A study of the etiology of referred Otalgia

Introduction: Otalgia is one of the complaints which may occur at any age. The etiology of the pain may be in the ear, structures around the ear or other head and neck structures. This is caused by the complex nervous connections in the head and neck areas, the ear, the pharynx and the nose. Since understanding the etiologies of referred otalgia can help in the assessment and treatment of the disease, this research was conducted to identify the etiologies of referred otalgia in patients visiting the ENT Clinic in Gorgan, Iran. Materials and Methods: This prospective research was conducted on patients who visited the ENT Clinic with an earache, but in initial assessments the ear was normal. Patients' data consisting of sex, age, complaint, the inflicted side, physical findings in the ear, the nose, the throat and head and neck were recorded in a questionnaire. These data were then analyzed with SPSS software. Results: Of 770 patients with otalgia, 94 patients (12.2%) had referred otalgia. Of these patients 27.7% were men and 72.3% were women. The most common etiology of referred otalgia was dental problems (62.8%), and one patient who was being treated for pharyngitis had carcinoma of the base of the tongue. In 47.8% of cases the pain was in the left ear, in 43.4% in the right ear, and in 8.7% it was bilateral. Conclusion: In view of the fact that a significant proportion of the patients who complained of otalgia had no pathologies in the ear, thorough physical examination in adjacent structures especially teeth should be performed and malignancies should be considered as a possible etiology of otalgia

Risk factors for sensorineural hearing loss among high-risk infants in Golestan province, Iran in 2010 - 2011

Background: Hearing impairment, as one of the most common birth defects, is a hidden disability with negative impacts on speech and cognitive development. Objectives: The aim of this study was to assess the prevalence of sensorineural hearing loss (SNHL) and determine the associated risk factors among infants admitted to neonatal intensive care units (NICUs) and neonatal wards of teaching hospitals, affiliated to Golestan University of Medical Sciences, Gorgan, Iran. Patients and Methods: In this cross-sectional study, 791 infants were recruited via non-random sampling. Demographic and clinical characteristics of the subjects were gathered, and the Automated Auditory Brainstem Response (AABR) test was performed upon admission. Afterwards, the subjects were followed-up and re-assessed, using the AABR test. For infants with abnormal AABR results, the Auditory Brainstem Response (ABR) test was performed on the day of discharge. Results: The mean age of the infants was 3.75 ± 4.86 days upon admission, and 56.4% of the subjects were female. The mean length of hospital stay was 9.63 ± 1.1 days; the subjects were hospitalized for 3.50 ± 10.21 days in the NICUs and 6.1 ± 5.27 days in the neonatal wards. In total, 3.4% of the infants presented with SNHL. No significant difference was found between SNHL and neonates’ age (P = 0.52), sex (P = 0.5), or sepsis (P = 0.94). However, SNHL was significantly associated with gestational age (P = 0.045), birth weight (P < 0.001), length of hospital stay (P < 0.001), pathological jaundice (P=0.033), antibiotic treatments (P = 0.007), and total serum bilirubin level (P = 0.01). Additionally, binary logistic regression analysis demonstrated the association between SNHL and these factors. Conclusions: In this study, the prevalence of SNHL among hospitalized neonates was similar to previous reports in Iran and other countries. Based on the findings, administration of ototoxic drugs during the neonatal period can lead to SNHL. Therefore, it seems essential to regularly screen newborns under treatment and limit the indiscriminate use of ototoxic drugs. © 2015, Iranian Red Crescent Medical Journal

Autonomic laterality in caloric vestibular stimulation

BACKGROUND Caloric stimulation of the vestibular system is associated with autonomic response. The lateralization in the nervous system activities also involves the autonomic nervous system. AIM To compare the effect of the right and left ear caloric test on the cardiac sympathovagal tone in healthy persons. METHODS This self-control study was conducted on 12 healthy male volunteers. The minimal ice water caloric test was applied for vestibular stimulation. This was done by irrigating 1 milliliter of 4 ± 2 °C ice water into the external ear canal in 1 s. In each experiment, only one ear was stimulated. For each ear, the pessimum position was considered as sham control and the optimum position was set as caloric vestibular stimulation of horizontal semicircular channel. The order of right or left caloric vestibular stimulation and the sequence of optimum or pessimum head position in each set were random. The recovery time between each calorie test was 5 min. The short-term heart rate variability (HRV) was used for cardiac sympathovagal tone metrics. All variables were compared using the analysis of variance. RESULTS After caloric vestibular stimulation, the short-term time-domain and frequency-domain HRV indices as well as, the systolic and the diastolic arterial blood pressure, the respiratory rate and the respiratory amplitude, had no significant changes. These negative results were similar in the right and the left sides. Nystagmus duration of left caloric vestibular stimulations in the optimum and the pessimum positions had significant differences (e.g., 72.14 ± 39.06 vs 45.35 ± 35.65, P < 0.01). Nystagmus duration of right caloric vestibular stimulations in the optimum and the pessimum positions had also significant differences (e.g., 86.42 ± 67.20 vs 50.71 ± 29.73, P < 0.01). The time of the start of the nystagmus following caloric vestibular stimulation had no differences in both sides and both positions. CONCLUSION Minimal ice water caloric stimulation of the right and left vestibular system did not affect the cardiac sympathovagal balance according to HRV indices. © The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved

Correlation Between HMGB1 and TLR4 Expression in Sinonasal Mucosa in Patients With Chronic Rhinosinusitis

Objectives: Chronic rhinosinusitis (CRS) is one of the most common inflammations in the upper airway. Despite the wide prevalence of CRS, the pathogenesis of this disease is poorly understood. Several components of the innate immune system may play a significant role in CRS, including Toll-like receptor 4 (TLR4), TLR9, and high-mobility group box 1 protein (HMGB1). This study was conducted to determine the expression of TLR4, TLR9, HMGB1, and pNFκ-B p65 in paraffin-embedded blocks of patients with CRS with nasal polyps compared with those of the control group. Methods: Twenty-six formalin-fixed, paraffin-embedded samples from patients with confirmed CRS and 26 patients undergoing septoplasty due to anatomic variations and no other inflammatory nasal diseases as the control group were assessed. Expression patterns of HMGB1, TLR9, TLR4, and pNFκ-B p65 genes were examined using real-time quantitative reverse transcription polymerase chain reaction (Real-Time qRT-PCR). Statistical analyses were performed with SPSS and analyzed using unpaired 2-tailed t tests or 1-way analysis of variance. Results: Real-time PCR showed that the expression level of HMGB1 messenger RNA was significantly increased in the tissues of patients with CRS compared with controls (P <.05). The other 3 genes were also upregulated in the patients, but were not significant compared with control. Analysis of the Pearson correlation coefficient (r) revealed a significant positive correlation between HMGB1 and TLR4 (r = 0.79, P <.05) in patients and negative correlation between TLR4 and NfκB in the control group (r = 0.94; P <.05). Conclusions: Both HMGB1 and TLR4 are increased in the paranasal sinus mucosa of patients with CRS. These results suggest a possible contribution of HMGB1 and its internal receptor (TLR4) in the pathophysiology of CRS. © The Author(s) 2019

Esophageal cancer: 5-year survival rate at south-east of Caspian sea of northern Iran

Background: Locating at southern margin of Caspian sea and Asian esophagus cancer cordon Golestan state is one of the most common sites of this cancer. Objective: This study designed to evaluate the 5-years survival rate of esophagus cancer. Materials and Methods: 55 patients with esophagus cancer diagnosed by pathologic examination, age, gender, type of tumor, clinical manifestation on the time of tumor metastases, treatment and patient survival time studied. The collecting data were analyzed by SPSS 11.5, and life table and Kaplan Meier methods were applied. Results: 55 patients studied included 11 females and 44 males respectively with average survival life time of 12.8 months for the 5-year survival rate for patients diagnosed at early stage was 0.025, patients with systemic symptoms such as weight loss was 0.00. Far metastases adverse effect on highest survivals was observed among patients who underwent surgery; the survival rate for such patients was about 0.014. Conclusions: Esophageal cancer is high in southern margin of Caspian Sea, it is suggested to design studies to find the probable risk factors and the screening tests for on-time diagnosis

Recovery of olfactory and gustatory dysfunctions in coronavirus disease 2019 patients: A prospective cohort study

Objective This study aimed to determine the association of some demographic and clinical factors with recovery from olfactory and gustatory dysfunction in coronavirus disease 2019 patients in Iran. Methods This prospective cohort study was performed on 242 coronavirus disease 2019 patients with olfactory and gustatory dysfunction. The time from onset to recovery for olfactory and gustatory dysfunction was estimated by the Kaplan-Meier estimator. Results After six months, 239 patients (98.8 per cent) had completely recovered from olfactory dysfunction. Olfactory and gustatory dysfunction symptoms resolved in 80.99 per cent and 83.56 per cent of the patients, respectively, within the first 30 days of symptom onset. Mean recovery time for olfactory dysfunction (35.07 ± 4.25 days) was significantly longer in those infected during the first epidemic wave compared with those infected during the second wave (21.65 ± 2.05 days) (p = 0.004). A similar pattern in recovery time was observed for cases of gustatory dysfunction (p = 0.005). Conclusion The recovery rate for coronavirus disease 2019 related olfactory and gustatory dysfunction is high within the first month of symptom onset. Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Virus load and incidence of olfactory, gustatory, respiratory, gastrointestinal disorders in COVID-19 patients: A retrospective cohort study

Objectives: This study investigated the relationship between viral load and the incidence of olfactory and gustatory dysfunction (OD and GD), the incidence of respiratory and gastrointestinal symptoms and the recovery of OD and GD in COVID-19 patients. Design: A retrospective cohort study. Setting and Participants: This study was conducted on 599 outpatients' cases in Golestan province between February and June 2020. Main Outcome Measures: The incidence, severity (complete or partial) and recovery time of OD and GD and their associations with cycle threshold (CT) values of SARS-CoV-2 polymerase chain reaction were assessed. Results: The mean age of patients was 38.27 ± 13.62 years. The incidence of general symptoms included myalgia 70.1, headache 51.8, fever 47.7 and dyspnoea 21.4. 41.9 of patients had gastrointestinal symptoms, including abdominal pain 26.5, diarrhoea 25.2, nausea 20.5 and vomiting 12.9. 12.2 of patients had comorbidity. The trimester recovery rates of OD and GD were 93.94 and 94.74 respectively. The mean recovery time of OD and GD was 14.56 ± 13.37 and 13.8 ± 3.77 days respectively. The mean CT value in all patients was 27.45 ± 4.55. There were significant associations between the mean of CT value with headache (p = 0.04), GD (p = 0.002) and OD (p = 0.001). Conclusions: The finding of this study indicates a possible association between viral load with incidence of OD and GD in COVID-19 patient's cases and assures the recovery of OD/GD in these patients. © 2021 John Wiley & Sons Ltd

Epidemiological survey of suicide in Golestan province in the North of Iran (2003)

Background and purpose: Suicide is one of the most important causes of death in the world. The prevalence of suicide varies in different parts of Iran and the world. This study was done to determine the prevalence and types of suicide and its relation to gender, age and education in Golestan prevalence in North of Iran.Materials and Methods: This cross-sectional study was carried out on 1857 patients admitted to general hospitals in Golestan province during 2003. The data were collected through questionnaires filled by health workers and analyzed using SPSS software.Results: The prevalence of suicide was 117.8, 88.5 and 147.4 per 10000 in general population, males and females respectively. The rate of suicide in 20-24 age groups was 285.8 per 10000. The highest rate of suicide was observed in spring. Thirty one percent of samples had high school education. 48 percent of suicide attempts were with drugs and opium. Considering the ethnicity, the rate of suicide was 177 among native Fars, 79.6 in Turkman and 270 in Sistani per 10000, respectively.Conclusion: This study has shown that the rate of suicide is higher in this province comparing to other studies in some parts of Iran and other countries