The effect of local dexamethasone on stapedotomy surgery outcomes in patients with otosclerosis.

BACKGROUND: Some studies have shown a positive effect of systemic corticosteroid on hearing results after stapedotomy, but its side effects can limit its routine administration. AIM: The aim of this study was to investigate the effect of local dexamethasone on the results of stapedotomy surgery. MATERIAL AND METHODS: Fifty two patients undergone stapedotomy surgery for otosclerosis involved. In the case group after stapedotomy we fulfilled the middle ear with dexamethasone and then the placement of the prosthesis was done. In the control group after stapedotomy we did not use dexamethasone in the middle ear. RESULTS: Gender, age, nausea, vomiting, postoperative vertigo and nystagmus did not significantly differ between the groups. A significant difference was observed in tinnitus rate between two groups. In the case group ABG decrease was higher and bone conduction thresholds improved at frequencies of 1000, 2000, and 4000 three months after surgery. CONCLUSION: Since local dexamethasone had a positive effect on the results of stapedotomy surgery, it can be used instead of systemic corticosteroids to reduce the side effects and increasing surgery's success rate. SIGNIFICANCE: If local dexamethasone had a positive influence on the results of stapedotomy surgery, it can be used instead of systemic corticosteroids to reduce the side effects and increasing surgery's success rate.

The effect of cisplatin-based chemotherapy on hearing loss (the frequency of >8 kHz) in children with cancer.

INTRODUCTION: In this study we investigated the effect of cisplatin-based chemotherapy on hearing loss in children with cancer. MATERIAL AND METHOD: In this retrospective study, 20 children aged 6 to 17 years with cancer who were treated with cisplatin and had normal results on initial audiometry test were included. The demographic, clinical, and medical information of all children was extracted and recorded. The hearing thresholds were determined for the frequency of >8 kHz by an audiometrist two weeks after receiving the last course of cisplatin. Finally, all data was analyzed. RESULTS: In this study, 20 children with cancer were included of who 9 were girls (45 %) and 11 were boys (55 %). The patients' mean age at the time of diagnosis was 6.65 years. Results showed that children who received cisplatin ≥70 mg/m2 (P.value = 0.09) and ≥ 7 courses of cisplatin (P.value = 0.01), and a cumulative dose higher than 400 mg/m2 (P.value = 0.02) had higher chance of hearing loss. CONCLUSION: According to the results it can be concluded that since higher doses caused higher risk of hearing loss and also since lower doses were effective for treatment of the cancer in children therefore to preventing the hearing loss, lower doses of cisplatin are recommended for cancer treatment in children.

Sinonasal mucormycosis during 2 years of COVID-19 pandemic in central Iran: incidence rate and clinical features / Mucormicosis sinonasal durante 2 años de pandemia de COVID-19 en el centro de Irán: tasa de incidencia y características clínicas

Introduction As a novel infectious disease, COVID-19 is caused by SARS-COV-2, spreading rapidly worldwide. ENT specialists have faced this challenging disease in various ways since the emergence of the COVID-19 pandemic. We are currently facing an increase in cases referred due to sinonasal mucormycosis which is a rare but invasive, rapidly progressive, and life-threatening infection. We provide an overview of this disease's incidence rate and clinical features. Methods This descriptive cross-sectional study was conducted on 46 sinonasal mucormycosis patients who were histopathologically confirmed after sinonasal endoscopic surgery in our educational therapeutic hospital during 2 years of the COVID-19 pandemic from March 20, 2020, to March 20, 2022. Results There was an increase in the incidence of mucormycosis more than twice as much as before. All patients had a history of COVID-19 and 69.6% were diabetic. The median time to symptom onset from COVID-19 detection was 3.3 weeks. A total of 60.9% received steroids while 85.7% were prescribed during COVID-19 treatment. The most common manifestation was orbital involvement (80.4%). Of the 46 study cases, unfortunately, 17 (37%) died. An exciting point in our study was the incidence of peripheral facial palsy which is associated involvement of multiple other cranial nerves (II, III, IV, V, VI) considered to be the likely occurrence of a rare phenomenon called Garcin's syndrome. Conclusion Based on the results of this study, during 2 years of the COVID -19 pandemic, there was an increase in the incidence of sinonasal mucormycosis more than twice as much as before. (AU)

Introducción La enfermedad infecciosa COVID-19, causada por el SARS.COV-2 se ha extendido rápidamente por el mundo. Como otorrinolaringólogos, nos hemos enfrentado a esta enfermedad de diversas maneras durante el periodo de pandemia. Actualmente evidenciamos a un aumento de casos de mucormicosis nasosinusal, infección rara pero invasiva, rápidamente progresiva y amenazante para la vida. Presentamos una descripción general de la incidencia de esta enfermedad, así como sus características clínicas. Métodos Estudio descriptivo transversal de 46 pacientes con mucormicosis nasosinusal confirmados histopatológicamente en un hospital universitario de Irán desde el 20 marzo de 2020 hasta el 20 de marzo de 2022. Resultados El aumento en la incidencia de mucormicosis ha sido más del doble en comparación con el pasado. Los pacientes todos tenían antecedentes de COVID-19, y el 69.6 % de ellos eran diabéticos. El plazo promedio de aparición de los síntomas ha sido 3.3 semanas desde la detección del COVID-19. Un total de 60.9% de pacientes recibieron esteroides mientras que el 85.7% fueron recetados durante el tratamiento contra el COVID-19. La manifestación más frecuente fue la afectación orbitaria (80.4%). De los 46 casos de estudio, lamentablemente, 17 (37%) fallecieron. Un punto emocionante en nuestro estudio fue la incidencia de parálisis facial periférica que está afectada y asociada con la participación de muchos otros nervios craneales (II, III, IV, V, VI) que se considera que es la probable ocurrencia de un fenómeno raro llamado síndrome de Garcin. Conclusión En base a los resultados de este estudio podemos concluir que la incidencia de mucormicosis nasosinusal se duplicó en Irán durante el periodo de pandemia. (AU)

The Effect of Electrical Stimulation Therapy on Brain Derived Neurotrophic Factor in Patients with Tinnitus.

Introduction: The aim of this study was to determine the effect of electric stimulation therapy on brain-derived neurotrophic factor (BDNF) in patients with tinnitus. Materials and methods: In this before-after clinical trial study, 45 patients aged 30-80 years old with tinnitus were involved. The hearing threshold, loudness, and frequency of tinnitus were assessed. Tinnitus Handicap Inventory (THI) questionnaire was completed by the patients. Before holding electrical stimulation sessions, the patients were evaluated for serum brain-derived neurotrophic factor (BDNF) level. Patients underwent five electrical stimulation sessions of 20 min for 5 consecutive days. After completion of electrical stimulation session, THI questionnaire was re-completed by the patients and they were evaluated for serum BDNF level. Results: Mean BDNF level before and after the intervention was (1238 ± 494.2) and (1148.2 ± 496.7), respectively (P = 0.04). Mean loudness score before and after the intervention was (6.36 ± 1.47) and (5.27 ± 1.68), respectively (P = 0.01). Mean THI score before and after the intervention was (58.21 ± 11.8) and (53.17 ± 15.19), respectively (p = 0.01). In patients with severe THI1, there was a significant difference between serum BDNF level (p = 0.019) and loudness (p = 0.003) before and after the intervention. However, in patients with mild, moderate, and very severe THI1, no such effect was observed (p > 0.05). Conclusion: According to the results of the present study, electrical stimulation therapy significantly decreased the mean plasma BDNF level in patients with tinnitus, especially in patients with severe tinnitus so it can be used as a marker to define the response to treatment and determine the severity of tinnitus in primary evaluations.

Sinonasal mucormycosis during 2 years of COVID-19 pandemic in central Iran: incidence rate and clinical features.

INTRODUCTION: As a novel infectious disease, COVID-19 is caused by SARS-COV-2, spreading rapidly worldwide. ENT specialists have faced this challenging disease in various ways since the emergence of the COVID-19 pandemic. We are currently facing an increase in cases referred due to sinonasal mucormycosis which is a rare but invasive, rapidly progressive, and life-threatening infection. We provide an overview of this disease's incidence rate and clinical features. METHODS: This descriptive cross-sectional study was conducted on 46 sinonasal mucormycosis patients who were histopathologically confirmed after sinonasal endoscopic surgery in our educational therapeutic hospital during 2 years of the COVID-19 pandemic from March 20, 2020, to March 20, 2022. RESULTS: There was an increase in the incidence of mucormycosis more than twice as much as before. All patients had a history of COVID-19 and 69.6% were diabetic. The median time to symptom onset from COVID-19 detection was 3.3 weeks. A total of 60.9% received steroids while 85.7% were prescribed during COVID-19 treatment. The most common manifestation was orbital involvement (80.4%). Of the 46 study cases, unfortunately, 17 (37%) died. An exciting point in our study was the incidence of peripheral facial palsy which is associated involvement of multiple other cranial nerves (II, III, IV, V, VI) considered to be the likely occurrence of a rare phenomenon called Garcin's syndrome. CONCLUSION: Based on the results of this study, during 2 years of the COVID -19 pandemic, there was an increase in the incidence of sinonasal mucormycosis more than twice as much as before.

The association between metabolic syndrome and the prognosis of idiopathic sudden sensorineural hearing loss.

INTRODUCTION: In this study, we investigated the association between metabolic syndrome and the prognosis of idiopathic sudden sensorineural hearing loss. METHODS: In this prospective cohort study, 79 patients with idiopathic SSNHL admitted to the ENT ward were involved. Patients were under treatment with two-dose pulse methylprednisolone and then oral corticosteroid (Prednisolone 1 mg/kg for up to 2 weeks and more). In all patients, the mean hearing threshold was measured before treatment and 3 weeks after the treatment. Metabolic syndrome criteria were assessed in all patients too. Then, based on these diagnostic criteria all data in patients with and without metabolic were compared. RESULTS: There was a significant difference in Hypertension, BMI > 25, high TG and low HDL (p.v = 0.001) between two groups (metabolic syndrome group and non-metabolic syndrome group). The rate of recovered patients was significantly lower in the metabolic syndrome group than in the non-metabolic syndrome group (p.v = 0.001). It was found that metabolic syndrome (OR = 2.02), diabetes mellitus (OR = 7.32), HTN (OR = 4.09), BMI > 25 (OR = 3.24) and high initial hearing threshold (OR = 3.96) were clearly related to the poor prognosis of treatment. CONCLUSIONS: According to the findings of this study, it was found that metabolic syndrome had a negative effect on hearing improvement in patients with idiopathic SSNHL.

Investigating the possible association between thyroid nodule location and the malignancy risk of the nodules in FNA samples.

INTRODUCTION: In this study we aimed to investigate the association between thyroid nodule location and the malignancy risk of the nodules in FNA samples. METHODS: In this cross sectional study, 400 patients with thyroid nodule size >1.5 cm, thyroid nodule size >1 cm with micro-calcification, and thyroid nodule size <1 cm with sonographic or clinical signs of malignancy who referred to a training hospital, were involved. Morphologic characteristics of nodules, including nodule size, laterality and polarity were recorded. In patients with multinodular goiter, the anatomical location was recorded and analyzed. RESULTS: In our study, 345 female patients (86.3 %) and 55 male patients (13.8 %) with thyroid nodule were involved. The majority of thyroid nodules were identified in the right lobe (n = 182, 45.5 %) and left lobe (n = 177, 44.3 %), respectively. A total of 323 nodules were benign and the remaining (n = 77) were malignant. The frequency of malignancy in the upper pole of the thyroid (31.6 %) was higher compared to that in the middle pole (10.7 %), lower pole (19.1 %), and isthmus region (26.8 %), leading to a significant difference (p.value = 0.001). The mean size of thyroid nodules was 15.68 mm in benign nodules and 20.08 mm in malignant nodules. CONCLUSION: Our results showed that thyroid nodules found in the upper lobe carried the greatest risk for malignancy. Accordingly, it seems that the location of thyroid nodules can be an independent risk factor in determining the malignancy risk of thyroid nodules and can be used to enhance clinical decision making in thyroid FNA samples.

Efficiency-Efficacy Assessment of External Lateral Osteotomy Technique Versus Internal One in the Rhinoplasty.

In this study we aimed to compare external lateral osteotomy technique vs. internal one in the rhinoplasty. In this before-after clinical trial study 30 patients who were candidates for rhinoplasty involved. In each patient, external lateral osteotomy was performed on one side and internal lateral osteotomy was performed on the other side randomly. Information, including patients' age, sex, grade of edema and ecchymosis 1, 3, and 7 days after the surgery, and the type of lateral osteotomy, the amount of step deformity, the need for the specialist intervention, nasal bone mobility, and flail nasal bone was recorded and analyzed. The incidence of edema and ecchymosis on the first and the third day was statistically lower in the external method (P value < 0.001). Although the incidence of edema and ecchymosis on the seventh day was lower in the external method, it was not statistically significant (P value > 0.05). Forty seven percent of patients in the internal method and 36% of patients in the external method had step deformity (p value < 0.001). Fifty percent of patients in the internal method and 41% of patients in the external method needed the specialist intervention (p value > 0.05). Seventy four of patients in the internal method and 83% of patients in the external method had nasal bone mobility (p value > 0.05). Out of 30 patients, only one had flail nasal bone. Based on our findings, the external technique is suggested as a more effective and convenient method with less complications for inexperienced surgeons.

The Efficacy of Combined VHIT and VNG in the Diagnosis of Vertigo Caused by Meniere's Disease.

This study aimed to evaluate the efficacy of video head impulse test (VHIT) and Videonystagmography (VNG) diagnostic tests in the diagnosis of vertigo caused by Meniere's disease. In this cross-sectional study 20 patients (10 in Meniere's group and 10 in control group) with vertigo attacks were involved. Patients were diagnosed with Meniere's disease (according to clinical criteria) or acute vertigo due to other causes after taking a history, complete examination, audiometry screening, and recording patient information in a pre-prepared checklist. Patients were referred to an audiology clinic for performing ECOG, VHIT, and VNG. All variables and sensitivity, specificity, positive predictive value, and negative predictive value were recorded and analyzed. There was no statistical difference between two groups regarding the mean age and gender of the patients (p > 0.05). The results showed no statistically significant difference between the study groups regarding the frequency distribution of ECOG, VNG, VHIT results. Also the results showed no statistically significant difference between the study groups regarding the frequency distribution of combined VNG and VHIT results. Combined VNG and VHIT had a relatively low sensitivity but high specificity in diagnosing Meniere's disease compared with the ECOG test, which had a sensitivity of 70% and a specificity of 90%. At the time of attack in this study, combined VNG and VHIT had a sensitivity of 50% and a specificity of 90%. According to the results of the current study, it can be concluded that patients in whom the result of combined VNG and VHIT was positive for Meniere's were more likely to have Meniere's disease based on clinical criteria.

Comparison of the effect of peritonsillar infiltration of tramadol vs dexmedetomidine on post-tonsillectomy pain.

INTRODUCTION: This study aimed to comparing the effect of peritonsillar infiltration of tramadol and dexmedetomidine in relieving post-tonsillectomy pain. METHODS: In this randomized double blinded clinical trial study, 90 children 5-12 years old undergoing tonsillectomy, involved. Induction of anesthesia was done by fentanyl 1 µg/kg, sodium thiopental 5 mg/kg and atracurium 0.5 mg/kg and intubation was done after 3 min. Anesthesia maintained by nitrous oxide 60% and oxygen 40% with isoflurane (1.2%). Tramadol 2 mg/kg in group A, dexmedetomidine 1 µg/kg in group B, and normal saline in group c were injected into the bed and anterior tonsillar pillar and surgery has begun after 3 min of injection. Time of surgery, all hemodynamic variables, pain intensity and degree of sedation were recorded and evaluated. RESULTS: The results showed that duration of the surgery (p value = 0.28) and duration of anesthesia (p value = 0.43) were not significantly different between the groups but pain score was significantly lower in dexmedetomidine group in comparison to tramadol and placebo group (p value = 0.001). The first time for analgesic request was longer in dexmedetomidine group (p value = 0.001) and Hemodynamic parameters were significantly lower in tramadol and dexmedetomidine group (p value = 0.001). Sedation level was not significantly different between tramadol and dexmedetomidine group (p value = 0.001). CONCLUSION: According to the results peritonsillar infiltration of dexmedetomidine is effective and safe in relieving post-tonsillectomy pain.

Correlation of Serum Vitamin D Levels with Chronic Rhinosinusitis Disease Severity.

INTRODUCTION: The present study was conducted to investigate the association between the serum vitamin D levels and severity of disease in chronic rhino sinusitis (CRS) patients. MATERIALS AND METHODS: This prospective cross-sectional study was conducted on a total of 93 patients suffering from chronic rhino sinusitis with nasal polyposis (CRS w NP). Serum level of 25-hydroxyvitamin D was detected using a simple blood test. A22-item questionnaire, namely the sinonasal outcome test-22 (SNOT-22), was used to assess the subjective disease severity and patients' quality of life. In addition, the radiographic signs of the disease severity were evaluated using the Lund-Mackay Scale (LMS). RESULTS: The mean age and serum vitamin D level of the patients were measured at 37.7±13.6 years and 24.6±16.9 ng/ml, respectively. Moreover, the mean of LMS and SNOT-22 scores were calculated at 14.2±11.2 and 40.8±17.6, respectively. There was a negative correlation between the SNOT-22 and serum levels of vitamin D (P=0.034). Similarly, LMS and serum vitamin D levels were correlated negatively (P=0.027). Furthermore, the results revealed a direct relationship between LMS and SNOT-22 (P<0.0001). CONCLUSION: According to the obtained results, there was a significant relationship between the serum vitamin D levels and severity of disease in patients with CRS w NP. Therefore, serum vitamin D levels could be added to the routine workup of the patients suffering from CRS w NP.

Changes in elastic properties of the nasal tip using Columellar strut graft versus tongue-in-groove method over one year after rhinoplasty.

INTRODUCTION: In this study, we decided to investigate the changes in elasticity of the nasal tip using Columellar strut graft versus toung in groove method over a year after rhinoplasty. MATERIALS AND METHODS: In this before-after randomized clinical trial study, 44 candidates for rhinoplasty were enrolled Columellar strut graft group (n = 22) and toung in groove group (n = 22). Also 22 patients who referred to ENT clinic without any previous rhinoplasty and without any decision for it during the next year, considered as control group. One group underwent columellar strut graft and the other one underwent tongue in groove rhinoplasty and in control group participants received no intervention. Nasolabial angle and elasticity of the nasal tip were recorded and compared before the surgery, immediately after the surgery, 3 months and one year after the surgery. RESULT: There was no significant difference between the mean elasticity of the nose and the nasolabial angle before the surgery, immediately after the surgery and 3 months after the surgery between the groups. However, there was significant differences in the mean elasticity of the nose and the nasolabial angle between the groups one year after the surgery (P value < 0.05). Pearson correlation coefficient test showed a significant correlation between nasal tip elasticity 3 months and 1 year after rhinoplasty (P = 0.032, r = 0.459) and nasolabial angle 3 months and 1 year after rhinoplasty (P = 0.045, r = 0.431). CONCLUSION: According to the results, it can be concluded that the both the Columellar strut graft and toung in groove methods improve elastic properties of the nasal tip and nasolabial angle after rhinoplasty compare to the control group.

The Effect of Gelfoam Impregnated With Botulinum Toxin on Allergic Rhinitis.

INTRODUCTION: This study evaluated the effect of gelfoam impregnated with botulinum toxin on the symptoms induced by allergic rhinitis. MATERIALS AND METHODS: In total, 30 patients with allergic rhinitis who did not respond to common therapies were included in this clinical trial study. All patients were treated with intranasal gelfoam impregnated with botulinum toxin type a (40 unit in each side) placed in the middle meatus of each nostril. The main symptoms of allergic rhinitis were scored from zero to three by the patients. Symptoms recorded and compared before and two months after the treatment. RESULT: The mean age of patients was 31.03±6.9 years. The mean score for sneezing was 2.23 before the treatment which significantly decreased to 1.06 after the treatment (P<0.05). The mean scores of rhinorrhea, nasal congestion, and nasal itching were 2.53, 2.03, and 1.93, respectively, before the treatment which significantly decreased to 0.93, 1, and 0.8 after the treatment (P<0.05). No reported side effects was observed in this study. CONCLUSION: According to the results, treatment with gelfoam impregnated with botulinum toxin is an effective and safe method in patients who have not responded to common therapies for allergic rhinitis. Accordingly, it is recommended to relieve symptoms in patients with seasonal allergic rhinitis in order to maintain the effectiveness of this treatment at least 8 weeks.

Effect of Cold Diet and Diet at Room Temperature on Post-Tonsillectomy Pain in Children.

INTRODUCTION: The present study aimed to compare the effect of cold diet and diet at room temperature on post-tonsillectomy pain in children. MATERIALS AND METHODS: In the present study a total of 120 children within the age range of 4-12 years who underwent tonsillectomy were randomly assigned to two groups, namely group C with a cold-served diet and group room temperaturewith a room-temperature-served diet postoperatively. Each patient's post-operative pain was evaluated using the Face, Legs, Activity, Cry, Consolability (FLACC) scale prior to oral diet initiation after the operation, before thesecond acetaminophen dose, before the next day breakfast, and before discharge. RESULTS: Out of 103 children, 48 and 55 children were femaleand male, respectively. The average age of the children was 7 years and 2 months. There was no significant difference in gender and age between the two groups. There were no significant differences in the mean scores of FLACC scale between the two groups at different times, including before starting an oral diet (P>0.15), before the second dose of acetaminophen (P>0.22), before the next day breakfast (P>0.32), and before discharge (P>0.83). In terms of bleedingfrequency, as well as nausea and vomiting, no significant difference was observed between the two groups. CONCLUSION: The obtained results of this study indicated that using cold liquids and foods after tonsillectomy did not have a significant effect on post-tonsillectomy pain in children. According to the findings, it is not rational to advise the mother or the child about the temperature of fluids and foods consumed post-tonsillectomy.

Comparison of Accuracy of Subjective Measurement of Tip-Supra Tip Difference During Rhinoplasty Between Plastic Surgeons.

INTRODUCTION: This study compared the subjective measurement of difference between the nasal tip and supra tip (TSD) (using eyes) versus objective measurement of TSD (by a ruler) during rhinoplastic surgery to determine the accuracy of subjective measurements among surgeons with varying degrees of experience. MATERIALS AND METHODS: In this analytical observational study, 40 cosmetic rhinoplasty candidates were involved. Those with the history of rhinoplastic surgery were excluded from the study. At the end of the operation, the surgeon was asked to estimate the TSD subjectively. The researcher, without the intervention of the surgeon, remeasured TSD by a presterile ruler. The researcher recorded both objective and subjective TSD measurements and the experience of the surgeon in rhinoplasty in the checklist. RESULT: Of 40 cosmetic rhinoplasty candidates, 17 were operated by a surgeon with >10 years' experience (group 1), and 23 by a surgeon with <5 years' experience (group 2). The results indicated that 5 surgeries (29.4%) in group 1 and 6 surgeries (26.1%) in group 2, had 0-mm difference in subjective and objective measurement. The difference of <1 mm between subjective and objective measurement was achieved in 13 surgeries (76.5%) in group 1 and 13 surgeries (56.5%) in group 2 (P = 0.191). CONCLUSION: According to the results, it can be concluded that the surgeon's experience is effective in reducing the differences in measurements of TSD in both measurement modes.

Changes in Nasal Tip and Lateral Nostril Characteristics After the Semi-Tongue-in-Groove Technique in Open Rhinoplasty Surgery.

INTRODUCTION: This study aimed to evaluate postsurgical changes of nasal tip and lateral nostril characteristics after semi-tongue-in-groove (TIG) technique in open rhinoplasty surgery. MATERIALS AND METHODS: This prospective observational study was performed in a before-after setting on 22 patients who underwent open rhinoplasty surgery using semi-TIG technique. Postoperative photographs were analyzed for nasal tip and lateral nostril changes at several time points (1, 4, and 12 weeks after surgery) and were compared with preoperative photographs. Nasal tip support change after the surgery was also assessed using a purpose-designed device. RESULTS: In total, 22 patients were studied (20 females, 2 males). The tip support increased by 98%, 291.8%, and 377% at certain time points after the surgery. The tip rotation increased significantly at all measuring time points, postoperatively. The length of upper lip increased at all time points after semi-TIG technique. Columellar show and nostril length and height decreased significantly after the surgery. CONCLUSION: The characteristics of the nasal tip and lateral nostrils along with nasal tip support showed significant improvement after the semi-TIG technique. Therefore, this technique is recommended in selected rhinoplasty cases to achieve more favorable objective results.

The relationship between endoscopic and radiologic findings and olfactory status of patients with chronic rhinosinusitis with nasal polyps before and after the endoscopic sinus surgery.

INTRODUCTION: This study was attempted to investigate the relationship between radiologic and endoscopic findings and pre- and post-operative olfactory scores in chronic rhinosinusitis with nasal polyps. MATERIALS AND METHODS: In this study, 40 patients aged 19-64 years with chronic rhinosinusitis with nasal polyps (CRSwNP) undergoing endoscopic sinus surgery were involved. The patients' olfactory status was evaluated using Smell Identification Test (Iran SIT) before and 3 months after the surgery. Patients' nasal endoscopic signs were recorded using Modified Lund-Kennedy scoring system before and 3 months after the surgery and radiological symptoms were recorded based on Lund-Mackay CT scoring before the surgery. Then the relationship between olfactory status and endoscopic and radiological findings was investigated. RESULTS: With respect to mean of olfactory score, a significant difference was observed before and after the surgery (p value = 0.001). There was a significant difference between means of pre- and post-operative endoscopy scores (p value = 0.001). Pre-operative endoscopic and CT scan scores had a negative correlation with pre- and post-operative olfactory scores (p value < 0.05). Pre-op. olfactory scores had negative correlation with post-op. endoscopy scores (p value = 0.02). Post-op. olfactory scores had negative correlation with post-op. endoscopy scores but was not statistically significant (p value = 0.22). CONCLUSION: Our results revealed that pre-operative endoscopy and radiology findings were consistent with the olfactory status of patients with CRSwNP before and after endoscopic sinus surgery.

The Effect of Spreader Graft and Mattress Suture Technique on Rhinoplasty in Patients With Nasal Hump Smaller Than 3 mm.

INTRODUCTION: Rhinoplasty is a common plastic surgery that potentially has some complications such as postoperative deformities and breathing problems. A humpy nose is among the main reasons for rhinoplasty. Nasal valve (the narrowest part of the nasal airway) collapse may be occurred after nasal hump removal. Spreader graft is essential after more than 3 mm nasal hump removal. But the value of this graft is unknown for patients with nasal hump smaller than 3 mm. Mattress suture is another technique for widening the nasal valve angle. This study compares the effects of spreader graft and mattress suture technique on postoperative deformity and nasal valve patency in patients with nasal hump smaller than 3 mm as compared with control group (no graft and suture). METHODS: In this clinical trial study 210 patients who underwent rhinoplasty with 2 different techniques involved. Their postoperative deformity and nasal valve patency were evaluated by subjective (questionnaire and digital photography) method before and after rhinoplasty during 6 months follow-up. RESULTS: Statistically, nasal obstruction had no significant difference before and after rhinoplasty and no significant difference was observed between spreader graft and mattress sutures (P > 0.05), but significantly better results than control group (P < 0.05). CONCLUSION: In this study the results of nasal valve patency of 2 techniques were similar. Because of several considerations in spreader graft technique such as needing to septoplasty in this technique even in patients without septal deviation that causes longer surgical duration, excessive blood loss, it is recommended to use Mattress suture in patients with nasal hump smaller than 3 mm.

The Role of Immunological Factors on Sudden Sensoryneural Hearing Loss.

INTRODUCTION: In this study, we examined the role of immunological factors on sudden sensory neural hearing loss (SSNHL). MATERIALS AND METHODS: This prospective case-controlled study was performed in patients with SSNHL who referred to the ear, nose, and throat (ENT) ward. Fifty-six patients with SSNHLoccurring within a 72-hr period were selected as the case group and 56 participants who had no recent history of disease were assigned to the control group. Mean levels of immunological factors including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibody (ANA), anti-neutrophil cytoplasmic antibody (ANCA) (C, P), anti-cyclic citrullinated peptide (anti-CCP), DSM, hemoglobin (Hb), complement component 3 (C3), and complement component 4 (C4) were evaluated in the blood samples in each group. RESULTS: There were 31 male and 25 female participants in the control group, while the case group had 26 male and 30 female participants. The mean age of the participants was 36.2 ± 13.4 years in the control group and 40.80 ± 13.37 years in the case group. The two groups differed significantly in terms of mean ESR, ANA, C3, C4 and monocytes, with higher levels in the case group (P<0.05). However, differences in mean CRP, anti-Ds DNA, Hb, anti-CCP, white blood cells (WBC), neutrophils, lymphocytes, eosinophils, and platelets were not statistically significant between the case and control groups (P>0.05). CONCLUSION: Because some of the immunological factors investigated in this study were significantly higher in patients with SSNHL, it can be concluded that there is an association between these immunological factors and SSNHL. Further studies are recommended to accurately determine the effect of these factors on the development of SSNHL and its treatment.

Pneumocephalus after Tympanomastoidectomy: A Case Presentation.

INTRODUCTION: Pneumocephalus is the presence of air or gas within the cranial cavity. It can occur following otorhinolaryngological procedures. A small pneumocephalus spontaneously heals without any treatment. In severe cases, conservative therapy includes a 30-degree head elevation, avoidance of the Valsalva maneuver, analgesics, osmotic diuretics, and oxygen therapy. CASE REPORT: A 56-year-old woman was referred to the emergency department due to a severe headache in the frontal area for 2 days before admission. The patient experienced nausea and vomiting in the morning and had no history of seizures or decreased consciousness. Examination of neurological symptoms was completely normal and showed no symptoms of meningeal irritation. In terms of past history, the patient had undergone tympanomastoidectomy surgery and resection of the cholesteatoma 1 week previously. The Mount Fuji sign was found on the brain computed tomography (CT) scan of the patient. Treatments such as CBR (complete bed rest), 30-degree head elevation, anti-fever, analgesics and oxygen therapy, along with anti-compulsive drug (phenytoin), were prescribed. At the end of 5 days, the patient's pneumocephalus was resolved completely. CONCLUSION: Pneumocephalus should be considered a post-operative complication of tympanomastoidectomy. In most cases, pneumocephalus responds to conservative therapy. Supplemental oxygen increases the rate of absorption of pneumocephalus. Serial imaging is needed to ensure gradual reduction of the pneumocephalus.