electrode insertion and prevent misplacement.

Introduction: The management of subglottic and tracheal stenosis is challenging for any ENT surgeon. The treatment choice depends on the site, severity of stenosis, patient symptoms, and surgeon preferences. The various options for the management include endoscopic balloon dilatation, various types of laryngotracheoplasty, resection anastomosis, and insertion of a silicon T-tube. Compared to the above, silicon T-tube stenting is a better alternative, as it is a onetime procedure, easy to perform with fewer chances of complications. Shiann Yann lee technique is a form of laryngotracheoplasty with long-term stenting using silicon T-tube. This article analyzed our silicon T-Tube insertion result in patients with subglottic and tracheal stenosis using this technique.

Materials and methods: In this retrospective study, we included a total of 21 patients with subglottic and tracheal stenosis who underwent silicon T-Tube insertion. Data regarding the site of stenosis, procedure, complications, and outcome were analyzed.

Results: Out of 21 patients, nine patients had subglottic stenosis (42.8%), 8 had cervical tracheal stenosis (38.09%), 3 had thoracic tracheal stenosis (14.28%), and 1 (4.7%) had combined subglottic and cervical tracheal stenosis. Out of 21 patients,7 (33.3%) have undergone successful removal of silicon T-Tube so far, one death due to medical reasons, and 13 patients (61.9%) are still on Silicon tube on regular follow-up. They are comfortable with the tube in situ.

Conclusions: Silicon T-Tube for benign acquired laryngotracheal stenosis with Shiann Yann Lee's technique is effective, safe with less complication, and good acceptability and tolerance by the patient.

Introduction: Anatomical variations of the neck muscles have previously been reported, involving in particular the omohyoid and sternothyroid muscles. We herein report a novel variant neck muscle found during a routine surgical procedure.

Case report: A 63-year-old women underwent a pelvi-mandibulectomy with bilateral neck dissection for a squamous cell carcinoma of the floor of mouth pT3N1. On the right neck dissection, the present peculiar muscle was discovered. It was located in the lateral region of the neck, deeply to the sternocleidomastoid muscle and caudally to the hyoid bone. It took origin from the sixth cervical vertebrae's transverse process and attached caudally to the middle third of the clavicular bone, after having passed superficially to the omohyoid muscle's intermediate tendon.

Conclusions: Neck muscles are important during head and neck surgery due to their significance as surgical landmarks and their relationship with noble vessels. Being aware of possible variant that can alter classical anatomical reference points is important to prevent iatrogenic trauma.

Introduction: The foramen of Huschke (FH) is a developmental bone defect located anteroinferior to the external auditory canal. In this study, the frequency of FH and the presence of TMJ herniation into the external auditory canal were investigated using high-resolution computed tomography (HRCT) of the temporal bone in patients with FH. In addition, it was aimed to determine whether there is a relationship between the degree of mastoid pneumatization and mastoid volume and the presence of FH.

Materials and methods: The HRCT images of 352 patients were retrospectively evaluated for the presence of FH and TMJ herniation into the external auditory canal. The degree of pneumatization was determined in 50 patients with FH and 53 patients without FH, and the mastoid volume was measured.

Results: Of the 704 temporal bones, 50 (7.1%) were detected to have FH 16 (4.5%) on the right and 34 (9.7%) on the left. The incidence of FH was higher in women on the right than in men (p<0.01). There was strong correlation between the FH width and age for the left side (r=0.466, p<0.01). The mastoid volume was 3.2-15.9 cm3 in the patients with FH and 3.2-16.2 cm3 in those without FH. The degree of pneumatization and mastoid volume did not significantly differ between the both groups (p>0.05). TMJ herniation into the external auditory canal was detected in one of the patients with FH.

Conclusions: We could not find a relationship between mastoid bone pneumatization and FH development. The presence of FH should be detected before TMJ and ear surgeries to prevent possible complications.

Introduction: Toxoplasma Gondii (TG) is a zoonotic protozoan with extensive symptomatology. Toxoplasmic lymphadenopathy is considered an affirmative sign and is proved by a biopsy of the enlarged nodule. This study was conducted to compare the clinical, serological, and histopathological findings for the diagnosis of toxoplasmic lymphadenopathy.

Materials and methods: This study involved biopsy examinations from twelve cases with TG lymphadenopathy. ELISA serological tests were performed for TG specific IgM and IgG immunoglobulins. PCR was done to ratify the results obtained by ELISA.

Results: The ages of the patients ranged from 15 to 48 years (mean=27.8). Most of the cases are male n=8(66.7%), while female n=4(33.3%). The asthenia was not only the most frequent clinical presentation (83.3%), but it also last longer. All cases had a positive biopsy. Eight (67.7%) cases revealed seropositivity. Two of them had positive PCR in those who were positive IgM, suggesting that the infection was acute. Six (50%) cases revealed positive IgG tests, while those with negative serology were 4(33.3%). The site of lymph nodes involvement had been assessed and mostly cervical (91.6%).

Conclusion: The histopathological results yielded 100% positive findings, thus biopsy was very important in the diagnosis and differential diagnosis of lymph nodes enlargement. The chronic phase of toxoplasmosis does not show the protozoa in the blood causing an absent DNA band for amplification of the PCR cycles, which could explain the lack of bands particular for TG. A negative serological test does not exclude toxoplasmic lymphadenitis, especially in immune-compromised patients.

Introduction: Laryngeal squamous cell carcinoma is one of the most critical head and neck cancers. Total laryngectomy is one of the main options for treating laryngeal squamous cell carcinoma responsible for forming pharyngocutaneous fistula (PCF), which increases morbidity and mortality. This study aimed to determine PCF incidence and identify the factors associated with this complication.

Materials and methods: In a retrospective cohort study, 85 patients who underwent total laryngectomy at Imam Khomeini Hospital (Tehran, Iran) from 2011 to 2019 were selected as the study population. The presence/absence of PCF, weight, anemia status (Hb <12.5 g/dl), renal dysfunction status (GFR <90 mL/min/1.73m2), malnutrition status (Albumin <3.5 g/dl), and marginal involvement status was extracted from postoperative medical records. The data were analyzed using SPSS ver. 26.0.

Results: The overall incidence of PCF was 11.8%. The mean ±SD of the duration of hospitalization in patients with PCF was 32.40 ±14.75 days, and in patients without PCF was 16.89 ±7.05 days (P = 0.009). The mean ±SD of time to develop a fistula was 7.4 ±3.74 days.

Conclusions: The statuses of anemia, malnutrition, renal dysfunction, surgical margin, history of radiotherapy, pharynx closure, gender, and age were unrelated to the incidence of PCF. Further studies with a larger sample size are recommended.

Introduction: Skin tumors are prevalent in the head and neck especially auricle but pilomatricoma is extremely rare in ear lobule.

Case report: A 7-year-old girl without a history of previous illness presented with a 1.5-month history of a lesion in the right ear lobule that tended to grow in size. It was a 2*2*2cm round, slightly painful lesion with soft tissue and light red in color that yielded bloody or serous fluid on aspiration. The lesion was enucleated. The diagnosis was pilomatricoma.

Conclusion: Although very rare, pilomatricoma should be considered as a differential diagnosis of ear lobule neoplasms.

Introduction: An abnormal mass in the head and neck involving the supraglottic and cervical region offers a wide range of differential diagnoses. The pathology is either benign or malignant in nature. Castleman disease (CD) is an uncommon lymphoproliferative disorder characterised by hypervascular lymphoid hyperplasia and is classified into unicentric or multicentric disease. Histopathologically it is divided into hyaline vascular (HV), plasma cell (PC), and mixed cellularity variants. The multicentric disease is linked with PC and has the propensity to progress to lymphoma or Kaposi Sarcoma.

Case report: We report a case of a 45-year-old gentleman who presented with a painless anterior neck swelling and left supraglottic mass for six months. Computed tomography (CT) contrast imaging demonstrated a homogenous enhancing lesion at the left supraglottic and the midline of the anterior neck with erosive changes of the thyroid cartilage. A surgical resection of the anterior neck mass was performed. The diagnosis of Castleman disease plasma cell variant was made by histopathologic evaluation. The patient remained well post-resection.

Conclusion: Supraglottic multicentric Castleman disease is the least expected diagnosis in this case. Unicentric disease is treated with surgery. However, limited studies are available in determining the effectiveness of surgery in multicentric diseases. The plasma cell variant requires a multidisciplinary and multimodal approach due to an inclination towards malignancy. Research is needed to determine the role of surgery in multicentric disease and to develop optimum guidelines for managing cases. To date, there is unsubstantial literature describing supraglottic multicentric disease.

Introduction: Seborrhoeic keratosis (SK) is a benign neoplasm of the skin. They are usually found to occur anywhere in the body except palms, soles and mucous membranes. The skin of the external auditory canal is an extremely rare site for the occurrence of this benign neoplasm. Malignant transformation rarely occurs in this benign condition. It should be differentiated from other malignant condition like squamous cell carcinoma, basal cell carcinoma, Bowen's disease, malignant melanoma or keratoacanthoma. Surgery is the mainstay of treatment though recurrence is very common. It can be removed by cryotherapy using liquid nitrogen or curettage, light fulgaration, shave removal or painting with pure TCA if the lesion is small. Diathermy shoul be used as minimal as possible to avoid scar formation.

Case report: An elderly female presented to ENT OPD with left ear blood-stained discharge. On inspection there was irregular blackish mass filling the entire left external auditory canal, fine needle aspiration cytology came to be seborrhoeic keratosis. Since on imaging the tumor was confined to the external auditory canal, it was excised completely by transcanal route. Surprisingly histopathology came to be squamous cell carcinoma. Considering the age and limited confinement of the tumor, she was kept on regular follow up.

Conclusion: Seborrhoeic keratosis though a common benign tumor, malignant transformation may occur. Treatment is patient specific and may be modified considering the age and comorbidity of the patient.