Iranian Journal of Otorhinolaryngology最新文献

Introduction: Accumulated and compacted ear wax or cerumen can cause conductive hearing loss, discomfort and vertigo, and infection. This study investigates the effect of Carbamide peroxide (CP) compared with Phenol glycerin (PG) ear drops on cerumen.

Materials and methods: This experimental study investigated the effect of PG and CP ear drops on cerumen in ex vivo and in vivo phases. In the ex vivo phase cerumen degredation was scored following PG and CP treatments. In the in vivo phase, 29 patients with bilateral cerumen impaction were randomly entered the study. PG and CP were applied 3 times a day (each time 5 drops) for 4 days by patients. After treatments, the time of cerumen removal was measured.

Results: Instant changes showing degredation of cerumen (grade 1) was evident when it was exposed to CP, on the other hand degredation changes (grade 1) in cerumen treated with PG was only evident after 20 min incubation at 37 ^oC, while grade 3 degredation was evident in cerumen treated with CP after the same time incubation. Although the time needed for removal of cerumen was lower in CP treatment (54.10±31.77) compared to PG treatment (67.10±35.54), the difference was not statistically significant.

Conclusion: Based on the literature and our results, carbamide peroxide is suggested as a proper treatment for patients with EAC obstruction caused by cerumen compaction, because not only it is significantly effective in cerumen degredation, but also no side effects have been reported.

Introduction: In around 10-20% of angiofibroma cases, the tumor penetrates the skull base to involve intracranial structures, posing difficulty in treating them surgically. Today, advancement in skull base surgery has brought about a paradigm shift, and extensive angiofibroma tumors with intracranial extension are approached surgically today with minimal morbidity.

Materials and methods: This study was a retrospective analysis of angiofibroma with significant intracranial extension Radkowski staging IIIb from 2011 to 2021 who came to our center. There were seven children of angiofibroma with significant intracranial extension Radkowski staging IIIb, out of whom, four patients had undergone surgical resection at our center. Three patients underwent surgery by pre-auricular lateral subtemporal approach and one patient by maxillary swing approach. Preoperative embolization was done in all the patients one day before the day of operation.

Results: Gross total removal of the tumor was achieved in all three patients who had undergone pre-auricular lateral subtemporal approach with no permanent complication. All three patients had a minimum follow-up of one year with no recurrence.

Conclusion: The pre-auricular lateral subtemporal approach provides the shortest shallow route to the affected skull base with direct visualization of the tumor base. Hence recommended for angiofibroma with Radkowski staging IIIb.

Introduction: Sarcoidosis is an idiopathic systemic granulomatous disorder that can affect multiple organs, including rare extrapulmonary sites like the premaxilla. This case report presents a rare occurrence of premaxillary sarcoidosis, a condition scarcely reported in medical literature.

Case report: The patient, a 62-year-old male, presented with a progressively enlarging painless swelling on the right cheek over a three-year period. Despite multiple Fine Needle Aspiration Cytology (FNAC) examinations yielding no conclusive diagnosis, a contrast-enhanced computed tomographic (CT) scan revealed an ill-defined lesion in the premaxillary soft tissue. Biopsy and subsequent excision procedures confirmed the presence of non-caseating granulomas with asteroid bodies, indicative of sarcoidosis. With no systemic involvement and complete excision of the disease, further treatment was not necessary.

Conclusion: This case highlights the challenges in diagnosing premaxillary (Extrapulmonary Sarcoidosis) sarcoidosis due to its rarity and resemblance to other dental and maxillofacial conditions and granulomatous lesions. Accurate diagnosis requires a high index of suspicion, multidisciplinary approach, involving clinical assessment, histopathological analysis, and imaging modalities. By deepening our understanding of these uncommon presentations, this report aims to enhance clinical awareness and contribute to improved patient outcomes.

Introduction: Soft tissue hemangiomas are among the most prevalent soft tissue tumors and can pose diagnostic challenges due to their propensity to extend into various regions. In our case, imaging studies facilitated effective characterization of the mass, and timely intervention with sclerotherapy enabled adequate initial control of the lesion. Subsequently, medical management with propranolol and a second scheduled surgical intervention with sclerotherapy contributed to a reduction in the lesion size, alleviation of symptoms, and improvement in prognosis.

Case report: We present a rare case of a giant cervical soft tissue hemangioma with laryngeal extension in an adult female, initially misdiagnosed as a primary laryngeal hemangioma. This case underscores the critical role of diagnostic imaging in assessing the extent of these vascular tumors.

Conclusions: A thorough assessment of the suspected site, as well as the entire head, neck, and chest, should be conducted for all patients with suspected hemangiomas.

Introduction: This study aimed to investigate the relationship between preoperative fine needle aspiration cytology (FNAC) for parotid tumors and the level of surgical training among residents, as well as to further elucidate its effectiveness as a diagnostic tool in the hands of the treating physician.

Materials and methods: Surgical records from patients who underwent parotid surgery between 2014 and 2022 were retrieved. Residents reported their perceived level of training duringthese procedures. Contingency tables were used to correlate the cytological with final histopathological results.

Results: A total of 286 patients who had undergone preoperative FNAC were included in the study. A preoperative diagnosis of pleomorphic adenoma or Wharthin's tumor was significantly associated with higher training scores among surgical residents. In contrast, a diagnosis of malignancy, other benign tumors, or indeterminate cytology was correlated with poor training scores (χ2 = 176.35; df = 2; p-value <0.001, Cramer's V 0.79). FNAC demonstrated a sensitivity of 88% and a specificity of 99.2% for detecting malignancy, with a positive likelihood ratio of 103.8 (95% CI: 26.02-414.34) and a negative likelihood ratio of 0.12 (95% CI: 0.06-0.26).

Conclusions: Our findingssuggest that preoperative cytological diagnoses of parotid tumors with a favorable prognosis, such as Wharthin's tumors, can enhance training and mentorship opportunities provided by senior surgeons. This is particularly significant for academic institutions with residency programs.

Introduction: Hypocalcemia is a common complication of total thyroidectomy (TT). This study was designed to investigate the effect of preoperative vitamin.D (Vit.D) status on the occurrence of post-total thyroidectomy hypocalcemia.

Materials and methods: Patients who underwent TT without parathyroidectomy were divided into three groups based on their preoperative Serum Vit.D levels (<20 ng/ml, 20-30 ng/ml, and ≥30 ng/ml were considered deficient, insufficient, and normal Vit.D levels, respectively). Serum levels of calcium and phosphorus were measured before and 24 hours after surgery in all patients. The patients were examined for clinical symptoms and signs of hypocalcemia postoperatively. In cases with positive clinical symptoms and signs of hypocalcemia and/or calcium levels <8 mg/dl, PTH level was measured before starting calcium infusion, while serum calcium and phosphorus levels were also measured 24 hours later.

Results: Among 100 patients enrolled in this study, 81% were females. The mean age was 36.60±8.32 years. Before surgery, the mean Vit.D level was 26.9±16.89 ng/ml, while 47% of cases had normal Vit.D level, 32% had insufficient vitamin levels, and 21% had Vit.D deficiency. Twenty-four hours after surgery, the calcium (P=0.356) and phosphorus (P=0.743) levels were not significantly different between the three Vit.D groups. A comparison of postoperative PTH levels between the three Vit.D groups showed no significant difference (P=0.596).

Conclusions: Based on our findings, preoperative serum Vit.D levels did not affect postoperative serum calcium levels.

Introduction: Cellular cannibalism is defined as a process of non-apoptotic cell death. This phenomenon has been indicated to be associated with aggressiveness, anaplasia, invasiveness, and metastatic potential of various malignancies. The Aim of this study is the evaluation of cell cannibalism in oral dysplastic lesions and oral cancer.

Materials and methods: A total of 31 cases of squamous cell carcinoma (SCC), 30 epithelial dysplasia, and 36 hyperkeratosis (HK) were enrolled in this Cross-sectional study. All hematoxylin and eosin tissue sections were examined in 10 high-power fields for tumor cell cannibalism. Data were analyzed using the Kruskal-Wallis and Fisher's exact test.

Results: Cell cannibalism was found in all cases of SCC, 58.3% of dysplastic lesions, and 3.7% of HK cases. The mean number of cells with cannibalism was 19.48± 4.94 in SCC patients, 1.03± 1.25 in dysplastic lesions, and 0.03± 0.18in HK with a significant difference (P<0.001). High grades dysplastic and cancerous lesions exhibited more cannibalistic cells (P=0.01, P= 0.27, respectively).

Conclusions: In addition to oral SCC, cell cannibalism was found in oral epithelial dysplasia; which was significantly more in SCC. This phenomenon was in association with grades of differentiation and might be considered a potential criterion for malignant transformation and high-grade lesions.

Introduction: Ear symptoms of granulomatosis with polyangiitis can range from ear fullness and otalgia to conductive or sensory neural hearing loss and sudden deafness. Cochlear implantation in these patients faces two challenges: access to the round window and control of mastoid and middle ear inflammation. The combined approach in cochlear implantation is a classic trans-facial recess approach facilitated by a trans-canal view.

Case report: In this case report, we present the "combined approach" in a 20-year-old lady with granulomatosis with polyangiitis who underwent cochlear implantation successfully using the combined approach.

Conclusion: Post-operative results suggest that the "combine approach" seems to be a safe, easy, and fast cochlear implantation technique for chronic otitis media with an atelectatic middle ear and retracted tympanic membrane or narrow facial recess space. It is a single-stage surgery that has no need for the obliteration of the ear and has less morbidity.

Introduction: Schwannoma, a peculiar benign nerve sheath tumour, is frequently hard to differentiate from other nerve tumours, such as neurofibroma. Around 25%-45% of all schwannomas emerge in the head and neck region, but only 0.1-1.5 % involve laryngeal structure. This tumour is most accurately diagnosed with biopsy via direct laryngoscopy; however, at some points this approach cannot detect a definitive diagnosis due to the surrounding capsule of the tumour and its similar histopathologic finding with other nerve sheath tumour.

Case report: Here, a case of 56-year-old female is reported with chief complaints of severe progressive dyspnea and dysphagia. Diagnosis of schwannoma was confirmed on radiological and histopathological examination with certain hurdles. A complete surgical excision via endoscopic approach was done, revealing that the bottom of the mass was attached to the right arytenoid mucosa. The histopathological features showed non-malignant atypical neurofibroma but later confirmed as laryngeal schwannoma from immunohistochemical staining.

Conclusion: Although schwannoma has an excellent outcome and prognosis when occurring elsewhere in the body, laryngeal involvement is an extremely rare area for this lesion. Complete resection with a patient-customized approach to the lesion is required to avoid relapses and provide good functional results.

Introduction: There needs to be more unanimity in the treatment approaches for supraglottic squamous cell carcinoma. This study evaluated the survival outcomes of patients who underwent transoral laser microsurgery for this type of cancer.

Materials and methods: This longitudinal study was conducted at a tertiary university hospital in Iran. Forty-one patients with supraglottic squamous cell carcinoma who underwent transoral laser microsurgery were included. The required data were extracted from medical records. Survival analysis using the Kaplan-Meier method was used to obtain the 5-year overall recurrence-free and laryngectomy-free survival rates.

Results: This study included 40 males (97.6%) and one female (2.4%). The mean ± standard deviation of patients' age was 55.17±8.43 years. The 5-year overall recurrence-free survival rate in all patients was 68.0%. In contrast, 76.0% of the cases were laryngectomy-free after five years. Patients in the T1 and T3 categories had better overall and laryngectomy-free survival rates when stratifying by disease stage, respectively. The 3-year local control rates of tumor were 80.0%, 63.1%, and 82.3% for T1, T2, and T3, respectively. The larynx could be preserved in four patients (80.0%) with T1, 15 patients (57.8%) with T2, and 14 patients (82.3%) with T3.

Conclusion: Our results suggest that transoral laser microsurgery may result in satisfactory recurrence-free survival and good oncologic outcomes. However, considering the indication of radiotherapy in some patients, the therapeutic effects of radiotherapy are part of the survival rate observed in this study.