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

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

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

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)

A Survey of Relationship between Rheumatoid Arthritis and Hearing Disorders

RA (rheumatoid arthritis) is a chronic multisystem disease with a variety of systemic manifestations. One of these manifestations, is hearing disorder, so study of the relation between RA and hearing disorders is seem important. This was a case-control study which has done from December 2004 to August 2006. This study compared 50 patients with RA, with age, sex and job-matched as control. Audiometric tests in different frequencies show that hearing threshold in high frequencies specially in 8000 Hz had a significant difference between two groups, also acoustic reflexes were absent in case groups and had significant difference between two groups too. The evaluation of sensory neural hearing loss showed that this hearing loss is sensory not neural. Based on this study, frequent evaluation of audiometric tests is recommended for controlling hearing disorders by therapeutic and rehabilitation procedures in RA patients

Transnasal Endoscopic Approach For Sinonasal Inverted Papilloma

Inverted papillomas of the nose and paranasal sinuses are uncommon neoplasms, characterized by their tendency to occur and by their association with malignancy. In the past decade there has been a trend toward the use of endoscopic surgical techniques in the management of these tumors. This article presents the results of a prospective study of 24 patients with inverted papilloma resected by the endoscopic approach. 21 patients had unilateral disease and three patients had bilateral involvement. None of the patients had orbital or cranial extension. No association with malignancy was seen. Following endoscopic surgery, four patients had recurrences that required surgery. No complication occured in any of the patients. The results of endoscopic surgery for inverted papilloma is much better than nonendoscopic transnasal approaches and compares favorably with radical extranasal approaches. Endoscopic surgery is an effective surgical option for inverted papilloma removal

Assessment of septoplasty effectiveness using acoustic rhinometry and rhinomanometry

Introduction: Septal deviation is the chief cause of chronic nasal obstruction. In order to treat such cases, nasal septoplasty surgery is usually performed based on patient complaints and a surgeon's examination, both of which are subjective. This study aims at using the objective parameters of acoustic rhinometry and rhinomanometry to evaluate the effectiveness of septoplasty surgery.   Materials and Methods: A prospective study was performed in 30 candidate patients for septoplasty surgery. Acoustic rhinometry and rhinomanometry tests were performed on all patients both before and 3 months after the operation. The symptom recovery rate was recorded according to the patient's statements and anterior rhinoscopic examinations 3 months after surgery. Data were analyzed using a t-test and chi-square tests in a SPSS package.   Results: A total of 26 of 30 patients returned for a post–procedure follow-up examination after 3 months. Patients were aged from 18 to 32 years (average, 25 years). In total 69.2% (18 patients) were satisfied with the results of the procedure. In addition, rhinomanometry resulted in a decrease in general nasal resistance if patients used decongestants (P=0.03). However, the decrease was not significant before the use of decongestants (P=0.12). Furthermore, according to the results from acoustic rhinomanometry, there was an increase in the nasal cross-sectional area on both the narrow and wide sides after the operation (

The Effect of Topical Tranexamic Acid on Bleeding Reduction during Functional Endoscopic Sinus Surgery

Introduction:Bleeding is a common concern during functional endoscopic sinus surgery (FESS) that can increase the risk of damage to adjacent vital elements by reducing the surgeon’s field of view. This study aimed to explore the efficacy of topical tranexamic acid in reducing intraoperative bleeding. Materials and Methods:This double-blind, randomized clinical trial was conducted in 60 patients with chronic rhinosinusitis with polyposis (CRSwP) who underwent FESS. Patients were randomly divided into two groups; tranexamic or salinetreatment. During surgery, normal saline (400 mL) or tranexamic acid (2 g) in normal saline with a total volume of 400 mL were used in the saline and tranexamic groups, respectively, for irrigation and suctioning. The surgeons’ assessment of field of view during surgery and intraoperative blood loss were recorded. Results:Mean blood loss was 254.13 mL in the saline group and 235.6 mL in the tranexamic group (P=0.31). No statistically significant differences between the two groups were found in terms of other investigated variables, such as surgical field quality based on Boezzart’s scale (P=0.30), surgeon satisfaction based on a Likert scale (P=0.54), or duration of surgery (P=0.22). Conclusion:Use of tranexamic acid (2 g in 400 mL normal saline) through washing of the nasal mucosa during FESS did not significantly reduce blood loss or improve the surgical field of view. Further studies with larger sample sizes and higher drug concentrations, and using other methods of administration, such as spraying or applying pledgets soaked in tranexamic acid, are recommended

Radiofrequency Uvulopalatoplasty for Primary Snoring

Simple snoring is a social problem, one that can gravely affect the patient's married life. About 40% of men and 20% of women are affected, and it often goes along with sleep-disordered breathing. Up to now various surgical techniques have been defined such as UPPP(uvulopalatopharyngo plasty), and laser-assisted uvulopalatoplasty (LAUP). Among the surgical methods, RAUP (radiofrequency assisted uvulopalatoplasty) is a minimal invasive, an easy performed, and time and cost effective one. We designed a before and after a clinical trial. The inclusion criteria were age >18 years, complaint of nocturnal snoring, have a bed partner to assess snoring, AHI<5 events per hour in the polysomnography, malampathy score (soft palate position) I or II, an elongated uvula, grade I and II of pharyngeal webbing and patient consent was needed too. A 10-score visual analog scale (VAS) of snoring severity was completed by bed partner. All of 35 included patients underwent RAUP under local anesthesia by the same expert surgeon. After 3 months, 6 months and one year, subjective snoring decreased significantly compared to the preoperative period. The decline in VAS in 6 month compared to 3 months postoperatively, was not significant (P=0.223). When comparing 1 year and 6 months after treatment, the VAS scores were increased, but they were not significant (From 1.8 to 1.9, P=0.78). Three months after treatment minor complications consisted of: nasal regurgitation in 2 patients (5.7%), nasal speech in 2 (5.7%) and exacerbation of snoring in 2 (5.7%) patients.There was no major complication including mucosal laceration, uvular damage and obstruction of the airway. The rate of snoring decrease did not correlate with age, sex and BMI. Based on this study and literature review, it seems RAUP is a safe surgery, which may decrease symptoms of snoring, at least, in short-term follow-up