Hematological Indices in COVID-19 Patients with Rhinosinusitis Mucormycosis

Introduction

Rhinosinusitis mucormycosis (RM) is an invasive opportunistic fungal infection, especially among COVID-19 patients. The current study aimed to assess the peripheral blood hematological disorders of COVID-19 patients-associated RM.

Materials and Methods

During ten month, in two COVID-19 centers in Mashhad, Iran, from June 2021 to March 2022, eighty-three patients suspected of COVID-19 with rhinosinusitis or rhino-orbital mucormycosis participated in this study. The hematological indices of these patients were measured by independent sample T-test or Mann-Whitney test for quantitative data, and the qualitative variables were analyzed using Chi-square or Fisher's exact test in SPSS version 20 at a significance level of 0.05.

Results

Of the COVID-19 patients, 40 (48.2%) were affected by RM, and leukocytosis due to neutrophilia was observed in 30% of them. Leukocyte counts were normal in 10 (25%) patients, but 1 (2.5%) and 3 (7.5%) had leukopenia and lymphopenia, respectively. Leukocytosis plus lymphopenia was observed in 7 (17.5%) patients. Also, the synchronicity of leukopenia and lymphopenia was seen in 5 (12.5%) patients. Leukopenia, lymphopenia, and neutropenia have occurred concurrently in 2 (5%) patients. The complete blood count (CBC) showed that RBCs, hemoglobin (Hb), hematocrit (HCT), MCH, MCHC, platelet (PLT), and lymphocytes decreased while neutrophils increased.

Conclusion

Among the hematological parameters, leukocytosis due to neutrophilia and reduction in Hb, HCT, and PLT are more dominant factors in COVID-19 patients-associated RM.

Response Comment on "Detection of Lophomonas blattarum (Order: Hypermastigida from Iranian Patients with Allergic Rhinitis"

The Article Abstract is not available.    

PRP-Fibrin Glue for Pain Reduction and Rapid Healing in Tonsillectomy

INTRODUCTION

Many ongoing challenges have been applied to reduce the considerable postoperative pain and increase wound healing after tonsillectomy, but they are still not optimally managed. This study applied autologous platelet-rich plasma (PRP) & platelet-rich fibrin glue (PRFG) to reduce pain and increase wound healing.

MATERIALS AND METHODS

PRP & PRFG were prepared from 26 patients' blood. At the end of the tonsillectomy, one tonsillar bed was selected randomly, PRP was injected, PRFG was applied topically on the bed wound, and the other sites were left untreated. The treated and untreated tonsillar beds were compared for pain and wound healing the next day, 3rd day, 6th day, 9th day, and 15th day.

RESULTS

There were no complications during and after the injection. The mean age was 24.76 ±5.54 years. In the treated beds in comparison to untreated beds, pain decreased marginally in 1st day (intervention:4.5±2.54, control:5.53±2.94, P-value=0.18) and 3rd day (intervention:3.92±2.96, control:4.8±2.82, P-value=0.276), and significantly in 6th day (intervention:2.3±2.46, control:3.92±2.6, P-value=0.026), 9th day (intervention:1.26±1.48, control:2.76±2.4, P-value=0.009) and 15th day (intervention:0.73±1.07, control:1.84±2.36, P-value=0.08) after surgery. Healing did not change in 1st day (P-value=1), changed marginally in 3rd day (P-value=0.2), and increased significantly in 6th day (P-value=0.001), 9th day (P-value=0.006), and 15th day (P-value=0.004) after surgery.

CONCLUSIONS

Autologous PRP injection & PRFG application offer an effective, safe, and non-invasive method for reducing pain and increasing wound healing after tonsillectomy.

Detection of Lophomonas blattarum (Order: Hypermastigida) from Iranian Patients with Allergic Rhinitis

Background

Allergic rhinitis (AR) is one of the most common allergic diseases triggered by indoor and outdoor allergens. Certain arthropods, such as mites and cockroaches, contain protozoa like Lophomonas blattarum in their intestines to help with digestion that may have some role in AR. We aimed to determine the frequency of L. blattarum in nasal smears of patients with AR in comparison with healthy controls.

Methods

In this prospective cross-sectional study (March 2015-March 2016), 36 patients with a clinical presentation of AR (with a positive prick test including mites) and 34 normal controls were included at ear, nose, and throat (ENT) clinic at Imam Reza Hospital of Mashhad, Iran. Nasal secretions were evaluated to examine presence of L. blattarum in the patients and control group by direct method. Diagnosis of L. blattarum was based on microscopic observation both on direct smear and Giemsa stained specimens.

Results

Patients with AR had a higher frequency of L. blattarum in their nasal smears than the control group (25% vs. 2.9%) (P=0.001).

Conclusion

We found L. blattarum more frequently in the nasal secretion of AR patients compared with healthy subjects; this protozoon may have some role in this condition. However, the relationship between L. blattarum and AR requires further studies to allow a greater understanding.

Mucormycosis in pre-COVID-19 and COVID-19 era: A study of prevalence, risk factors and clinical features

Objective

Mucormycosis is a rare yet devastating fungal disease with a frequently fatal outcome. The purpose of this study was to compare the prevalence of mucormycosis, evaluate its risk factors, and assess the patients' outcomes in pre-COVID-19 and COVID-19 era.

Methods

In this retrospective observational study, clinical data of 158 patients with confirmed histopathological diagnosis of mucormycosis were collected from the medical records departments of Imam Reza and Ghaem hospitals, Mashhad, Iran during 2018-2021. The collected data were risk factors associated with mucormycosis including age, gender, underlying diseases, details of corticosteroid administration, and complications such as blindness and mortality.

Results

Of 158 studied patients, 48 patients were diagnosed in the pre-pandemic period whereas 110 cases were admitted during the pandemic era. COVID-19 associated mucormycosis (CAM) was observed in 58.1% of the pandemic cases. In the pre-pandemic period, cancer (89.5% vs. 39%, p < .001) was significantly more prevalent while during the pandemic era, the prevalence of diabetes mellitus (16.7% vs. 51%, p < .001) was remarkably higher. Moreover, the mortality rate of mucormycosis was considerably reduced after the pandemic (64.6%-45.4%), especially in CAM patients (35.9%).

Conclusion

The COVID-19 pandemic has led to an increased prevalence of mucormycosis, due to the convergence of interlinked risk factors such as diabetes mellitus, corticosteroid therapy, and COVID-19. Therefore, clinicians must be aware of the probable occurrence of mucormycosis in the first or second week of COVID-19 infection in vulnerable patients and use the steroids cautiously.

Level of evidence

4 Laryngoscope Investigative Otolaryngology, 2022.

Potential Effects of Rhinoplasty on Voice in Professional Voice Users

BACKGROUND AND AIM

Surgical procedures involving the manipulation of the airway structure have the potential to affect the quality of voice by changing the resonance properties. Regarding this, the present study was conducted to investigate the effect of rhinoplasty on the voice of professional voice users.

METHODS AND MATERIALS

This cohort study was conducted on 30 professional voice users. For the purpose of the study, the patients completed the Voice Handicap Index (VHI). In addition, they were subjected to voice analysis that included the measurement of nasality in speech production (i.e., nasalance), using the nasometer II. Computerized speech lab was also utilized to examine vowels /e/ and /a/, each of which was sustained for 5 sec by the participants.

RESULTS

The mean VHI scores were 8.5 ± 1.98 and 7.36 ± 1.71 before and after the surgery, respectively, indicating no significant difference between the two investigated stages (Z = - 0.53, P = 0.59). However, there was a significant difference between the patients with and without preoperative obstruction in terms of the VHI score (χ²= 11.06, P = 0.004). With regard to orality, it had the mean values of 16.86 ± 7.45 and 15.22 ± 7.37 before and after the surgery, respectively. Furthermore, the mean values of nasality at the pre- and post-operation stages were 59.42 ± 6.04 and 56.28 ± 10.07, respectively. The comparison between the pre- and post-surgical orality and nasality revealed no significant difference (t = 1.226, P = 0.23 and t = 0.93, P = 0.36, respectively).

CONCLUSION

Although rhinoplasty is supposed to affect voice and vocal resonation, the induced changes are not problematic for the professional voice users.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Olfactory Dysfunction in Patients Infected with 2019 Novel Coronavirus

INTRODUCTION

The current study aimed at investigating the occurrence and features of olfactory dysfunction in patients with confirmed coronavirus disease 2019 (COVID-19) infection.

MATERIALS AND METHODS

Patients with laboratory and clinically confirmed COVID-19 infection were enrolled in this longitudinal study. They were managed in either the inpatient or outpatient setting. The demographic, clinical, and outcome data were retrieved from patients' medical records. Olfactory dysfunction features, including the onset pattern, duration, and recovery time were investigated. The visual analog scale (VAS) was utilized as a self-rating subjective measurement of olfactory function.

RESULTS

According to the results, the mean age of the patients (n=502) was obtained at 46.8±18.5 years; moreover, 52.4% and 47.6% of cases were female and male, respectively. It was also revealed that 35.4% and 64.5% of the subjects were outpatients and hospitalized, respectively. Based on the findings, 178 (38.4%) subjects had olfactory dysfunction. The mean values of VAS in hyposmic patients were estimated at 2.5±2.5, 8.3 ±2.1, and 9.4±1.6 at the first evaluation, in 2 weeks, and after 1 month of follow-up (P<0.001). The onset of olfactory dysfunction was more suddenly (58.7%). The majority of cases experienced olfactory dysfunction at the same time as other symptoms 72(51.1%). Based on the results, 0.4% of subjects infected with COVID-19 had olfactory dysfunction as an isolated symptom. The olfactory dysfunction was recovered after 2 weeks in 18 (25.3%) anosmic and 37(46.8%) hyposmic patients.

CONCLUSION

Olfactory dysfunction seemed to be an important symptom of COVID-19 infection. The occurrence of this disturbance as a transient self-limited condition was significantly higher among female subjects.

Association Between Serum Vitamin D Level and Ménière's Disease

OBJECTIVES

Ménière's disease (MD) is a well-known inner ear disease; however, the etiopathogenesis is unknown. Several factors may be involved. Meanwhile, vitamin D is reported to have an important role in inner ear physiology. The aim of this study is to evaluate the relation between vitamin D deficiency and MD.

STUDY DESIGN

This matched case-control study compared serum vitamin D levels between patients with definite MD and those without it.

SETTING

The study was done between August 2018 and December 2019 at Ghaem University Hospital in Mashhad, Iran.

METHODS

Twenty-eight patients with definite MD were matched with a group of 84 healthy individuals, regarding age, sex, body mass index, and occupation (indoor vs outdoor). The serum level of vitamin D (25-hydroxyvitamin D3) was measured in both groups.

RESULTS

The mean ± SD vitamin D level was 18.9 ± 9.7 ng/mL in the case group and 25.2 ± 13.7 ng/mL in the control group (P = .027). There was a significant difference between the case and control groups according to the results of the conditional logistic regression model (P = .03; adjusted odds ratio, 0.96). In the MD group, 17 (60.7%) patients were vitamin D deficient, 6 (21.4%) insufficient, and only 5 (17.9%) sufficient.

CONCLUSIONS

The results of this study show that serum vitamin D level in MD is significantly lower than that of the control group. However, the role of vitamin D supplementation in the management of MD needs further study.

LEVEL OF EVIDENCE

4.

The effect of standardized honey on mucosal healing of the nose and paranasal sinuses after polypectomy: A randomized controlled, double blind pilot study

OBJECTIVES

Nasal polyposis (NP) is a chronic inflammatory disease. Honey has several anti-microbial, anti-oxidants, healing, and anti-inflammatory properties which may reduce the need for steroids in this situation. Therefore, the aim of this study is to show the effect of standardized honey on mucosal healing of the nose and paranasal sinuses after polypectomy.

DESIGN AND METHOD

In this double-blind, randomized, placebo-controlled clinical trial, 28 patients with nasal polyposis underwent functional endoscopic sinus surgery (FESS). Besides common post-op medications, normal saline (as a placebo) and diluted processed honey were used separately in the two nostrils of each patient. Two endoscopic follow-ups using the Philppot-Javer (P-J) scoring system were performed to assess the healing and recurrence of polyps on either side. The secondary outcome measure was the patients' satisfaction rate.

RESULTS

The patients' mean age was 38.03±11.9 years. 15(57.7%) had a positive prick test and also 15(57.7%) had dense eosinophilic infiltration in their surgical specimens. In the first and second follow-up sessions, total P-J scores showed better results for honey in comparison to the normal saline side but that results were not significantly different (P=0.93, P=0.07); whereas it is fair to say that in the second follow-up, the ethmoid and maxillary sinuses demonstrated a greater difference compared to the other sites based on their averages but there were not significantly meaningful (P=0.05, P=0.06). The total score also showed better results for honey in comparison to the normal saline side but was statistically insignificant (P=0.07).

CONCLUSION

Diluted honey seems to have certain positive effects in reducing post-operative edema and the recurrence of nasal polyps in at least the ethmoid and maxillary sinuses; although this positive effect did not result in significant changes. (www.actabiomedica.it).

Post-Rhinoplasty Acne, Frequency and Role Players

Introduction

Acne is a common complain among post rhinoplasty patients. While rhinoplasty is done for aesthetic reasons and acne expressively affects the individual’s appearance, we aimed to study its incidence and role players.

Materials and Methods:

A descriptive cross-sectional study was performed on 152 (143 females and 9 males) patients admitted for rhinoplasty during January 2016 to March 2017. Patients were examined by a dermatologist prior to surgery and 7, 30 and 90 days after rhinoplasty using the Global Acne Grading System and responded to a list of questions on the probable risk factors of acne. Psychological status was examined by the perceived stress scale-14 and the Hospital Anxiety and Depression Scale.

Results:

The patients' mean age was 28.9±3.82 yrs. Mild and moderate acne were observed in 21.7% (n=33) of the cases in the preoperative visit. The incidence of mild and moderate acne was 36.1%, 42.8% and 23% after 7, 30 and 90 days of surgery, respectively. One week after rhinoplasty, acne manifested in 14.9% of cases with no history of acne. Mean age significantly differed between those with and without post-surgical acne at all post-surgical visits (P> 0.001 and P=0.001 and P=0.015, respectively). Hospital anxiety and depression and perceived stress levels were significantly higher in patients who presented with acne on the first post-surgical visit compared to those with no acne presentations (P=0.04 and P=0.02, respectively).

Conclusion:

External psychological stress may be the main role player in post-rhinoplasty acne. Consultation or referral of patients to an experienced psychologist is highly recommended for a better outcome and fewer complications.

Clinical comparison of the efficacy of spirulina platensis and cetirizine for treatment of allergic rhinitis

The aim of this study is to compare the efficacy provided by spirulina platensis and cetirizine for treatment of allergic rhinitis (AR). A randomised controlled clinical trial was performed on 53 patients with AR divided into experimental and control groups in an accredited tertiary academic centre. Subjects in the experimental group were treated with spirulina (2 g per day) and the control group was treated with cetirizine (10 mg per day) for 2 months. Symptoms were assessed based on a standard questionnaire and inflammatory mediators, and the results were compared before and after treatment. There were 23 men and 30 women with a mean age of 26.75 years (SD 9.26; range 8-58). The differences between the two groups in terms of age and gender were not significant. There was no significant difference between the two groups in clinical presentations before the intervention (P > 0.05). The prevalence of rhinorrhoea (P = 0.021), nasal obstruction (P = 0.039) and smell reduction (P = 0.030) in the experimental group improved significantly compared to those seen in the control group after intervention. Sleep condition, daily working and social activity improved significantly in the experimental group (P < 0.05). Furthermore, there was no significant difference between groups regarding inflammatory mediators before treatment; however, after 1 month of treatment, the levels of interleukin (IL)-1α (P < 0.001), IL-1β (P < 0.001) and IL-4 (P = 0.008) were all significantly lower, and IL-10 levels were significantly higher in the experimental group, compared to those in the control group. In conclusion, spirulina is more effective than cetirizine in improving cardinal symptoms of AR patients. Furthermore, spirulina can be considered as an alternative treatment in patients with AR.

Chronic rhinosinusitis with polyposis and serum vitamin D levels

The pathogenesis of chronic rhinosinusitis (CRS) is still unknown, but it is accepted that various inflammatory factors are responsible for the different CRS subtypes. Vitamin D3 has been shown to alter inflammatory mediators in some diseases and its deficiency might also be associated with CRS with nasal polyposis (CRSwNP). Herein, we investigated serum vitamin D3 levels in patients with CRSwNP and its association with disease severity. In a cross-sectional study, 166 cases with CRSwNP and 172 healthy subjects were enrolled. Serum vitamin D3 levels were measured and compared in both groups. Furthermore, the relationship between serum vitamin-D3 level and the patient’s allergic status and severity of disease (clinically and based on computed tomographic imaging and nasal endoscopy) among patients with CRSwNP was assessed. Serum vitamin D3 level in the CRSwNP group was significantly lower than in the control group (P < 0.0001). After controlling for possible confounding factors, an increase in vitamin D level showed a protective effect in CRSwNP (OR = 0.69 95% CI:0.62-0.76). A negative correlation was found between serum vitamin-D3 level and the Lund-Mackay score (LMS) (P < 0.0001, R = – 0.66), the Lund-Kennedy score (LKS) (P < 0.0001, R = – 0.71) and the Sino-Nasal Outcome Test-22 (P < 0.001, R = – 0.49). Serum vitamin D level in the CRSwNP group was significantly lower than the control group. Disease severity, based on imaging, endoscopic and clinical criteria, was inversely associated with serum vitamin D levels.

Evaluation of the frequency of invariant natural killer T (iNKT) cells in nasal polyps

Nasal polyps (NP) are associated with inflamed mucosa of unknown etiology. The role of T cells in nasal polyposis is unclear. Invariant natural killer T cells (iNKT) can promote Th2 responses and have been implicated in some types of asthma. As there are shared inflammatory pathways involved in asthma and NPs, we evaluated the frequency of iNKT in 17 patients with NPs, but without asthma. A median of 6% polyp cells were T lymphocytes, of which iNKT were 0 to 2.38% (mean 0.674%). In the matched group (n = 10), iNKT in NPs was significantly higher than PBMCs (1.057% vs 0.155%, P < 0.05). Relative expression of Vα24 to TCR-beta genes in polyps (n = 14) was higher than blood in matched samples (n = 4). The presence of greater proportions of iNKT in NPs than in blood suggests that iNKT may play a role in the pathogenesis of nasal polyposis.

Risk Factors for Sensorineural Hearing Loss in Neonatal Hyperbilirubinemia

INTRODUCTION

Hyperbilirubinemia is a common neonatal problem with toxic effects on the nervous system that can cause hearing impairment. This study was conducted to assess the risk factors for sensorineural hearing loss and other coexisting problems in icteric infants.

MATERIALS AND METHODS

In a case-control study, 200 term infants with bilirubin levels higher than 20 mg/dl admitted to the neonatal intensive care unit of Ghaem Hospital, Mashhad during 2007-2015 were investigated. Profiles of infants with hearing impairment (n=60) were compared with those of icteric newborns with normal hearing (140 newborns) as the control group. After confirming the clinical diagnosis of jaundice by laboratory findings, a validated questionnaire containing mother and infant profiles were used for data collection. The auditory brainstem response test was used for assessment of infant hearing status after discharge.

RESULTS

Sensorineural hearing loss among infants with severe hyperbilirubinemia was found to be 4.8%. Serum total bilirubin (P=0.001), creatinine levels (P=0.002), direct Coombs test results (P=0.001), etiology (P=0.000) and treatment for jaundice (P=0.000), eye movement disorders (P=0.001), opisthotonos (P=0.001), and microcephaly (P=0.001) were found to be significantly different between the two groups (P<0.005). The prognostic predictability of sensorineural hearing loss based on total bilirubin level was found to be 82%.

CONCLUSION

Hearing impairment occurs about 10-50 times more frequently in neonates with severe jaundice. Total bilirubin level has the highest predictability for infant hearing status. Blood group and Rhesus (Rh) incompatibilities between mother and child and G6PD deficiency are important known causes for hearing impairment due to jaundice.

Drug Induced Sleep Endoscopy in Obstructive Sleep Apnea

BACKGROUND

One of the main challenges of surgical treatment in Obstructive Sleep Apnea (OSA) is identifying the correct site of upper airway obstruction in an individual patient. Drug-Induced Sleep Endoscopy (DISE) in sedated patients with obstructive sleep apnea is the technique of choice for revealing anatomic and dynamic collapsible areas.

MATERIALS AND METHODS

In a prospective cross-sectional study adult patients with OSA documented by polysomnography were evaluated by sleep endoscopy. DISE had been done by an otolaryngologist in the setting of operating room during infusion of propofol and after the start of snoring. Endoscopic findings were recorded and evaluated from the aspect of obstruction level, severity, and multiplicity.

RESULTS

Twenty OSA patients (60% men) with mean±SD age of 38.9±9.26 years and mean Body Mass Index (BMI) of 26.57 kg/m2 were included in the study. OSA was severe in 11(55%) and moderate in 5(25%) subjects. Unilevel airway collapse was observed as retropalatal in 4(20%) and retrolingual in 3(15%) subjects. Multilevel collapse had been observed in the other 13(65%) patients. Most patients (65%) had multilevel obstruction especially those with BMI>30 (p<0.05). With increasing BMI, obstruction changed from unilevel to multilevel. None of the subjects showed complications with propofol or endoscopy procedure.

CONCLUSION

Our study showed DISE is safe, easy to perform, and informative in OSA patients. In particular, we observed a significant association between obesity and multilevel upper airway collapse.

Identification of fungal causative agents of rhinosinusitis from Mashhad, Iran

Background and Purpose:

Rhinosinusitis is a common disorder, influencing approximately 20% of the population at some time of their lives. It was recognized and reported with expanding recurrence over the past two decades worldwide. Undoubtedly, correct diagnosis of fungi in patients with fungal rhinosinusitis affects the treatment planning and prognosis of the patients. Identification of the causative agents using the standard mycological procedures remains difficult and time-consuming.

Materials and Methods:

Based on clinical and radiological parameters, 106 patients suspected of fungal rhinosinusitis were investigated in this cross-sectional prospective study from April 2012 to March 2016 at an otorhinolaryngology department. In this study, internal transcribed spacer (ITS) and calmodulin (CaM) sequencing were respectively validated as reliable techniques for the identification of Mucorales and Aspergillus to species level (both agents of fungal rhinosinusitis).

Results:

Of these, 63 (59.4%) patients were suspected of allergic fungal rhinosinusitis (AFRS), 40 (37.7%) patients suspected of acute invasive fungal rhinosinusitis (AIFRS), and 3 (2.8%) patients suspected of mycetoma. In patients suspected of AFRS, AIFRS, and mycetoma only 7, 29, and 1 had positive fungal culture, respectively. After ITS and CaM sequencing, Aspergillus flavus was the most common species isolated from non-invasive forms, and A. flavus and Rhizopus oryzae were more frequently isolated from invasive forms.

Conclusion:

Aspergillus flavus is the most common agent of fungal rhinosinusitis in Iran, unlike most other reports from throughout the world stating that A. fumigatus is the most frequent causative agent of this disease.

Congenital Vomer Agenesis: Report of Two Cases

INTRODUCTION

Congenital vomer agenesis is an extremely rare condition in which the vomer bone does not fully develop, which can lead to septal perforation.

CASE REPORT

We report two cases with a defect in the vomer bone in the posteroinferior portion of the septum, found accidentally while performing a pre-operative CT scan for nasal obstruction evaluation. They were diagnosed with congenital vomer agenesis.

CONCLUSION

There are afew reports of vomer agenesis in literatures. By increasing usage of sinonasal endoscopic examination,we expect to address more cases in the future.

Subcutaneous Emphysema, Pneumomediastinum and Pneumothorax in a Patient with Dermatomyositis

INTRODUCTION

Spontaneous pneumomediastinum, pneumothorax, and subcutaneous emphysema are rare, but serious complications of inflammatory myopathies and occur more commonly in DM than PM. complications of dermatomyositis (DM) and polymyositis (PM), both of which can be fatal.

CASE REPORT

A 20-year-old woman was admitted with neck pain, dyspnea, cough, and fever. She had been diagnosed with dermatomyositis 21 months prior. A thorax computed tomography (CT) scan revealed ground glass opacities in her lungs, pneumomediastinum, pneumothorax, and subcutaneous emphysema. Despite intensive immunosuppressive therapy, clinical deterioration and radiological progression were observed, ultimately the patient died.

CONCLUSION

During the care for a patient with dermatomyositis, the otorhinolaryngologist should be cautious of rapidly progressive and fatal neck subcutaneous emphysema. For a patient with dermatomyositis and with normal bronchoscopy and esophagoscopy, the main treatment is control of dermatomyositis with medical therapy. Therefore, a tracheostomy and/or mechanical ventilation may not be necessary.

Efficacy of Supportive Therapy of Allergic Rhinitis by Stinging Nettle (Urtica dioica) root extract: a Randomized, Double-Blind, Placebo- Controlled, Clinical Trial

The aim of this study was to survey the exact benefit of this herb in the management of clinical and laboratory signs and symptoms of allergic rhinitis. In a randomized double blind clinical trial, 74 patients with the signs and symptoms of allergic rhinitis and a positive skin prick test were selected and randomly divided into 2 groups who were takenUrtica dioica 150-mg, Urtidin^® F.C Tablet) or placebo for one month. Their signs and symptoms, eosinophil percentage on nasal smear, serum IgE, and interleukin IL-4, IL-5, interferon- γ) levels were recorded. Forty patients completed the trial. Based on the Sino- Nasal Outcome Test 22 SNOT-22), a significant improvement in clinical symptom severity was observed in both groups P < .001). Furthermore, a statistically significant reduction in mean nasal smear eosinophil count was observed after treatment with Nettle P < .01). However, the mean IgE and IL4 and IL5 levels in the study group before and after treatment with Nettle saw no significant changes P > .1). Intergroup pre- and post-treatment laboratory findings suggested that there was a significant difference in post-treatment changes of mean IFN γ levels between the study and placebo group P = 0.017). Although the current study showed certain positive effects of Nettle in the management of allergic rhinitis on controlling the symptoms based on the SNOT-22, similar effects were demonstrated by placebo as well. We believe that our limitations underscore the need for larger, longer term studies of Nettle for the treatment of allergic rhinitis.

Allergic rhinitis and dental caries in preschool children

Background:

Allergic rhinitis (AR) may be overdocumented in cases of dental caries because of controversies in the literature This study was conducted to investigate the potential relationship between AR and dental caries in children.

Materials and Methods:

A total of 296 children were included in this cross-sectional study. Participants were evaluated using the decay-missing-filled (DMF) index, and their AR status was evaluated by physical examination and through a standard questionnaire. Baseline demographics and clinical characteristics were compared among groups using Student's t-test or the Mann–Whitney U-test, the Chi-square test, and/or Fisher's exact test as appropriate. A level of P < 0.05 was regarded as statistically significant.

Results:

Evidence of AR was found in 77 (35.1%) participants. There was no significant difference in the rate of tooth decay or DMF between participants with or without AR (P = 0.07), but a significant difference was observed in the number of missing and filled teeth between those with and without AR (P < 0.05). There were no significant differences in educational level, family income, milk intake, use of pacifier, use of a toothbrush, saliva secretion, or body mass index (P > 0.05 in all cases) between AR-positive and AR-negative patients. Fluoride therapy and oral breathing were identified as confounding factors and controlled using log-linear analysis. The mean rate of DMF in patients who also had AR was 20% greater than in the AR-negative group (odds ratio [OR] = 1.21, confidence interval [CI]: 1.05–1.35) and 15% greater in among children who breathed orally than those who did not (OR = 1.15 CI: 1.02–1.31).

Conclusion:

AR and oral breathing may have an effect on oral health and dental condition, leading to an increased rate of tooth loss, oral fillings, and development of dental caries.

Opium Addiction and Risk of Laryngeal and Esophageal Carcinoma

INTRODUCTION

Cigarette smoking and alcohol consumption have a well-known effect on the development of upper aerodigestive tract carcinomas, but such a role for opium is questionable. This study was designed to assess the correlation between opium inhalation and cancer of the larynx and upper esophagus.

MATERIALS AND METHODS

Fifty eight patients with laryngeal cancer, ninety eight patients with upper esophageal cancer and twenty seven healthy individuals with no evidence of head and neck or esophageal malignancies were selected from Otolaryngology and Radiation Oncology Department of Mashhad University of Medical Sciences. Duration and amount of cigarette smoking and opium consumption were recorded through comprehensive interviews.

RESULTS

The crude odds ratio for laryngeal cancer was 5.58 (95% CI 2.05-15.15, P=0.000) in cigarette smokers relative to non-smokers and 9.09 (95% CI 3.21-25.64, P=0.000) in opium users relative to non-users. The crude odds ratio for esophageal cancer was 0.44 (95% CI 0.18-1.09, P=0.07) in cigarette smokers relative to non-smokers and 1.44 (95% CI 0.57-3.62, P=0.43) in opium users relative to non-users. After adjusting for smoking, the odds ratio for laryngeal cancer in opium users relative to non-users was 6.06 (95% CI 1.10-33.23, P=0.05). Laryngeal cancer was detected at a significantly lower age in opium users (54.54±10.93 vs 62.92±10.10 years, P=0.02) than in smokers. This effect was not observed in esophageal cancer. Although the duration (year 17.50±14.84 vs 21.91±14.03; P=0.34) and amount (pack/day 0.625 vs 0.978; P=0.06) of smoking were higher among those who were opium dependent, these differences were not statistically significant (P=0.34 and P=0.06, respectively).

CONCLUSION

Opium addiction by snuffing is an independent risk factor for the development laryngeal cancer but not esophageal cancer. Cigarette smoking increases this risk. Opium dependency increases the likelihood of developing laryngeal cancer at a younger age.

Asthma in Rhinosinusitis: A Survey from Iran

INTRODUCTION

The coexistence of asthma and chronic rhinosinusitis (CRS) is more common than expected given their individual prevalence in the general population and may affect patient's quality of life. The aim of this study was to evaluate the prevalence of asthma in chronic rhinosinusitis in Mashhad, Northeast Iran.

MATERIALS AND METHODS

This study was performed in two university hospital from November 2012 for 12 months. In total, 153 patients with chronic rhinosinusitis were enrolled and referred to a particular pulmonologist for asthma evaluation.

RESULTS

The mean age of participants was 40.54±13.11 years, and 41.8% were male. In total, 63.4% of patients had the polypoid form of CRS. The proportion of patients in this study with asthma was 41.8%, compared with a general asthma prevalence in this region of 13.5%.

CONCLUSION

There is a high prevalence of asthma among patients with CRS, but it often remains undiagnosed. Asthma in CRS patients should be diagnosed and treated in order to improve patient's quality of life. We recommend an evaluation of the lower airways in all of these patients as well as further studies in this field.

Acute invasive fungal rhinosinusitis: our experience with 18 cases

Acute invasive fungal rhinosinusitis (AIFRS) is a rapidly progressive life threatening infection that is seen most commonly among immunocompromised patients. We present a case series of 18 patients clinically and histopathologically diagnosed with AIFRS with a mean follow-up of 9.11 ± 2.51 months (range 6-17). Demographic data, apparent symptoms and signs, underlying disorders, and outcomes are discussed. The mean age was 39.56 ± 20.66 years (range 2-75). The most common underlying diseases were diabetes mellitus (50 %) and leukemia (44.44 %). Mucosal biopsy confirmed fungal invasion of the nasal mucosa in all cases. The main fungi were Rhizopus oryzae (55.56 %), Absidia mucor (16.67 %), and Aspergillus fumigatus (27.78 %). Headache and facial pain (77.8 %), facial paresthesia (55.6 %), and ophthalmoplegia (33.3 %) were the most common symptoms and signs. Computed tomography and endoscopic findings showed various stages of sinonasal (100 %), pterygopalatine fossa (55.56 %), orbital (44.45 %), and cerebral (5.56 %) involvement. All patients underwent serial surgical debridement (3.78 ± 1.80 times; range 2-8) simultaneously with systemic antifungal therapy and proper management of the underlying disease. The most extreme case with brain involvement survived and recovered with no evidence of recurrent disease following treatment. All patients were considered cured after two endoscopic negative histopathologic evaluations. Three patients (16.67 %) died, one from uncontrolled leukemia and two due to renal failure. AIFRS is a potentially fatal condition, however, early diagnosis and management of the underlying disease accompanied with systemic antifungal and aggressive serial surgical intervention appears to be effective in reducing mortality in most patients.

Is Sudden Hearing Loss Associated with Atherosclerosis?

INTRODUCTION

Sudden sensorineural hearing-loss (SSNHL) patients constitute approximately 2-3% of referrals to ear, nose and throat (ENT) clinics. Several predisposing factors have been proposed for this condition; one of which is vascular disorders and perfusion compromise. In this research the atherosclerotic changes and their known risk factors are studied in SSNHL patients.

MATERIALS AND METHODS

Thirty SSNHL patients and 30 controls were evaluated with regard to cardiovascular risks including history, heart examination, blood pressure, body mass index, waist circumference, electrocardiogram, blood sugar, triglycerides, cholesterol, high-sensitivity C-reactive protein (HSCRP); also, carotid artery color Doppler study was undertaken to measure intima media thickness(IMT).

RESULTS

IMT and HSCRP showed an increased risk in the case group compared with the controls (P= 0.005 & P=0.001). However, waist circumference, history of smoking, fasting blood sugar, lipid profile, and electrocardiogram revealed no significant difference between the two groups. Interestingly, blood pressure and body mass index were higher in the controls in this study.

CONCLUSION

Sudden sensorineural hearing loss may be associated with subclinical atherosclerosis.

The effects of inferior turbinoplasty on nasal airflow during cosmetic rhinoplasty

Rhinoplasty is one of the most common and challenging cosmetic procedures. One of the complications of rhinoplasty associated with dissatisfaction is nasal obstruction, which is often due to narrowing of the nasal valve area. Application of certain procedures such as turbinoplasty can prevent and correct this problem. This study aim was to investigate the effect of inferior turbinoplasty in reduction of airflow resistance and nasal obstruction. Using active anterior rhinomanometry, nasal airflow was measured in 50 patients who underwent cosmetic rhinoplasty and bilateral turbinoplasty before and 6 months after surgery. None of the patients subjectively complained of nasal obstruction before or after surgery. According to rhinomanometry results, improvement in nasal airflow was seen both in inspiration and expiration, although only expiration was significant (p = 0.034). Airflow changes in males and females and in different age groups was not significant (p > 0.05). It appears that rhinoplasty does not adversely affect nasal airflow when it is accompanied by simple adjuvant procedure inferior turbinoplasty.

Accessory tongue: Classification and report of a case

Accessory tongue (AT) is a rare congenital anomaly. Due to rarity of AT, various terminologies are applied, including accessory tongue, bifid tongue, double tongue, cleft tongue, and supernumerary tongue. It seems that the anomaly has geographic distribution and most reported cases are from India and Middle East. No comprehensive classification has been introduced yet. So, we present a classification for AT according to review of all papers and documents that we found, and report a 2-month-old male infant with this anomaly.

Distance between Anterior Commissure and the First Tracheal Ring: An Important New Clinical Laryngotracheal Measurement

INTRODUCTION

The distance between the anterior commissure of the larynx and the first tracheal ring (AC.T. distance) is of great importance in laryngotracheal surgeries. The amount of narrowing of the subglottic airway is used as a quantitative mean to determine whether the lesion is subglottic or has extended to the trachea and therefore helps in the prediction of the final prognosis.

MATERIALS AND METHODS

In this study, the larynx was exposed by direct laryngoscopy under general anesthesia. The case was considered to be difficult because the exposure did not optimally reveal the anterior commissure, therefore a cricoid tape or anterior commissure laryngoscope was used. A zero degree Hopkins lens was used to view the anterior commissure and the first tracheal ring. Special markers were used to mark the two points with the distance between those being considered as the AC.T. distance. The relationship between AC.T. distance and the patient's age, sex, BMI, and laryngeal exposure condition during laryngoscopy was also studied.

RESULTS

Eighty-two patients participated in this study. The mean AC.T. distance was measured and was found to be 32.67±3.34 mm in males and 29.80± 3.00 mm in females. This difference was statistically significant between the two groups (P<0.05). There was no statistically significant relationship between BMI, age, laryngeal exposure condition, and the AC.T. distance.

CONCLUSION

The AC.T. distance was measured to be around 3 cm; with males measuring greater than females. However, future studies may lead to a more accurate practical scale for laryngotracheal surgeries due to possible technical or human errors, in addition to racial differences.

Epidemiological Survey of Sinonasal Malignancy in North-East Iran

INTRODUCTION

Sinonasal malignancies are uncommon neoplasms with several histological subtypes. These malignancies have a poor prognosis and, because of the nonspecific nature of the symptoms, most patients are diagnosed late when the disease is already at an advanced stage. Therefore, most sinonasal malignancies tend to be treated with surgery and postoperative radiotherapy. Understanding the incidence and prevalence of clinical symptoms, pathology, diagnosis, and subsequent prognosis of the disease is important for early diagnosis.

MATERIALS AND METHODS

Medical records of patients with a confirmed diagnosis of sinonasal malignancy in a tertiary referral center from 1998 to 2009 were retrospectively investigated by chronological examination. Information relating to symptoms, pathology, and treatment of patients were collected from the checklists and used to generate tables and graphs, while descriptive statistical tests were used to compare data.

RESULTS

The records of 69 patients were examined, including 45 (65.2%) male and 24 (34.8%) female patients with a combined mean age of 54.07±16.04 years. Twenty-one patients (30.4%) were aged less than 45 years and 48 (69.6%) were more than 45 years of age. The most common symptom was facial swelling in 46 (66.6%) patients and the most common kind of tumor was squamous cell carcinoma in 28 (40.6%) patients. The primary location of the tumor in most patients was the maxillary sinus (54 patients; 78.3%). A majority of patients present in advanced stage (stage III or more) with intraorbital (39.1%) or intracranial (4.3%) involvement, or regional lymphatic (28.99%) or distance metastasis (7.2%). The most common treatment was surgery (17 patients; 24.6%).

CONCLUSION

Due to their nonspecific symptoms, most sinonasal malignancies are diagnosed at an advanced stage of the disease. Therefore, all patients with nonspecific symptoms, especially older males, should be evaluated for sinonasal malignancies in order to eliminate this diagnosis.

Hearing disorders in Turner's syndrome: a survey from Iran

Turner syndrome (TS) is one of the most frequently encountered sex-linked chromosomal abnormalities, occurring in one per 2,000 female births. These patients present with short stature and failure to begin puberty. In this syndrome, there are multiple organ abnormalities, including auditory disorders. TS patients were referred to the ENT clinic by a pediatric endocrinologist. A questionnaire was filled out and the patients went through a complete otologic examination. They were then referred to the audiology clinic to undergo audiologic test battery plus high-frequency pure tone audiometry. From a total of 48 ears examined, 11 (22.9 %) had a normal audiometry. Mid-frequency sensorineural hearing loss (SNHL), high-frequency SNHL, combined and mixed hearing loss were diagnosed in 6 (12/5 %), 20 (41/7 %), 6 (12/5 %) and 1 (2/1 %) ear, respectively. Tympanogram results showed normal compliance (A, As, Ad) in the majority of cases. B and C patterns were found in a few cases. Speech discrimination score was normal in all patients whereas speech reception threshold was normal in 92 % of the ears. Audiometry abnormality especially SNHL is common in TS patients, with the high-frequency pattern being the most frequent.

The prevalence of allergic rhinitis in patients with chronic rhinosinusitis

INTRODUCTION

Chronic rhinosinusitis (CRS) is a multifactorial disease. Allergies are considered a predisposing factor to CRS; however, this remains controversial. The objective of this research was to investigate the prevalence of co-morbidities and allergic reaction, and to specify the most common allergens in patients with confirmed CRS.

MATERIALS AND METHODS

One hundred patients with signs and symptoms of CRS who met the diagnostic endoscopic and radiologic criteria of chronic rhinosinusitis were selected. They filled out a questionnaire and underwent a skin prick test for the common inhalant allergens. Allergic rhinitis was diagnosed according to the history and positive skin prick tests.

RESULTS

The mean age of patients was 34. Males were slightly more involved (54%). The prevalence of polypoid and none-polypoid rhinosinusitis was 54% and 46% respectively. The patients' most common symptoms were nasal discharge (95%), blockage (94%), smell disorders (63%), cough (45%), halitosis (41%), lethargy (37%), and aural fullness (36%). Allergy to at least one allergen was noted in 64% of the CRS patients which is higher than general population in Mashhad, Iran with allergic rhinitis (22.4%). Salsola was the most common allergen. There was no significant difference in allergic reactions between polypoid and non-polypoid CRS patients.

CONCLUSION

Allergic reactions was found in Iranian CRS patients with or without polyposis to be much higher than general population in Mashhad with allergic rhinitis alone.

Middle Ear Function in Sinonasal Polyposis: A Case-Control Study

Objectives:

Determine the effect of sinonasal polyposis on middle ear (ME) and Eustachian tube (ET) function.

Methods:

In a case-control survey, 90 cases in 3 groups including 42 advanced stage sinonasal polyposis patients, 24 patients with chief complaint of nasal obstruction in the absence of polyposis, and 24 healthy cases (not suffering from nasal obstruction or allergic rhinitis) were studied. Subjective ear- and nose-related complaints, tympanic membrane condition and movement during the Valsalva and Toynbee maneuvers, type of nasal secretions, polyposis staging both clinically (Lund Kennedy) and by imaging (Lund McKay), audiometric evaluation, and ET function tests were recorded.

Results:

Subjective hearing loss ( P = .017), impaired TM movement during Toynbee maneuver ( P = .027), Type B tympanogram ( P = 0.025) showed significant difference in the polyposis group in comparison with the other 2. Furthermore, allergic rhinitis and nasal mucopurulent secretion were seen significantly more commonly among polyposis patients compared with other groups ( P = .026, P = .000, respectively). TM movement during Toynbee maneuver ( P = .004), type B tympanogram ( P = .030), and Toynbee test ( P = .004) showed a significant difference between patients who had purulent secretion compared with those without.

Conclusions:

It seems that sinonasal polyposis may change middle ear function to some extent, but the changes are related to the inflammation (allergic or infectious) associated with polyposis, rather than the nasal airway obstruction per se.

Smell Decline as a Good Predictor of Sinonasal Polyposis Recurrence after Endoscopic Surgery

Objectives:

Evaluate the most sensitive symptom that predicts recurrence of nasal polyposis.

Methods:

In this prospective study, we evaluated 62 patients with diffuse nasal polyposis. All patients underwent functional endoscopic sinus surgery. Sino-Nasal Outcome Test (SNOT-22) was answered by patients at preoperative visit and 1, 3, 6, 12, and 24 months after surgery. All of the patients were on maintenance therapy with nasal corticosteroid and saline irrigation postoperatively for 6 months. Patients were followed up with serial endoscopic examination, and computed tomography (CT) scan was performed if indicated.

Results:

All 62 patients (37 male, 25 female) completed the study. The mean age was 41.24 ± 12.47 years. Allergic rhinitis and asthma existed in 45% and 43.5% of cases respectively. Seven patients (11.3%) underwent revision surgery during the 2-year follow-up period. Fifty-two patients had a smell problem preoperatively, but 98.1% of them regained satisfactory olfaction after the surgery. The severity of symptoms gradually increased in patients with recurrence of polyposis but at a different point of time ( P value = .008). Sense of smell was the first symptom that became worse in patients with relapse (mean 6 months) followed by nasal secretion (12 months) and obstruction (24 months). Patients with asthma and allergic rhinitis showed the symptoms of recurrence sooner than other patients ( P < .05).

Conclusions:

The most sensitive symptom for the recurrence of nasal polyposis is decrease in sense of smell. Recurrence of nasal obstruction was noticed in the late stage of relapse when frank polyposis formation was established.

An unusual cause of dysphonia with hemoptysis: a laryngeal live leech

INTRODUCTION

Foreign bodies in the upper airway are one of the most challenging otolaryngology emergencies and have various presentations depending on their physical properties and location. Leeches are blood-sucking hermaphroditic worms that vary in color, length, and shape. They usually reside in fresh-water streams and lakes. When rural untreated water is drunk, leeches may localize in the nose, pharynx, and esophagus, or rarely in the larynx.

CASE REPORT

This case is a man who was referred to our otolaryngology clinic with a complaint of hemoptysis and mild respiratory distress. The patient's symptoms were all relieved post operatively and he was discharged on the second day following the procedure.

CONCLUSION

Leeches should be suspected as an airway foreign body in patients with a recent history of drinking stream water.

Differentiation between CSF Otorrhea and Rhinorrhea in an Obscure Case of Recurrent Meningitis

INTRODUCTION

Leakage of cerebrospinal fluid in the skull base may be accompanied with recurrent meningitis. The site of leakage may either be anterior (in the nose and paranasal sinuses) or posterior (in the temporal bone). Various imaging techniques can be used to precisely locate the point of leakage but despite all the advances in imaging techniques there are still some rare cases in which the surgeon can't be sure on the management approach before the beginning of surgery.

CASE REPORT

In this article we present one of these cases; we used intrathecal fluorescein to locate the source of the leak and made the final decision on the operating table.

CONCLUSION

Intrathecal fluorescein is helpful in locating the leakage in the ear or the nose in ambiguous cases.

HIV: An Epidemiologic study on Head and Neck Involvement in 50 Patients

INTRODUCTION

Acquired immunodeficiency syndrome (AIDS) is a worldwide infection. Because of the vast array of manifestations of AIDS and its many atypical presentations, it is becoming increasingly challenging for clinicians to accurately diagnose new lesions.

MATERIALS AND METHODS

In a descriptive cross-sectional study conducted from 2007 to 2010, 50 patients with a proven human immunodeficiency virus (HIV) infection were evaluated. Based on the findings of a physical examination and paraclinic tests, HIV signs and symptoms were recorded.

RESULTS

The mean (range) age of the patients was 35.45 ±5.24 (5-55) years. Forty-two (84%) cases were male and eight were female. The mean duration of carrying the virus was 4.51 ±1.03 years. Oral manifestations were the most common (94%), followed by rhinologic (88%), otologic (66%), and finally neck (44%) manifestations.

CONCLUSION

Head and neck presentations are very common in HIV patients; therefore otolaryngologists, as the first physicians who may encounter such patients, should be aware of this condition.

The potential effects of rhinoplasty on voice

BACKGROUND

Rhinoplasty is one of the most popular cosmetic surgical procedures in Iran. Surgery on the vocal tract can potentially change the voice characteristics. To the best of the authors' knowledge, no study has described voice changes after rhinoplasty, and the results of this study may help physicians to be aware of potential voice alterations following rhinoplasty.

METHODS

The authors selected 27 patients for this study. Patients completed Voice Handicap Index questionnaires, and the authors performed perceptual and acoustic analyses before and 5 months after rhinoplasty.

RESULTS

The Voice Handicap Index score and its physical and emotional subscales showed a statistically significant increase after rhinoplasty, indicating a worsening of voice quality after rhinoplasty. Blind perceptual analysis by six trained listeners revealed a statistically significant increase in hyponasality after rhinoplasty. Acoustic analysis showed that the frequency of the first and second nasal murmurs increased for the phonemes "m" and "n," while the amplitude of these murmurs decreased significantly after surgery. The same pattern was seen for the phoneme "a" when it was produced between two nasal consonants, as in the word "man."

CONCLUSIONS

Rhinoplasty can change vocal characteristics by narrowing the nasal cavity. Rhinoplasty has some effects on the voice, but these changes are problematic in general for most patients. However, for individuals who rely on their voice for professional reasons, the surgeon should preoperatively discuss these changes with the patient and consider more conservative types of surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Parental smoking and allergic rhinitis in children

BACKGROUND

Parental smoking is one of the controversial risk factors associated with allergic rhinitis. The aim of this study was to investigate the relationship between parental smoking and allergic rhinitis; considering confounding factors.

METHODS

A cross-sectional study was conducted on 671 children aged 2 to 7 years. Random cluster sampling was used to select the participants. The signs and symptoms of allergic rhinitis in children were assessed through standard questionnaires and physical examinations.

RESULTS

In the multivariate analysis, parental smoking (odds ratio [OR] 1.07; 95% confidence interval [CI], 0.48-2.41) was not a significant risk factor for allergic rhinitis; positive family history of allergy was the only significant factor among other factors (OR 23.64; 95% CI, 11.63-48.04). Sex (OR 1.16; 95% CI, 0.60-2.24), family size (OR 1.06; 95% CI, 0.22-5.05), family income (OR 0.60; 95% CI, 0.24-1.47), and parents' education (OR 1.79; 95% CI, 0.61-5.20) were not statistically significant.

CONCLUSION

The findings suggest that there is no significant relationship between parental smoking and allergic rhinitis.

Unilateral recurrent laryngeal and hypoglossal nerve paralysis following rhinoplasty: a case report and review of the literature

INTRODUCTION

Injury to cranial nerves IX, X, and XII is a known complication of laryngoscopy and intubation. Here we present a patient with concurrent hypoglossal and recurrent laryngeal nerve paralysis after rhinoplasty.

CASE REPORT

The patient was a 27-year-old woman who was candidate for rhinoplastic surgery. The next morning after the operation, the patient complained of dysphonia and a sore throat .7 days after the operation she was still complaining of dysphonia. She underwent a direct laryngoscopy, and right TVC paralysis was observed. Right hypoglossal nerve paralysis was also detected during physical cranial nerve function tests. Hypoglossal and recurrent laryngeal nerve function was completely recovered after 5 and 7 months, respectively, and no complication was remained.

CONCLUSION

Accurate and atraumatic intubation and extubation, true positioning of the head and neck, delicate and gentle packing of the oropharynx, and maintenance of mean blood pressure at a safe level are appropriate methods to prevent this complication during anesthesia and surgical procedures.

Urinary melatonin levels and skin malignancy

Melatonin inhibits tumor genesis in a variety of in vivo and in vitro experimental models of neoplasia. In industrialized societies, light at night, by suppressing melatonin production, poses a new risk for the development of a variety of cancers such as breast cancer. This effect on skin has been previously studied only in animals and not in humans. Our goal was to examine the relationship between 24-hour 6-sulphatoxymelatonin levels and skin cancer in a case-control study of 70 patients with skin cancer and 70 healthy individuals. The level of 6-sulfatoxymelatonin was measured in 24-hour urine by the ELISA method. In the case group, 55 (78%) patients had basal cell carcinoma and 15 (22%) had squamous cell carcinoma. The mean level of 24-hour urine 6-sulfatoxymelatonin was significantly higher in the control group (P<0.001). Also, sleep duration had a significant difference between the two groups (P=0.001). It seems that a low level of 24-hour urinary 6-sulfatoxymelatonin renders human beings prone to skin cancer. This association, however, requires further investigation.

An effective technique for endoscopic resection of advanced stage angiofibroma

INTRODUCTION

In recent years, the surgical management of angiofibroma has been greatly influenced by the use of endoscopic techniques. However, large tumors that extend into difficult anatomic sites present major challenges for management by either endoscopy or an open-surgery approach which needs new technique for the complete en block resection.

MATERIALS AND METHODS

In a prospective observational study we developed an endoscopic transnasal technique for the resection of angiofibroma via pushing and pulling the mass with 1/100000 soaked adrenalin tampons. Thirty two patients were treated using this endoscopic technique over 7 years. The mean follow-up period was 36 months. The main outcomes measured were tumor staging, average blood loss, complications, length of hospitalization, and residual and/or recurrence rate of the tumor.

RESULTS

According to the Radkowski staging, 23,5, and 4 patients were at stage IIC, IIIA, and IIIB, respectively. Twenty five patients were operated on exclusively via transnasal endoscopy while 7 patients were managed using endoscopy-assisted open-surgery techniques. Mean blood loss in patients was 1261± 893 cc. The recurrence rate was 21.88% (7 cases) at two years following surgery. Mean hospitalization time was 3.56 ± 0.6 days.

CONCLUSION

Using this effective technique, endoscopic removal of more highly advanced angiofibroma is possible. Better visualization, less intraoperative blood loss, lower rates of complication and recurrence, and shorter hospitalization time are some of the advantages.

The effect of local injection of epinephrine and bupivacaine on post-tonsillectomy pain and bleeding

INTRODUCTION

Tonsillectomy is one of the most common surgeries in the world and the most common problem is post-tonsillectomy pain and bleeding. The relief of postoperative pain helps increase early food intake and prevent secondary dehydration. One method for relieving pain is peritonsillar injection of epinephrine along with an anesthetic, which has been shown to produce variable results in previous studies. Study Deign: Prospective case-control study.

SETTING

A tertiary referral centers with accredited otorhinolaryngology-head & neck surgery and anesthesiology department.

MATERIALS AND METHODS

Patients under 15 years old, who were tonsillectomy candidates, were assigned into one of three groups: placebo injection, drug injection before tonsillectomy, and drug injection after tonsillectomy. The amount of bleeding, intensity of pain, and time of first post-operative food intake were evaluated during the first 18 hours post operation.

RESULTS

The intensity of pain in the first 30 minutes after the operation was lower in the patients who received injections, but the difference was not significant during the first 18 hours. The intensity of pain on swallowing during the first 6 hours was also lower in the intervention groups as compared with the placebo group. The amount of bleeding during the first 30 minutes post operation was lower in the two groups who received injections, but after 30 minutes there was no difference.

CONCLUSION

Injection of epinephrine and bupivacaine pre- or post- tonsillectomy is effective in reducing pain and bleeding. The treatment also decreases swallowing pain in the hours immediately after surgery.

The prevalence of allergic fungal rhinosinusitis in sinonasal polyposis

Allergic fungal sinusitis (AFS) is a noninvasive form of fungal rhinosinusitis with a prevalence of 6-9 % among all rhinosinusitis cases requiring surgery. The fungi causing AFRS have a great diversity and regional variation in the incidence of AFS has been reported worldwide. The aim of this study was to evaluate the prevalence of AFS among rhinosinusitis patients in the north east of Iran. In a prospective cross-sectional study 127 patients with sinonasal polyposis who were candidates for surgery were recruited. All cases were evaluated by sinonasal CT scan, Prick test for common regional allergens, total serum immunoglobulin E (IgE) level, and allergic mucin culture for fungi in suspected cases. Data analyses were done using SPSS version 13.0. Their mean age was 37.4 ± 11.6 years, the male-to-female ratio was 69/58. Eleven patients (9.45 %) met the AFS criteria. Nine cases had a positive culture for Aspergillus specimen and three for Alternaria. Prick test was positive for at least one allergen in 28 cases (22.05 %). The most common allergen was weed. The total IgE level was significantly higher in AFS patients. This study showed the prevalence of AFS among patients with nasal polyposis to be 9.45 %.

Nasal Septum Perforation due to Methamphetamine abuse

INTRODUCTION

Spontaneous Perforation of the nasal septum is an uncommon condition. Nasal inhalation of substances such as cocaine has long been linked to this Perforation.

CASE REPORT

This report describes the case of a 46-year-old woman who was addicted to methamphetamine and who presented with perforation of the nasal septum.This is the first reported case of nasal septal necrosis linked to nasal inhalation of methamphetamine.

CONCLUSIONS

Patient history and assurance regardingillegal drug consumption and abuse is a key point for fast and accurate diagnosis. The pathophysiology of drug-induced sinunasal disease and a review of the literature are also presented.