Pharyngocutaneous Fistula after Laryngectomy: Incidence, Predisposing Factors, and Outcome

Pharyngocutaneous fistula is a common and troublesome postoperative complication after total laryngectomy. The objective of this report was to determine the incidence, predisposing factors, and outcome of postlaryngectomy pharyngocutaneous fistula in patients operated on in our department and to describe the management of the complication. The medical records of 146 consecutive patients who underwent laryngeal surgery for squamous cell carcinoma of the larynx between 1990 and 2005 were assessed. All patients had similar preoperative/postoperative care. We studied a number of factors that could influence fistula formation such as age, gender, smoking, systemic disease, preoperative radiotherapy, previous tracheotomy, site of tumor, surgical procedure, positive surgical margins, type of closure (T vs. vertical), concurrent neck dissection, suture material, clinical stage, histologic grade, and experience of surgeon (consultant vs. resident). A pharyngocutaneous fistula was observed in 13% (19/146) of the patients within a mean time of 9.6 days from surgery. Spontaneous closure with local wound care was noted in 17 (89%) patients whereas a surgical closure was necessary in two. One patient required surgical closure by direct suture of the pharyngeal mucosa. Pectoralis major myocutaneous flap was used in another one. Our findings showed that fistula formation was significantly more common in patients who received previous radiotherapy or who had positive surgical resection margins or had a systemic disease. The mean healing time was 26 days. We concluded that pharyngocutaneous fistula remains a troublesome complication of the early postoperative period after total laryngectomy. There are many conflicting reports in the literature concerning the predisposing factors, but our data showed that the presence of systemic diseases, previous radiotherapy, and positive surgical margins can all be important predisposing factors, or at least underlying causes. Our experience confirmed that most fistulas can be successfully managed with conservative treatment

Detection of Streptococcus pneumoniae and Moraxella catarrhalis in patients with paranasal chronic sinusitis by polymerase chain reaction method

Background: Sinusitis is a complex involvement of the upper respiratory system by bacteria, viruses, fungi, or other allergens. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the dominant bacterial microorganisms involved in acute sinusitis, whereas in chronic sinusitis, Staphylococcus aureus and some anaerobic bacteria are the prevailing pathogens. Appropriate antibiotic treatment requires sinusitis bacteriology assessment. The aim of this study was to isolate bacteria in clinical samples from patients with chronic sinusitis. Methods: A total of 55 samples were collected from patients with chronic sinusitis undergoing surgery at Imam Khomeini Hospital in Ahvaz, Iran. Samples were cultured in conventional medium, and for each culture, Gram staining, catalase, coagulase, oxidase, and DNAse tests were performed and isolates were stored for polymerase chain reaction analysis. Results: Twenty-three isolates were obtained from five patients, including S. aureus (23.6%), Rhizomucor (1.8%), and Escherichia (1.8%) by the culture method and M. catarrhalis (3.6%) and S. Pneumoniae (7.2%) by the polymerase chain reaction method. Compared with acute sinusitis, the microbiology of chronic sinusitis remains controversial. Results are affected by many factors, including diversity of molecular and culture methods, sterilization of sampling area, sample transfer to laboratory, use of antibiotics prior to surgery, and nasal polyps. Conclusion: In Iran, the causative agents of chronic sinusitis are similar to those in other countries. Compared with other bacteria, S. aureus was observed more often in asthmatic patients with sinusitis

Foreign body aspirations in Infancy: a 20-year experience

<p><b>Objective</b>: Foreign body aspirations comprise the majority of accidental deaths in childhood. Diagnostic delay may cause an increase in mortality and morbidity in cases without acute respiratory failure. We report our diagnostic and compare the relevant studies available in literature to our results.</p> <p><b>Methods</b>: In our Hospital, bronchoscopy was performed on 1015 patients with the diagnosis of foreign body aspirations (from 1998 to 2008). Of these cases, 63.5% were male and 36.5% female. Their ages ranged from 2 months to 9 years (mean 2.3 years). Diagnosis was made on history, physical examination, radiological methods and bronchoscopy.</p> <p><b>Results</b>: Foreign bodies were localized in the right main bronchus in 560 (55.1%) patients followed by left main bronchus in 191 (18.8%), trachea in 173 (17.1%), vocal cord in 75(7.4%) and both bronchus in 16 (1.6%). Foreign body was not found during bronchoscopy in 48 cases (8.7%). The majority of the foreign bodies were seeds. Foreign bodies were removed with bronchoscopy in all cases. Pneumonia occurs in only 2.9% (29/1015) patients out of our cases<b>.</b></p> <p><b>Conclusion</b>: Rigid bronchoscopy is very effective procedure for inhaled foreign body removal with fewer complications. Proper use of diagnostic techniques provides a high degree of success, and the treatment modality to be used depending on the type of the foreign body is mostly satisfactory.</p

Evaluation of Hearing Results in Otosclerotic Patients after Stapedectomy

Introduction: Otosclerosis one of the most common causes of conductive hearing loss is more common in females and in their middle ages. It is usually a bilateral and progressive disease. Surgical operation is suggested as the exclusive management of otosclerosis. This study aims to evaluate the hearing results after stapedectomy in otosclerotic patients in Ahwaz. Materials and Methods:  In this case series study, the records of otosclerotic patients who had undergone stapedectomy or stapedotomy in Imam Khomeini and Apadana Hospitals of Ahwaz, Iran during 1997-2007 were evaluated. All the operations were performed by a single surgeon (first author). Data were analyzed using SPSS and descriptive statistical tests. Results: One hundred ninety seven patients were included in this study. 66.8% were female and the age range was 20-40 years. The affected ears were reported as follows: right ear (65%), left ear (35%) and bilateral (18%). ABG was reported as less than 10db in 63.9% of patients; between 10 to 20db in 29.99% and more than 20db in 5%. Surgical complications were observed in 4.5% of patients (1.5% intraoperatively and 3% postoperatively). Discussion: Saccular dysfunction seems to be an important finding in SSNHL. Although it is more prevalent in the patients with vertigo, it can be found in the non-dizzy cases. VEMP disturbance in SSNHL shows more extensive pathological involvement. Conclusion: Just like previously conducted studies, satisfactory surgical outcomes with rare complications were observed in the appropriate population under study

Incidence of Complications Developed after the Insertion of Ventilation Tube in Children under 6 years old in 2008-2009

Introduction: One of the main treatments of chronic otitis media with effusion is ventilation of the middle ear with a ventilation tube (VT). The objective of this study was to determine the incidence and the types of VT complications in children with otitis media with effusion in Ahwaz. Materials and Methods: In this prospective study, the medical records of 208 children (52 male and 35 female) in Imam Khomeini and Apadana hospitals were reviewed. The children were between 10 months and 6 years old. The patients were followed up 12-18 months after ventilation tube insertion. We reviewed age, sex, postoperative otorrhea, eardrum atrophy, tympanosclerosis and persistent perforation. In all these patients, the indication for surgery was chronic middle ear effusion. The data were analyzed and presented as numbers and percentages using SPSS17.0. Results: Transient otorrhea occurred in 12.5% and delayed otorrhea in 8.2%. Otorrhea non-responsive to medical treatment was seen in 1.9%. Complications after tympanostomy tube extrusion included atrophy (27.8%) myringosclerosis (37.9%), and persistent perforation (2.4%).The average extrusion time was 10.5 ±5 months (ranging between 3-22 months). Conclusion: After extrusion of the ventilation tube, patients should be followed up regularly for recurrence of OME. Myringosclerosis, tympanic membrane atrophy and otorrhea are the most common complications of otitis media with effusion. However, they are generally insignificant. Consequently, in the majority of these complications, there is no need for any treatment

Association between Serum Levels of Interleukin-6 and Stage of Laryngeal Cancer

Introduction: The purpose of this study was to investigate the relationship between serum levels of interleukin-6 (IL-6) and the severity and extent of squamous cell carcinoma (SCC) of the larynx based on stage of tumor progression and histological grade.   Materials and Methods: All patients with a diagnosis of laryngeal cancer who underwent laryngoscopy and biopsy while hospitalized in Imam Khomeini Hospital in Ahvaz were enrolled. Tumor stage was calculated based on the TNM system, and divided into early (stage 1,2) or advanced stage (stage 3,4). In addition, patients were divided into low-grade (well differentiated) or high-grade (moderate and poorly differentiated) groups based on pathology reports from biopsy specimens. Several healthy volunteers were also enrolled as the control group. After collecting the blood samples, quantitative serum levels of IL-6 were measured (pmol/L) using IL-6 kits (Bender MedSystem, Germany). Results for quantitative variables are presented as mean and standard deviation and qualitative variables as percentages. Mann-Whitney, Kruskal-Wallis and Pearson’s chi square tests were used for statistical analyses. Results: Thirty-eight patients (82.6%) were male and eight patients (17.4%) were female. IL-6 serum level was 28.8±4.7 pmol/L in the patient group and 2.64±2.88 pmol/L in the control group (P=0.0001). The serum level of IL-6 was 7.27 ± 5.31 pmol/L in early-stage patients and 54.43 ± 6.06 pmol/L in advanced-stage patients (

Toothbrush: A Report of an Unusual Foreign Body

Introduction: Ingestion of a foreign body is a common problem among all age groups. Most of the foreign bodies in the pharynx are usually lodged at the level of cricopharynx. The diagnosis is based on history, clinical, and radiological examination. Most foreign-body ingestions are accidental, but there may be contributory factors such as mental disorder, alcoholism, and prison incarceration. Toothbrush ingestion is uncommon and requires prompt medical attention.   Case Report: In this article, a rare case of a toothbrush foreign body is presented. The ingestion was caused by a seizure and the toothbrush was removed through surgical management.   Conclusion:  An ingested toothbrush will not pass spontaneously. The best management is early endoscopy performed by a skilled surgeon. If this is unsuccessful, surgical management can be performed