Anatomic variations of paranasal sinuses in patients with chronic sinusitis and their correlation with CT scan staging

The presence of anatomic variations of paranasal sinuses must be noted in order to attain a full understanding and accurate diagnosis of chronic sinusitis. The frequency of anatomic variations in chronic sinusitis is different in various studies. The purpose of this study is to assess the frequency of anatomic variations in chronic sinusitis patients admitted to Otolaryngology ward of Shahid Sadoughi hospital in the year 2004 and underwent functional endoscopic sinus surgery. Based on preoperative paranasal sinus CT scan the extent of patients diseases on a scale of 0-IV and the presence of anatomic variations was determined. A total of 120 patients were included. We found Agger Nasi cells in 43(36), Haller cells in 5 (4.17) conchae bullosa in 15(12.5), paradoxical middle turbinate in 2 (1.67) and septal deviation in 54 patients (45). Patients with Agger Nasi (P.value : 0.015) and conchae bullosa (P.Value : 0.024) demonstrated significantly higher scores on sinus CT scan compared with patients without Agger Nasi cells and conchae bullosa respectively. Three months postoperatively we observed significantly less resolution of nasal congestion (P.Value : 0.006) in patients with septal deviation than patients without it. No significant difference was seen among patients with and without other anatomic variations with regard to resolution of rhinorrhea and nasal congestion three months postoperatively. © 2007 Tehran University of Medical Sciences. All rights reserved

Humoral and cellular immunity parameters in children before and after adenotonsillectomy

Adenoids and tonsils are active lymphoid organs and play an important role against invading antigens of upper aerodigestive tract in children. The present study analyzes the changes in cellular and humoral immunity of children six months after adenotonsillectomy. The study population consisted of 30 children whit chronic adenotonsillar hypertrophy and 30 age-matched healthy children. In all children serum level of IgM and IgG, percentage of T lymphocytes (CD3), T helper cells (CD4), T cytotoxic cells (CD8) and B lymphocytes (CD20) were measured before surgery. These parameters were remeasured in patients 6 months after adenotonsillectomy. Before the operation, a reduction in percentage of T lymphocytes (CD3),TCD4,TC8 and B CD20 was seen compared to control group. This reduction was only significant in T lymphocytes (CD3).The serum IgM and IgG levels were not different in two groups. Six months after operation, the percentage of lymphocytes T CD3, T CD8 and BCD20 was increased and reached the control group. The IgM level was also significantly decreased in patients after operation. Our results indicate that cellular and humoral immunity decreases in children with chronic adenotonsiller hypertrophy preoperatively and increases to healthy children level, six months postoperatively. It means that chronic adenotosillar hypertrophy affect some parameters of cellular and humoral immunity and adenotonsillectomy by removing chronic stimulations and reverses these changes without any negative effect on immune function of patients. © 2007 Tehran University of Medical Sciences. All rights reserved

Low Level Laser Effect in Treatment of Patients with Intractable Tinnitus Due To Sensorineural Hearing Loss

Introduction: Tinnitus is defined as a perception of sound without an external acoustic stimulus. Due to large number of causes and limited knowledge of its pathophysiology, tinnitus still remains an obscure symptom.Methods: This was a cross-sectional study on 120 patients with tinnitus and sensorineural hearing loss who were randomly divided into two groups; one group received low-level laser and the second group used the same instrument but off, for 20 sessions of 20 minutes. A tinnitus handicap inventory (THI) and Visual Analog Scale (VAS) were used to evaluate the severity of patients' symptoms. Severity and frequency of tinnitus were also determined using Audiometric tests.Results: The average age of the 120 patients in the two groups of study were not statistically significantly different. The mean difference of severity of tinnitus between the two groups was statistically significant at the end of the study and 3 month after completion of treatment. The VAS and THI mean differences after the treatment were statistically significant between the two groups but not statistically significant after 3 months of completion the study.Conclusion: Low level laser radiation is effective for short-term treatment of Tinnitus caused by sensorineural hearing loss and its impact may be reduced over the time

Pneumocephalus after Tympanomastoidectomy: A Case Presentation

Introduction: Pneumocephalus is the presence of air or gas within the cranial cavity. It can occur following otorhinolaryngological procedures. A small pneumocephalus spontaneously heals without any treatment. In severe cases, conservative therapy includes a 30-degree head elevation, avoidance of the Valsalva maneuver, analgesics, osmotic diuretics, and oxygen therapy.   Case Report: A 56-year-old woman was referred to the emergency department due to a severe headache in the frontal area for 2 days before admission. The patient experienced nausea and vomiting in the morning and had no history of seizures or decreased consciousness. Examination of neurological symptoms was completely normal and showed no symptoms of meningeal irritation. In terms of past history, the patient had undergone tympanomastoidectomy surgery and resection of the cholesteatoma 1 week previously. The Mount Fuji sign was found on the brain computed tomography (CT) scan of the patient. Treatments such as CBR (complete bed rest), 30-degree head elevation, anti-fever, analgesics and oxygen therapy, along with anti-compulsive drug (phenytoin), were prescribed. At the end of 5 days, the patient's pneumocephalus was resolved completely.   Conclusion: Pneumocephalus should be considered a post-operative complication of tympanomastoidectomy. In most cases, pneumocephalus responds to conservative therapy. Supplemental oxygen increases the rate of absorption of pneumocephalus. Serial imaging is needed to ensure gradual reduction of the pneumocephalus

The Role of Immunological Factors on Sudden Sensoryneural Hearing Loss

Introduction: In this study, we examined the role of immunological factors on sudden sensory neural hearing loss (SSNHL).   Materials and Methods: This prospective case-controlled study was performed in patients with SSNHL who referred to the ear, nose, and throat (ENT) ward. Fifty-six patients with SSNHLoccurring within a 72-hr period were selected as the case group and 56 participants who had no recent history of disease were assigned to the control group. Mean levels of immunological factors including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibody (ANA), anti-neutrophil cytoplasmic antibody (ANCA) (C, P), anti-cyclic citrullinated peptide (anti-CCP), DSM, hemoglobin (Hb), complement component 3 (C3), and complement component 4 (C4) were evaluated in the blood samples in each group.   Results: There were 31 male and 25 female participants in the control group, while the case group had 26 male and 30 female participants. The mean age of the participants was 36.2 ± 13.4 years in the control group and 40.80 ± 13.37 years in the case group. The two groups differed significantly in terms of mean ESR, ANA, C3, C4 and monocytes, with higher levels in the case group (P0.05).   Conclusion: Because some of the immunological factors investigated in this study were significantly higher in patients with SSNHL, it can be concluded that there is an association between these immunological factors and SSNHL. Further studies are recommended to accurately determine the effect of these factors on the development of SSNHL and its treatment

Prevalence of Malnutrition in Patients with Head and Neck Cancer in Yazd, Iran

Background: Head and neck cancers are accounted for 4.9% of all cancers worldwide. The aim of this study was to evaluate the prevalence of malnutrition in patients with head and neck cancers in Yazd, Iran.Methods: Eighty-nine patients with locally advanced head and neck cancers who referred to a training clinic or a hospital were included in this cross sectional study. All patients were assessed for nutritional status by Patient Generated Subjective Global Assessment (PG-SGA) questionnaire, and serum albumin and hemoglobin levels.Results: Bases on PG-SGA assessment, 49.4% of the patients had proper nutrition, 30.4% were at risk or suspected to malnutrition, and 20.2% had severe malnutrition. The prevalence of malnutrition was significantly related to gender of patients, type of treatment and the stage of the disease. There was no significant relationship between the prevalence of malnutrition and age, although the prevalence of severe malnutrition was higher at older ages.Conclusion: The prevalence of malnutrition among our patients was high. Nutritional evaluation is very important to detect patients at risk of malnutrition or with malnutrition and helps to choose the nutritional treatment

Human papilloma virus and nasopharyngeal carcinoma: pathology, prognosis, recurrence and mortality of the disease

Background: One of the malignant tumors among head and neck cancers is nasopharyngeal carcinoma. Many studies consider human papilloma virus (HPV) as a cause for nasopharyngeal carcinoma. Methods: 41 paraffin-wax-embedded block samples were examined to detect HPV DNA and its subtype’s presence by polymerase chain reaction. The recurrence, prognosis and survival were evaluated for an average of 48 months. Results: HPV DNA was positive in 9 patients (22%). The overall recurrence rate was 75% in HPV negative patients and 11% in HPV positive ones. The mortality rate in HPV negative and positive patients was 37.5% and 0%, respectively. Conclusion: HPV type 18 and 16 were the most common subtypes. Also, it can be implied that patients which are HPV positive had better prognosis and also less recurrence. Key Words: human papilloma virus, nasopharyngeal cancer, polymerase chain reaction, prognosis, recurrence

Efficacy of Low-Level Laser Therapy in the Management of Tinnitus due to Noise-Induced Hearing Loss: A Double-Blind Randomized Clinical Trial

Background. Several remedial modalities for the treatment of tinnitus have been proposed, but an effective standard treatment is still to be confirmed. In the present study, we aimed to evaluate the effect of low-level laser therapy on tinnitus accompanied by noise-induced hearing loss. Methods. This was a double-blind randomized clinical trial on subjects suffering from tinnitus accompanied by noise-induced hearing loss. The study intervention was 20 sessions of low-level laser therapy every other day, 20 minutes each session. Tinnitus was assessed by three methods (visual analog scale, tinnitus handicap inventory, and tinnitus loudness) at baseline, immediately and 3 months after the intervention. Results. All subjects were male workers with age range of 30–51 years. The mean tinnitus duration was 1.85±0.78 years. All three measurement methods have shown improved values after laser therapy compared with the placebo both immediately and 3 months after treatment. Laser therapy revealed a U-shaped efficacy throughout the course of follow-up. Nonresponse rate of the intervention was 57% and 70% in the two assessment time points, respectively. Conclusion. This study found low-level laser therapy to be effective in alleviating tinnitus in patients with noise-induced hearing loss, although this effect has faded after 3 months of follow-up. This trial is registered with the Australian New Zealand clinical trials registry with identifier ACTRN12612000455864)

Results Of Endoscopic Transnasal Resection Of Sinonasal Inverted Papiloma

Inverted papilloma is an uncommon benign neoplasm originating from lateral nasal wall. It commonly invades paranasal sinuses and sometimes invasion to orbit and intracranial structures are seen. There are many surgical methods for its treatment, one of them is endoscopic transnasal approach."nMaterials and Methods: Between 1997 and 2001, 11 patients with this tumor were operated in Amiralam hospital in Tehran and Shahid Rahnemun in Yazd. Nine patients were operated by endoscopic transnasal route and two patients by combined Caldwell-luc and endoscopic transnasal routes."nResults: Tumors were on the right side in 3 patients, on the left side in 7 patients, and bilateral in one patient. There were no intracranial or orbital extensions. No pathologic report of malignancy was made. Surgical technique included complete tumor resection, anterior and posterior ethomidectomies, sphenoidectomy, frontal recess tumor resection and wide maxillary antrostomy, in cases in whom tumor was attached to lamina papyracea, the lamina was removed without any manipulation to orbital periosteum. Mean follow-up time was 29.8 months. There was no recurrence in 82% of cases. Tumor recurred in 18% of cases. No complications were seen."nConclusion: Although the standard treatment for this tumor is medial maxillectomy but endoscopic resection is an effective method in surgery of this tumor. It seems that if tumor does not extend to areas unreachable by endoscopic surgery, due to lower morbidity and excellent visualization of tumor, this method is preferable