Effects of Frequency-Controlled Ear Acupuncture on COVID-19- related Refractory Olfactory Dysfunction: a Randomized Clinical Trial.

Background: Olfactory dysfunction is a common COVID-19 symptom, posing treatment challenges. Objectives: We aimed to investigate the efficacy of frequency-controlled ear acupuncture in treating COVID-19-related olfactory dysfunction. Methods: A randomized, participant-blind clinical trial occurred at the Rasoul Akram Hospital (IRCT20210311050671N1). Forty patients were recruited, and 20 patients were randomly assigned to either the experimental or control group. The primary outcome was the improvement in patients' quality of smell. The olfactory dysfunction was confirmed using the Smell Identification Test. The intervention group received two sessions of acupuncture treatment according to auricular frequency treatment, with a one-week interval, while the control group received an equal number of switched-off laser sessions. Both groups were instructed to use nasal betamethasone drops. The patients were asked to rank their ability to smell before and after each intervention on a 10-point visual analog scale. Secondary outcomes were related side effects. Results: Covariance analysis revealed a significant difference in adjusted scores between the groups (F [37, 1] = 37.463; p = 0.000, Eta2 = 0.503). The smell quality improved from 2.80 ± 1.76 to 5.22 ± 3.40 after treatment in the intervention group (p = 0.007), while the control group showed no significant change (p = 0.184). Three patients reported short and transient side effects, such as nausea, headache, and dizziness, in the first hours after the intervention. Conclusion: Frequency-controlled ear acupuncture is an effective option for treating COVID-19-related olfactory dysfunction. The study highlights the potential of alternative therapies in the treatment of this condition, and further research is warranted to investigate its long-term effects.

Role of Electrodiagnostic Modalities in Detection of Nasal Septal Deviation.

Nasal Septal Deviation (NSD) is a common sign in otorhinolaryngology that can lead to facial asymmetry. In this case-control observational study, we assessed the role of EMG and NCS in the diagnosis of NSD and its effect on neuromuscular function. Participants were divided into two groups based on paranasal sinus computed tomography scan (PNS CT) results: NSD cases (n = 21) and controls without NSD (n = 13). EMG and NCS were performed on both groups to assess nasal alar muscles at the root of the zygomatic nerve. Our findings showed a significant correlation between NSD and EMG/NCS tests (P-value = 000) and a significant association between septal deviation and nasal alar lateralization (P-value = 000). EMG/NCS can be useful in assessing NSD by providing a better understanding of related neuromuscular structures and neuromuscular function of the nasal alar dilator muscles and aid in the diagnosis of NSD. Nasal Septal Deviation, EMG (electromyography), NCS (nerve conduction studies), Neuromuscular function, Facial asymmetry, Otorhinolaryngology, Paranasal sinus, Computed tomography, Nasal alar muscles, Zygomatic nerve, Nasal Obstruction, Nasal alar lateralization, Diagnosis.

Immune endotyping and gene expression profile of patients with chronic rhinosinusitis with nasal polyps in the aspirin-exacerbated respiratory disease (AERD) and the non-AERD subgroups.

BACKGROUND: Chronic Rhinosinusitis (CRS) is a paranasal sinus inflammatory disease and is divided into two subgroups defined as CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). CRSwNP displays a T helper (Th)2 biased phenotype, and based on sensitivity or tolerance to aspirin or non-steroidal anti-inflammatory drugs (NSAID), is further subdivided into Aspirin-exacerbated respiratory disease (AERD) and non-AERD groups. Considering the challenge of diagnosis and treatment in patients with CRSwNP, particularly the AERD subtype, and the significance of endotyping in these patients, we examined the immune profile and endotyping based on gene expression analysis in the AERD and the non-AERD groups of patients with CRSwNP. MATERIAL AND METHOD: In this study, 21 patients were enrolled and were categorized into AERD (N = 10) and non-AERD (N = 11) groups based on their sensitivity to aspirin. After the special washing period, nasal polyps were biopsied in both groups, and the infiltration of eosinophils, neutrophils, plasma cells, and lymphocytes was compared between the AERD and the non-AERD groups. Also, gene expression levels of transcription factors including Tbet, GATA3, RoRγt, and FoxP3 and inflammatory cytokines including interleukin (IL)1ß, IL1RAP (IL1 receptor accessory protein), IL2, IL4, IL5, IL10, IL13, IL17, TNFα, and IFNγ were investigated by quantitative Real-time PCR (qRT-PCR). Statistical analyses were performed using analytical tests including Kolmogorov-Smirnov, Mann-Whitney, and T-test. A P value less than 0.05 was considered statistically significant. RESULTS: The mean ± SD age of the studied groups was 37 ± 8.7 years old (21-50) for the AERD, and 40.4 ± 7.7 years old (31-52) for the non-AERD. LMS/EPOS/SNOT scores and pulmonary function tests showed no difference between the two groups. Serum immunoglobulin E (IgE) levels were found to be higher in patients with AERD (p = 0.04), however, the peripheral blood counts of eosinophils were comparable in the two groups. In the histopathologic analysis, the AERD group showed higher percentages of eosinophils (p = 0.04), neutrophils (p = 0.04), and plasma cells (p = 0.04) than the non-AERD group. Additionally, the gene expression levels of GATA3 (p = 0.001), IL4 (p = 0.04), IL5 (p = 0.007), and IL17 (p = 0.03) were significantly higher in the AERD than the non-AERD groups. CONCLUSION: Higher gene expression levels of GATA3, IL4, IL5, and IL17 were observed in the AERD group compared with the non-AERD group. These findings point to distinct patterns of inflammation in patients with AERD, with a predominance of Th2 inflammation.

The Effect of Topical Aminophylline on Hyposmia and Anosmia.

Introduction: Olfactory training is accounted as a significantly beneficial therapy for hyposmia or anosmia. There is some evidence about methylxanthine usage for this issue. In the present study, we have investigated the effects of topical aminophylline in hyposmic and anosmic patients. Materials and Methods: In this clinical trial study, patients were randomly divided into two groups (n= 20/each), the case group was given aminophylline drops over a three-month period (using the contents of the vial aminophylline in the form of nasal drops, 250 micrograms daily) with olfactory training and the control group was given normal saline drops with olfactory training over a three-month period. The olfactory capacities were assessed before the start and after the completion of treatments using a valid and reliable smell identification test. Results: In the saline and aminophylline groups, the mean ± SD relative changes in SIT score were 0.55±0.31 and 0.85±0.56, respectively. As a result, the SIT score in the saline group climbed by 55 percent but increased by 85 percent in the aminophylline group. The difference in SIT score between pre- and post-test was meaningful in both groups (P< 0.001). The aminophylline group scored significantly higher according to the marginal longitudinal regression model, adjusting baseline parameters. Conclusions: Intranasal aminophylline plus olfactory training significantly improved SIT scores in severe hyposmia or anosmia. Hypothetically, these effects are mediated through changes in cAMP and cGMP.

Evaluation of Serum Immunoreactivity to Common Indigenous Iranian Inhalation and Food Allergens in Patients with Meniere's Disease.

BACKGROUND: A few studies investigated the relationship between allergy and Meniere disease considering complete allergen panel. We aimed to evaluate the serum immunoreactivity in patients with Meniere's disease (MD) compared with healthy people according to common indigenous Iranian inhalation and food allergens. METHODS: Thirty-nine patients with MD referred to Rasoul Akram Hospital (Tehran, Iran) were evaluated and compared with a 41 membered control group. A panel of common inhalation and food allergens (using an immunoblotting method), as well as total immunoglobulin E (IgE) level (using the sandwich enzyme-linked immunosorbent assay method), were checked on the patients' serum. RESULTS: The mean total IgE level was 193.85 ± 175.43 IU/ml in the patients with MD and 117.61 ± 138.05 IU/ml in the control group, which was significantly higher than the other subjects in the control group (P = .016). There was a significant difference between the two groups regarding inhalation allergens such as; sweet vernal grass, cultivated rye, cultivated oat, Russian thistle, goosefoot, and rough pigweed (P = .01-0.038). Patients with MD reported more reactive to food allergens such as; rye flour, hazelnut, pepper, citrus mix 2, potato, strawberry, and celery allergens. There was a significant relationship between Meniere and serum immunoreactivity to inhalation and food allergens (both P = .001).Conclusion: Serum total IgE level in patients with MD (in both inhalation and food allergens groups) was higher than the control group, and there was a relationship between MD and immunoreactivity to common indigenous inhalation and food allergens of Iran.

Lagophthalmos of the upper eyelid after rhinoplasty: A case report.

Lagophthalmos is an inability to close the eyelids which can result from many causes. Septorhinoplasty surgery is an uncommon reason for that. This paper reports the lagophthalmos complication, after a septorhinoplasty surgery.

Persian Validation and Cultural Adaptation of the Body Dysmorphic Disorder Questionnaire-Aesthetic Surgery for Iranian Rhinoplasty Patients.

BACKGROUND: Body dysmorphic disorder (BDD) is one of the obsessive-compulsive disorders (OCD) which is very common in populations. However, the diagnosis rate is lower than the reality. BDD may lead to loneliness, jobless, avoidance of daily life and public activities. The Body Dysmorphic Disorder Questionnaire-Aesthetic Surgery (BDDQ-AS) is the validated questionnaire used to screen the BBD in patients seeking cosmetic surgeries. This study aimed to translate and validate a Persian version of the BDDQ-AS. METHODS: This analytical-descriptive cross-sectional study was conducted at Firoozgar Hospital, Tehran, Iran to validate the BDDQ-AS in Iranian society in 2020. A standard forward and back-translation procedure was followed. Overall, 79 Persian-speaking patients of both sexes referred to rhinoplasty surgery department at Firoozgar hospital were recruited. The control group consisted of 70 patients who also completed the final questionnaire. The BDDQ-AS was translated into Farsi. The final version was tested for reliability and validity in both groups. RESULTS: The internal consistency and split-half test were 89.2% and 92% respectively in rhinoplasty group. The spearman`s correlation coefficient between the scores obtained in BDD-YBOCS and BDDQ-AS was 0.757 (P<0.001) which confirmed the criterion validity and the minimum value of CVI was 0.79 that all items were relevant, transparent and simple. CONCLUSION: The Persian version of the BDDQ-AS questionnaire consist of 6 short yes/no questions which is less time-consuming and reliable for interpreting and screening. The sensitivity and specificity of this version are 85.71% and 81% respectively, which are adequate for screening.

Gastric pull-up with laryngeal preservation of the primary synovial sarcoma of the esophagus: A case report.

In patients who require a gastric pull-up, despite bilateral injury to the vocal cords and regurgitation, preservation of the larynx can improve their quality of life.

Effect of Low-Pressure Drainage Suction on Pharyngocutaneous Fistula After Total Laryngectomy.

OBJECTIVE: Pharyngocutaneous fistula (PCF) is one of the most severe multifactorial complications following laryngectomy. The current study aimed at determining the effect of a low-pressure vacuum drain on the incidence of PCF after total laryngectomy. METHODS: The current randomized clinical trial was conducted on 35 patients undergoing total laryngectomy in Hazrat Rasoul Akram and Firoozgar hospitals in Tehran, Iran. The subjects were divided into the vacuum drain (n = 15) and control (without vacuum drain) (n = 20) groups. The incidence of PCF and the recovery time were recorded. RESULTS: The rate of PCF formation from the stoma and wound edges was significantly lower in the low-pressure vacuum drain group than in the control group (6.7% vs 40%) (P < .05). There was no significant difference between the groups in time to recovery from PCF. CONCLUSION: The low-pressure vacuum drain method is effective in reducing the incidence of PCF after total laryngectomy.

Lipoma of the nasal septum: A case report.

Even routine diagnoses, such as septal deviation, which most people do not think need imaging, require careful examination because rare diagnoses such as lipoma may occur in the nose. Careful examination and imaging lead to the best treatment.

The Persian Version of Utrecht Questionnaire for Evaluation of Aesthetic Rhinoplasty Outcomes: Translation and Validation.

BACKGROUND: There are different questionnaires and approaches to evaluate the outcome of rhinoplasty operations. A short questionnaire, which can be completed in less than 2 minutes, is the Utrecht questionnaire that consists of a visual analogue scale (VAS) and five multiple-choice questions. In this study, we have translated the questionnaire in Persian and evaluated its reliability and validity. METHODS: Patients undergoing aesthetic rhinoplasty surgery in Firoozgar Hospital from January to March 2019 were enrolled. The questionnaire was translated to Persian and backward translated to English by independent medical extern Persian speakers with complete English proficiency. The internal consistency was measured by Cronbach's alpha, repeatability by Student t test of test-retest 4 weeks and 12 weeks follow-up post-operatively, and validity by comparing pre- and post- operative results. RESULTS: Thirty patients were included in the analysis. The Cronbach's alpha was 0.925 as a marker for internal consistency. The test-retest was acceptable for all the questions accordingly (p>0.05). The p values for pre- vs. post-operative tests were also significant for either all of the questions and the sum score. CONCLUSION: The translated questionnaire was internally consistent and repeatable. The questionnaire also seems to be valid for all questions and the sum score. According to our analysis, the translated Persian version of the Utrecht questionnaire seems to be internally consistence, reliable in test-retest analysis, and valid due to a pre-post operational analysis.

Investigating Human Papilloma Virus Types in Sinonasal Papilloma Using Polymerase Chain Reaction: Is It Really a Prerequisite for Nasal Papilloma Formation?

Sinonasal papilloma is a relatively rare disease. However, it is prevalent enough for every otorhinolaryngologist to encounter it several times throughout one's medical practice. The aim of this study was to identify the presence of Human Papilloma Virus in sinonasal specimens of patients with sinonasal papilloma. A cross sectional analytical study was performed on fresh tissue samples from 36 patients with sinonasal papilloma. Samples were studied by polymerase chain reaction for of Human Papilloma Virus detection. In conclusion, the majority of patients were of Human Papilloma Virus negative and there was no statistically significant difference in presence of squamous cell carcinoma in of Human Papilloma Virus positive and negative patients. Thus, further studies are needed to assess other potential factors that may influence the development of sinonasal papilloma.

Isolated laryngeal sarcoidosis.

To improve diagnosis and treatment of laryngeal sarcoidosis, we present a rare case of upper airway obstruction of unclear aetiology, with life-threatening complication.The patient was a 19-year boy who presented with progressive severe dyspnoea for eight months. After extensive diagnostic evaluations with no conclusive diagnosis, biopsy showed non-caseating granulomatous inflammation consistent with laryngeal sarcoidosis that was treated with a CO2 laser attached to a microscope. The laser was also used to resect epiglottitis, false focal cords, and aryepiglottic fold completely due to supraglottic swelling with a thick oedematous epiglottis. A 1.5-ms pulse-duration CO2 laser attached to a microscope is an effective technique of treating laryngeal sarcoidosis and preventing its hazardous complication. Beneficial effects of this method are not only an immediate improvement of the symptoms, but also this method decreases the need for long-term medical therapy with its side effects or avoid tracheostomy due to upper airway obstruction.