Cerebrospinal Fluid Leakage During Temporal Bone Surgery: Selecting Intra-operative Dural Closure with a Dumbbell-Shaped Muscle Graft as a Surgical Approach.

Cerebrospinal fluid (CSF) leakages of the temporal bone may arise during mastoid surgery. The leakages can have multiple potential etiologies, for instance, using a cutting burr near the bony tegmen or monopolar electrocautery on the surface of the dura mater. In this paper, we introduced an effective and simple technique for the management of CSF leakages of the temporal bone. In a prospective case series, 36 patients (16 males and 20 females) who have had an experience of incidental or inevitable CSF otorrhea or otorhinorrhea during temporal bone surgery were selected. All patients were treated using a muscle graft in a dumbbell-shaped design through the dura defect at the Amir-Alam University Hospital between April 2005 and November 2008. The mean size of the defects was 5 mm (a range of 2-10 mm). A dumbbell-shaped autologous muscle graft was immediately successful in sealing the leakage in all patients. Only five patients (13.8%) had some evidence of leakage remaining on the day after the operation, which was subsequently resolved by conservative management in four of them (11.1%). Only one patient (2.7%) was subjected to a second operation for a new defect. Recurrence of CSF leakage or other related complications were not observed during about 7 years of follow up. A free autologous muscle graft, using the dumbbell technique through a small to moderate dura defect is an effective, easily performed, and safe method to seal iatrogenic leakages of the temporal bone.

Methylprednisolone versus Dexamethasone for Control of Vertigo in Patients with Definite Meniere's disease.

INTRODUCTION: Definite Meniere's disease is associated with two or more definitive periods of vertigo along with hearing loss, plus tinnitus or aural fullness or both. This study aimed to compare the effect of intratympanic dexamethasone and methylprednisolone on the functional-level scale of pure-tone audiometry (PTA), and class outcome measures of vertigo. MATERIALS AND METHODS: In this clinical study, 69 patients with definite Meniere's disease, referred to the tertiary otolaryngology center, were randomly assigned to two groups: 36 patients were treated with intratympanic dexamethasone (4mg/dl) and 33 patients were treated with intratympanicmethylprednisolone (40mg/dl). Each group received three weekly injections. After a follow-up of 1 and 6 months, PTA changes and vertigo control were evaluated. RESULTS: There was no statistically significant difference between the two groups with regard to control of vertigo (P=0.866, P=0.879 for 1 and 6 months post injection, respectively). PTA improvement was statistically significantly higher in the methylprednisolone group (P=0.006). CONCLUSION: In summary, intratympanic corticosteroid is an effective treatment for Meniere's disease and can prevent other invasive treatments. Intratympanic methylprednisolone can improve hearing level to a greater extent than intratympanic dexamethasone, but the two groups were similarly beneficial in controlling vertigo. However, there was a trend toward a more sustained benefit with methylprednisolone.

Evaluation of the Correlation between CD44, Tumor Prognosis and the 5-Year Survival Rate in Patients with Oral Tongue SCC.

INTRODUCTION: 90% of the tumors in the head and neck are squamous-cell carcinomas (HNSCC), which have overall 5- year survival rate between 50% -60%. CD44 has been shown to be associated with the prognosis. MATERIALS AND METHODS: Biopsy specimens of 51 patients with oral tongue SCC were evaluated by Immunohistochemistry (IHC) for the CD44 antibody. RESULTS: There was no significant correlation between CD44 and survival (P=0.77), age (P=0.4), CD44 and lymph node metastasis (P=0.87), sex (P=0.947), smoking (P=0.287) and tumor size (P=0.813). However, there was significant correlation between smoking and survival. CONCLUSION: There are widespread discrepancies among the findings in the literature regarding the prognosis of CD44 expression in OCSCC. Our study shows that the expression of CD44 is not a marker of aggressive behavior in oral tongue SCC. Consequently, CD44 cannot be considered as handy tool to establish the tumor behavior, prognosis and 5- year survival rate of these tumors.

The effect of intratympanic dexamethasone with oral prednisolone as a primary treatment in idiopathic sudden sensorineural hearing loss.

INTRODUCTION: Sudden sensorineural hearing loss (SSNHL) is a true emergency that must be diagnosed and treated immediately. The purpose of this study is to compare the efficacy of treatment with intratympanic dexamethasone plus oral prednisolone daily or every other day with that of treatment with oral prednisolone alone. MATERIALS AND METHODS: Sixty-three patients with SSNHL that had been present for less than 10 days prior to the start of treatment were randomly allocated to three different groups. Patients in group A were treated daily with oral prednisolone 1 mg/kg for 10 days plus intratympanic dexamethasone 2 mg for the first 3 days of treatment. Patients in group B were treated every other day with oral prednisolone 1 mg/kg for 10 days with the addition of intratympanic dexamethasone 2 mg for the first 3 treatments. Patients in group C were treated daily with oral prednisolone 1 mg/kg alone for 10 days. Audiometric parameters including pure tone audiometry (PTA), speech reception threshold (SRT), and speech discrimination score (SDS) were assessed on days 1,5, and 10. RESULTS: There was a significant improvement in PTA, SRT and SDS in each group over the 10 days but the greatest improvement was seen in the SRT measurements of group A in comparison with group B (19.81 ± 2.15, P=0.04) and C (26.26 ± 0.08, P=0.01). The difference in SRT between groups B and C was not statistically significant. CONCLUSION: The administration of intratympanic dexamethasone 2 mg daily for 3 days has an additive effect to that of 10 days of oral prednisolone 1 mg/kg in the treatment of SSNHL.

Prophylactic antibiotics in otolaryngologic surgeries: from knowledge to practice.

INTRODUCTION: The management and use of antimicrobial drugs has clinical, economic, and environmental implications. In many countries, antimicrobial drugs are the most frequently prescribed therapeutic agents. Therefore, health-care policy should focus on how to establish a rational attitude toward antibiotics. This study was performed to investigate antibiotic usage as a prophylactic regimen in head and neck surgeries. MATERIALS AND METHODS: This study was a retrospective case series. Patients undergoing otolaryngology surgeries in a tertiary referral otolaryngology center were included. Members of operating room staff that were unaware of the study objectives collected patients' data using a questionnaire that contained information regarding general medical condition, disease, surgical procedure, and prophylaxis regimen and duration. RESULTS: Excluding infected patients, we studied 1349 patients during a four-month period who needed prophylactic antibiotics. A total of 34 different types of surgical procedures were performed. Out of the total number of patients, 503 (37.0%) received a parenteral antibiotic directly before surgery. The main antibiotics used before surgery were cephalosporins (94.9%). All of the 1349 patients were administered antibiotics after the procedure. These antibiotics where given with a mean number of doses of 4.81 (range: 1-68), and also consisted of mostly cephalosporins. CONCLUSION: Our results indicate that prophylactic antibiotics were being significantly misused in a tertiary referral center of a university hospital. Although teaching the principles of prophylaxis to physicians is important, we think that finding a way to bring this knowledge to practice is more important.

Large lipoma of the larynx: a case report.

Fewer than 15% of lipomas occur in the head and neck. Lipomas of the larynx are very rare benign laryngeal tumors (0.6%). To date less than 100 case of laryngeal lipoma have been reported in the literature.Clinical manifestation include progressive horseness, dyspnea, and even dysphagia. In the direct exam smooth or pedunculated mass is seen in the larynx and sometimes if tumor is large enough a mass palpated in the neck. In the computed tomography (CT) low attenuation mass is seen. Treatment of laryngeal lipoma consists of endoscopic removal or external surgical approach depending on tumor size. The authors present a case of laryngeal lipoma that involved the true vocal cord. The following is a report of a single case of laryngeal lipoma, Including esteroboscopy, radiologic and intraoperative finding as well as review of the literature.

Novel syndrome of cataracts, retinitis pigmentosa, late onset deafness and sperm abnormalities: a new Usher syndrome subtype with X-linked inheritance?

Tissues of the auditory, ocular and reproductive systems have some similarities in their protein families and structures. Consequently, syndromes comprising these systems are described. Hearing loss alone is a component of more than 400 known syndromes and is a common nonsyndromic congenital disorder. Here we describe a syndrome in five brothers with the distinctive presentation of late-onset progressive hearing loss, cataracts, retinitis pigmentosa, sperm motility and shape problems in a family from the Kurdish population in Iran. The clinical findings of these patients are presented in detail and compared to the classical Usher syndromes.