Our Experience in Subadventitial Dissection vs. Intracapsular Dissection Technique of Carotid Body Tumors Surgery.

This study provides a single-center experience involving intracapsular dissection for Shamblin II carotid body tumors (CBTs) and compares the outcomes with the classic technique of subadventitial resection. Based on the preliminary results, it seems that the enucleation technique facilitates the dissection of carotid body tumors, offering protection to cranial nerves and the internal/external/common carotid artery by utilizing the capsule as a barrier. The classic subadventitial resection approach and the enucleation technique have comparable postoperative complications. However, it is crucial to continue following the patients who underwent these resection techniques to determine the long-term outcomes. Moreover, the enucleation technique significantly reduces surgery duration and intraoperative blood loss.

Comparison of swallowing disorder in patients with tongue cancer undergoing reconstruction with either a radial forearm free flap or a submental island flap.

PURPOSE: In this study, the swallowing status of patients with tongue cancer undergone tongue reconstruction using radial forearm free flaps (RFFF) and submental flaps were compared. METHODS: A total of 26 patients with tongue cancer undergone tongue resection were randomly treated by tongue reconstruction with either submental flap or RFFF approach. Swallowing status of the patients was investigated using fiberoptic endoscopic evaluation of swallowing (FEES) by measurement of pharyngeal residue and penetration scales. RESULTS: The pharyngeal residue scale in vallecula and pyriform sinus and the average of vallecula and pyriform sinus on days 10 and 30 post-operation as well as penetration scale at the same time showed no significant difference between two groups. However, the time to start oral feeding was significantly reduced in the submental group compared to the free flap group (P = 0.031). A positive Pearson correlation was found between the size of oral tongue and base of tongue resection and some of swallowing parameters. CONCLUSION: Since there was no significant difference between submental and free flap respected to swallowing disorder, the submental flap is prior to free flap due to lower cost and hospitalization and less complication after tongue reconstruction.

Carotid Sheath Dissection and Histopathology During Neck Dissection in Head and Neck Carcinomas.

To investigate the carotid sheath in neck dissection (ND) specimens histopathologically in patients with head and neck carcinomas who had no evidence of previous neck surgery or direct involvement of the carotid sheath in their pre- or intra-operative evaluations. In this study, carotid sheath (CS) specimens of 40 patients with head and neck carcinomas (HNCA) who, depending on the condition of the primary tumor, required unilateral or bilateral elective or therapeutic selective neck dissection were histopathologically investigated by an expert head and neck pathologist to find any lymphoid or thyroid like tissue or tumor cells infiltration. A total of 50 carotid sheath (CS) specimens were investigated. None of the samples showed any evidence of tumor infiltration or accumulation of lymphatic tissue. We conclude that in patients with no histopathologic involvement of the carotid sheath in pre-operative or intra-operative tumor invasion, it is not necessary to remove CS in routine neck dissection.

The effect of ventilation tube insertion in central auditory processing disorders in children with otitis media with effusion.

INTRODUCTION: Otitis media with effusion is one of the most common diseases among children. The purpose of this research is to investigate whether the resolvement of conductive hearing loss from the insertion of a ventilation tube also improves central auditory processing disorders in children with otitis media with effusion. METHOD: In this cross-sectional study, 20 children between 6 and 12 years old were diagnosed with otitis media with effusion and 20 normal children were included in the study. The central auditory processing status was evaluated in all patients before ventilation tube insertion and after six months by Speech Discrimination Score, Speech Reception Threshold, Words-in-Noise, Speech in Noise, Consonant Vowel in Noise tests, and the results were compared. RESULTS: The mean score of Speech Discrimination Score and Consonant Vowel in Noise tests in the control group were significantly higher than the patient group before ventilation tube insertion and after surgery, in the patient group, the mean scores increased significantly. The mean scores of the Speech Reception Threshold, Words-in-Noise, and Speech in Noise tests in the control group were significantly lower than the patient group before ventilation tube insertion and after the operation, in the patient group, the mean scores significantly decreased. After VT insertion, these tests were close to the control group. CONCLUSION: Restituting normal hearing by ventilation tube treatment improves central auditory abilities as shown in speech reception, speech discrimination, the ability to hear, the ability to recognize monosyllabic words, and the power of speech in the presence of noise.

Therapeutic effects of Rosa canina, Urtica dioica and Tanacetum vulgare herbal combination in treatment of tinnitus symptoms: A double-blind randomised clinical trial.

OBJECTIVE: To evaluate the effect of Neurotec® herbal capsule (100 mg twice a day for 3 months) on the tinnitus symptoms in comparison with the placebo. DESIGN: A double-blind randomised clinical trial. SETTING: Otolaryngology clinic of Baqiyatallah Hospital. PARTICIPANTS: Patients suffering from subjective tinnitus. MAIN OUTCOME MEASURES: Pure tone audiometry was measured at .5, 1, 2, 4 and 6 kHz frequencies before and after the third month of intervention. In addition, Tinnitus Handicap Inventory (THI) questionnaire as well as visual analogue scale (VAS) for tinnitus loudness, daily annoyance, daily life or sleep disturbance, daily perception and mood alteration were evaluated. RESULTS: Finally, 103 (69 males and 34 females) patients with a mean age of 51.33 ± 13.91 years were analysed. In contrast with control group, patients in intervention group showed a remarkable decrease in THI score after 3 months of treatment (p < .05). Although both groups had improvements in VAS scores, mood disturbance, daily tinnitus perception and daily life alteration scores were only improved in the intervention group. The mean pure tone air and bone conduction were not significantly different between the control and the intervention group at baseline and 3 months after the intervention at .5, 1, 2 and 4 kHz (p > .05). CONCLUSION: A 3-month treatment with Neurotec capsules in addition to patient education is of benefit for managing symptoms in patients with chronic tinnitus.

Effects of a Novel Barley-Based Formulation on Allergic Rhinitis: A Randomized Controlled Trial.

OBJECTIVE: Current treatment options for Allergic Rhinitis (AR) may have their own limitations and side effects. This study aimed to investigate the effects of Ma-al-Shaeer (MS), a novel natural formulation based on Hordeum vulgare, in the treatment of AR compared with Fexofenadine (FX). METHODS: A total of 77 patients with AR were divided into two groups: MS group (n=38) and FX group (n=39). The first group received 15 g of dried MS powder, and the second group received 60 mg of FX twice daily for 14 days. At baseline (week zero) and after the 14-day treatment period (week two), both groups were evaluated for sneezing, rhinorrhea, nasal congestion, nasal itching, post nasal drip, eye, throat, or ear symptoms, headache, cough, mental function, quality of life scores, blood eosinophil count and total IgE levels. Rhinitis control assessment tests were conducted at week zero and again at one week after cessation of treatment (week three) in both groups. RESULTS: All symptoms of AR except cough were significantly reduced in both groups; for nasal congestion, post nasal drip, and headache, the MS treatment was found to be superior. Rhinitis control was significantly increased after treatment in both groups (p value < 0.001). Both drugs significantly reduced total IgE levels. There was no significant change in eosinophil count in either group. CONCLUSION: MS formulation based on H. vulgare may be an effective treatment for AR. Further studies are needed to confirm the effect of MS as an alternative treatment in AR.

Effect of ESS on Olfactory Threshold of Patients with CRS without Nasal Polyps.

OBJECTIVES: Chronic rhinosinusitis (CRS) is characterized by a long-time inflammatory disease of nasal and sinus mucosa. Olfactory dysfunction is common among CRS patients with a prevalence ranging from 48% to 83%. We aimed to assess the effect of ESS on olfactory function of patients with chronic rhinosinusitis without nasal polyps. METHOD: This randomized clinical trial was conducted on 30 patients with chronic rhinosinusitis without nasal polyps. Patients were randomly allocated to two intervention and control groups; patients in intervention group underwent endoscopic sinus surgery by a single surgeon and control group continued standard treatment with nasal irrigation of normal saline (4 times daily) and nasal corticosteroids (one puff in each nostril daily). Olfactory threshold was evaluated using smell threshold test (STT) before, one month and three months after intervention. RESULTS: Eventually 33 patients with a mean age of 42.70 ± 15.50 years in intervention and 43.12 ± 11.50 years in control group underwent analysis (p value=0.930). Mean olfactory threshold was 2.79 ± 0.73 in intervention and 2.67 ± 1.05 in control group prior to intervention (p value=0.345). Mean change of olfactory threshold was 0.30 ± 0.79 in intervention and 0.38±1.09 in control group one month after intervention (p value=0.214). Mean change of olfactory threshold was 0.13 ± 0.94 in ESS and 0.33 ± 0.60 in control group three months after intervention (p value=0.196). CONCLUSION: Our study revealed that changes in olfactory threshold were not significantly different between two ESS and standard medical therapy groups one and three months after intervention.

The Effect of PRP-enriched Gelfoam on Chronic Tympanic Membrane Perforation: A Double-blind Randomized Clinical Trial.

OBJECTIVE: To evaluate the effect of PRP-enriched gelfoam on the healing of chronic TM perforation in comparison with gelfoam alone. METHODS: In this double-blind randomized clinical trial Patients with chronic tympanic membrane were randomly allocated to two groups; intervention group underwent tympanoplasty with platelet rich plasma (PRP)- enriched gel foams and control group underwent operation with conventional gel foams alone. Patients information was recorded 4 and 12 months after surgery. RESULTS: Eventually 24 patients (12 males and 12 females) with a mean age of 43.33 ± 12.34 years in intervention and 41.33 ± 10.02 years in control group underwent analysis (p = 0.667). Complete TM healing was seen in 8 (66.67%) patients in intervention group and 3 (25%) patients in control group three months after intervention (p = 0.031, OR = 5.98). CONCLUSION: Addition of PRP to conventional gelfoams used in TM perforation repair increases the complete healing rate of TM perforation with less morbidity and complications.

Penetrating nose and maxillary sinus injury with a metal part of a military gun.

Foreign bodies (FBs) in the paranasal sinuses are rare, whether iatrogenic or traumatic. One of the most common causes of such traumatic injuries is gunshot wounds from the bullets. Removing FBs from the paranasal sinuses usually needs endoscopic or open surgery. We present the case of a 22-year-old male soldier who sustained a penetrating injury of his nose and maxillary sinus with an iron rod that was a part of his gun, which was removed without either endoscopic or open paranasal sinus surgery.

Consanguinity Among Parents of Iranian Deaf Children.

BACKGROUND: It seems that there is a relationship between consanguinity and profound hearing loss but there is little data about the association of consanguinity and hearing loss in Iran. OBJECTIVES: The aim of this study is to demonstrate the causes of profound bilateral sensorineural hearing loss among Iranian samples who are candidates for cochlear implantation. METHODS: This study was retrospective, analytical, and designed to collect information about profound hearing impaired cases referred to the Baqiyatallah Cochlear implantation center using enumeration. A total of 310 children with profound hearing impairments participated in this study. They were aged from 6 months to 4 years old. The study was done between January 2007 and April 2009. Chi-square tests were used to show whether there was any statistical difference between the incidence of marital consanguinity of their parents and the normal population. RESULTS: Sixty-five percent of those 310 children had parents who had married with their relatives. Of the 203 (65%) parents that had consanguineous marriages, 132 were first cousins, which includes the children of two brothers (37 [11.8%] patrilateral parallel cousins), the children of two sisters (38 [12.2%] multi-lateral parallel cousins), or the children of a brother and a sister (57 [18.3%] cross cousins). Fifty-four (17.4%) of the parents were second cousins and 17 (5.2%) were beyond second cousins. Also, hearing loss etiology was obvious in 237 (76.3%) of the patients with profound hearing loss but was unknown in 73 (23.7%). Hereditary was identified as the most common cause in 33% of the cases. CONCLUSIONS: Our data demonstrated a 65% occurrence of consanguineous marriage among the parents of deaf children, which is statistically different from the percentage of consanguineous marriage among Iranian population (38%). This indicates an obvious relationship between severe hearing loss and consanguineous marriage.

Prevalence of epileptiform discharges in children with sensori-neural hearing loss and behavioral problems compared to their normal hearing peers.

OBJECTIVE: Overactivity and behavioral problems are common problems in children with prelingually profound sensorineural hearing loss (SNHL). Data on epileptiform electroencephalography (EEG) discharges in deaf children with psychological disorders are so limited. The primary focus of this study was to determine the prevalence of epileptiform discharges (EDs) in children with SNHL and overactivity or behavioral problems. MATERIALS & METHODS: A total of 262 patients with prelingually profound SNHL who were referred to our cochlear implantation center between 2008 and 2010 were enrolled in this study. Children with SNHL who had diagnosis of overactivity and/or behavioral problems by a pediatric psychiatrist, underwent electroencephalography (EEG). EEG analysis was carried out by a board-certified pediatric neurologist. The control group consisted of 45 cases with overactivity or behavioral problems and normal hearing. RESULTS: One hundred thirty-eight children with mean age of 3.5±1.23 year were enrolled in the case group, of whom 88 cases (63.7%) were boy. The control group consisted of 45 cases with mean age of 3.2±1.53 years, of whom 30 (66.6%) cases were male. EDs were detected in 28 (20.02%) children of the case group (with SNHL) in comparison with 4 (8.88%) in the control group (without SNHL), which was statistically significantly different. CONCLUSION: In this study, we obtained higher frequency of EDs in deaf children with overactivity and/or behavioral problem compared to the children without SNHL. Further studies are required to evaluate the possible association of SNHL with EDs in overactive children.

The specificity and sensitivity of transient otoacustic emission in neonatal hearing screening compared with diagnostic test of auditory brain stem response in tehran hospitals.

OBJECTIVE: Since early detection (specially before 6 months of age) of deaf people leads to better hearing and speech outcome after treatment, several clinical trials have been performed in order to find a cost effective, short duration screening test for diagnosis of neonatal hearing impairment. The aim of this study was to assess the sensitivity and specificity of Transient Otoacustic Emission (TEOAE) test in newborns comparing with auditory brain stem response (ABR) in the age of 3 months and to analyze the association between risk factors and hearing loss in neonates. METHODS: A cross-sectional study was conducted January2008 - May 2009 in Tehran. 1000 newborns (526 boys and 474 girls) were assessed. First, all of neonates were evaluated by TEOAE 24h after birth. If responses of OAE were failing, they were retested 10 to 15 days after birth by TEOAE. Also, All Neonates were assessed by ABR in the age of 3 months. Descriptive Statistics was used to analyze data. FINDINGS: Eighteen out of 1000 neonates failed double-checked TEOAE tests, of which 6 were confirmed by ABR test (12 false positive results). Nine out of 1000 neonates had impaired ABR tests, from these patients, 6 had failed OAE as well, but 3 had normal OAE (3 false negative results). From these 9 patients 2 had profound hearing loss and received cochlear implantation. We found that OAE has 66.7% sensitivity and 98.8% specificity in diagnosis of neonatal hearing impairment. Its positive and negative predictive value was 33.3% and 99.7% respectively. Also we did not find statistically significant relationship between hearing loss and risk factors. CONCLUSION: TEOAE as a simple, non-invasive, short duration and cost effective method, is a suitable test for neonatal hearing screening. Even though only two thirds of patients were detected by this method, 99.7% negative predictive value makes it a good screening test. We recommend OAE as a suitable primary neonatal hearing screening all over the country.

Cochlear implant outcomes in children with motor developmental delay.

INTRODUCTION: Multiple handicapped children and children with syndromes and conditions resulting additional disabilities such as cerebral palsy, global developmental delay and autistic spectrum disorder, are now not routinely precluded from receiving a cochlear implant. The primary focus of this study was to determine the effect of cochlear implants on the speech perception and intelligibility of deaf children with and without motor development delay. METHOD: In a cohort study, we compared cochlear implant outcomes in two groups of deaf children with or without motor developmental delay (MDD). Among 262 children with pre-lingual profound hearing loss, 28 (10%) had a motor delay based on Gross Motor Function Classification (GMFC). Children with severe motor delays (classification scale levels 4 and 5) and cognitive delays were excluded. All children completed the Categories of Auditory Perception Scales (CAP) and Speech Intelligibility Rating (SIR) prior to surgery and 24 months after the device was activated. RESULT: The mean age for the study population was 4.09 ± 1.86 years. In all 262 patients the mean CAP score after surgery (5.38 ± 0.043) had a marked difference in comparison with the mean score before surgery (0.482 ± 0.018) (P=0.001). The mean CAP score after surgery for MDD children was 5.03, and was 5.77 for normal motor development children (NMD). The mean SIR score after surgery for MDD children was 2.53, and was 2.66 for NMD children. The final results of CAP and SIR did not have significant difference between NMD children versus MDD children (P>0.05). CONCLUSION: Regarding to the result, we concluded that children with hearing loss and concomitant MDD as an additional disabilities can benefit from cochlear implantation similar to those of NMD.

A repot of surgical complications in a series of 262 consecutive pediatric cochlear implantations in iran.

OBJECTIVE: Cochlear implantations have become a routinely performed and successful surgical intervention in both adults and children. The current article reports the complications encountered in various age groups of consecutive children who underwent implantation in our center. METHODS: We performed a prospective analysis of all profoundly deaf children who underwent cochlear implantation from March 2006 to July 2009 at Baqhiyatallah Cochlear Implantation Center. All patients were younger than 5 years old at the time of implantation. FINDINGS: The minor complications occurred in 49 (18.7%) cases, The most common postoperative complications were temporary facial weakness detected in 15 cases (5.7%) all of which were reversible. Magnet wound was observed in 14 (5.3%) patients, keloid formation in 10 (3.8%), wound infection in 2 (0.8%), otitis media in 5 (2%), and electrode movement, meningitis, vertigo, Laryngospasm each in 1 (0.4%) case was detected among our patients. CONCLUSION: Cochlear implantation in children continues to be reliable and safe in experienced hands, with a low percentage of severe complications as long as the patient is monitored closely.