Frequency -Specific Air- Conduction and Bone - Conduction Outcomes after Stapedotomy.

Introduction: The aim of this study was to investigate hearing outcome of stapes surgery, considering the post-operative air and bone conduction (AC&BC) changes, in a frequency specific approach. Materials and Methods: This was a retrospective cohort study. A total of 245 ears (231 patients), who underwent Stapedotomy at our tertiary referral center in a period of 5 years were enrolled in the study. Pure tone audiometry (PTA) was evaluated preoperatively and one month postoperatively. AC, BC, and Air-bone gap (ABG) were documented. Moreover, one-year post-op PTA was also recorded for more than a quarter of the cases. Results: Overall, significant improvements were observed in AC thresholds with a mean AC gain of 20.44±13.64 dB. At higher frequencies the results were poorer (AC gain of 27 dB at 250 Hz vs 7 dB at 8000 Hz). ABG significantly improved at all frequencies after one month. BC thresholds were typically better after surgery. However, there appears to be a worsening trend in BC thresholds at frequencies higher than 2000 Hz. In 68 patients with 1-year follow-up, BC thresholds were slightly worse (but not statistically significant) at most frequencies, in comparison to the one-month results. Conclusions: Stapes surgery significantly improves air and bone conduction hearing, particularly at lower frequencies. Nonetheless, there exists a potential for sensorineural hearing loss (SNHL) at high frequencies. However, the changes are insignificant and not within the speech frequencies. Therefore, patients are typically satisfied with the hearing outcome of the surgery.

Intratympanic Steroid for the Management of Sudden Hearing Loss: Introduction of a Tapering Method.

INTRODUCTION: Sudden sensorineural hearing loss (SSNHL) is a therapeutic challenge. There are several controversies regarding the management protocol of SSNHL. This study aimed to present the results of a novel treatment algorithm, which is a combination of systemic steroids and a tapering intratympanic (IT) dexamethasone regimen. MATERIALS AND METHODS: The past 10 years' medical records of idiopathic SSNHL cases in Ghaem and Emamreza hospital, Mashhad University of Medical Sciences were evaluated. Patients were assessed using standardized methods for pure-tone threshold audiometry. The management method of SSNHL treatment included oral steroids combined with IT administration of dexamethasone once a day for 7 days and continuing it on an alternate day and then weekly basis. Patients' recovery was assessed using Siegel's criteria. RESULTS: This study included a total of 248 cases of idiopathic sudden hearing loss, with a mean age of 40.63±16.19 years. In total, 105 (42.3%) and 143 (57.7%) patients were female and male, respectively. The most common associated symptoms included tinnitus (86.9%, n=205) followed by vertigo (52.1%, n=122). The final hearing outcome of patients showed that 39 (15.7%), 38(15.3%), 86 (34.7%), and 85 (34.3%) patients underwent a complete recovery, partial recovery, slight recovery, and no recovery, based on Siegel's criteria. CONCLUSIONS: The dose, interval, and duration of IT steroid treatment were not universally approved. The treatment method designed based on a tapering of IT steroid injection in combination with already known systemic administration of steroids can be a treatment option in SSNHL patients.

Correlation between Allergic Rhinitis and Otitis Media with Effusion.

INTRODUCTION: Otitis media with effusion (OME) is prevalent among children in such a way that it is the most common cause of hearing loss and surgery in childhood. Immunoglobulin E (IgE) mediated hypersensitivity has been proposed as a causative factor in the development of OME; however, there has been contrasting data in this regard. Therefore, the present study aimed to detect the possibilities of interconnection. MATERIALS AND METHODS: In this study, 37 OME children were selected as the case group and 52 children were randomly chosen as the control group. Allergic rhinitis prevalence, serum total IgE concentration, serum eosinophil count, and nasal scraping cytology were evaluated in all the children. Furthermore, the skin prick test was performed in the OME group and suspected allergic rhinitis patients in the control group. RESULTS: Allergic rhinitis prevalence was notably higher among OME patients than in the control group (P=0.01). There were no remarkable differences in eosinophil counts and serum IgE concentrations in the two groups. Nasal smear eosinophils did not show any significant difference between the two groups; however, Appreciable difference was observed in the allergic rhinitis patients, compared to other OME patients (P=0.004). CONCLUSION: There may be a correlation between allergic rhinitis and development of OME. Therefore, it seems reasonable to examine allergic rhinitis patients for OME.

Bonding to caries affected dentine.

OBJECTIVES: Dentine replacement materials are often placed over caries affected dentine (CAD). The aim of this study was to compare the bonding characteristics and interactions of selected hydraulic calcium silicate-based dentine replacement materials to CAD and sound dentine. METHODS: Three hydraulic calcium silicate-based dentine replacement materials were assessed: Retro MTA, Biodentine and Theracal LC. Material characterization was done by scanning electron microscopy and X-ray diffraction analyses. Blocks of sound and CAD were prepared and standardized by Vickers microhardness testing. Half of the affected and sound dentine blocks were pretreated with 5.25% NaOCl prior to material placement. The materials were stored either for 1 week or 24 weeks in 37°C in fully saturated conditions. Shear bond strength was assessed at both time periods. Radiopacity of the interfacial dentine was also evaluated to assess the remineralization potential of the dentine replacement materials. RESULTS: The reaction of Theracal was slower than that of the water-based materials. The bond strengths of different materials did not differ after 1 week (P>0.05). The bond strength of Biodentine and Retro MTA increased over time but no change was observed for Theracal. NaOCl pre-treatment deteriorated the bond strength to sound dentine but improvement was observed in affected dentine. Radiopacity changes were observed after 24 weeks. SIGNIFICANCE: Biodentine and Retro MTA showed better bonding to CAD. Pretreatment with NaOCl improved the bond strength of dentine replacement materials to CAD.

Islamic Attitudes and Rhinoplasty.

INTRODUCTION: Although the psychological aspects of rhinoplasty have been fully investigated in the medical literature, the religiosity of rhinoplasty candidates has not been taken into consideration. MATERIALS AND METHODS: In this cross-sectional study, the religious attitudes of 157 rhinoplasty candidates were compared with those of 74 subjects who had not requested rhinoplasty. A domestic validated reliable questionnaire was completed by all subjects to classify them with respect to religious attitude. Other factors such as age, sex and economic and educational status were also taken into consideration. From the surgeon's perspective, subjects were put into three categories: subjects who had a relative indication for rhinoplasty (Category.1), subjects with a well-defined nose based on accepted standards of facial aesthetic analysis (Category.2) and finally subjects with a severely deformed nose, such as deviated nose or nasal cleft lip deformity (Category.3). RESULTS: The mean age among subjects was 28.63 ± 7.05 years, and the majority were female (87%). The two groups of participants (those who did and did not express a desire for rhinoplasty) were analyzed from the point view of age, sex, economic and educational status. The economic and educational status of the two groups did not differ significantly (P>0.05). The religious score showed a significant difference between those who were interested in rhinoplasty (122.75±23.49) and those were not interested (138.78±21.85; P<0.001). CONCLUSION: Religion may affect a patient's decision to undergo rhinoplasty surgery, such that persons with a higher religious attitude tend to undertake it less often. However, individuals with major nasal deformities tend to decide undertake the surgery, irrespective of religious beliefs.

Drug Induced Sleep Endoscopy in Obstructive Sleep Apnea.

BACKGROUND: One of the main challenges of surgical treatment in Obstructive Sleep Apnea (OSA) is identifying the correct site of upper airway obstruction in an individual patient. Drug-Induced Sleep Endoscopy (DISE) in sedated patients with obstructive sleep apnea is the technique of choice for revealing anatomic and dynamic collapsible areas. MATERIALS AND METHODS: In a prospective cross-sectional study adult patients with OSA documented by polysomnography were evaluated by sleep endoscopy. DISE had been done by an otolaryngologist in the setting of operating room during infusion of propofol and after the start of snoring. Endoscopic findings were recorded and evaluated from the aspect of obstruction level, severity, and multiplicity. RESULTS: Twenty OSA patients (60% men) with mean±SD age of 38.9±9.26 years and mean Body Mass Index (BMI) of 26.57 kg/m2 were included in the study. OSA was severe in 11(55%) and moderate in 5(25%) subjects. Unilevel airway collapse was observed as retropalatal in 4(20%) and retrolingual in 3(15%) subjects. Multilevel collapse had been observed in the other 13(65%) patients. Most patients (65%) had multilevel obstruction especially those with BMI>30 (p<0.05). With increasing BMI, obstruction changed from unilevel to multilevel. None of the subjects showed complications with propofol or endoscopy procedure. CONCLUSION: Our study showed DISE is safe, easy to perform, and informative in OSA patients. In particular, we observed a significant association between obesity and multilevel upper airway collapse.

Smell Decline as a good Predictor of Sinonasal Polyposis Recurrence after Endoscopic Surgery.

INTRODUCTION: To evaluate the most sensitive symptom to predict early recurrence of nasal polyposis. Prospective longitudinal cohort study. Tertiary university referral center with accredited otorhinolaryngology residency programs. MATERIALS AND METHODS: In this prospective study, we evaluated 62 patients with diffuse nasal polyposis. All patients underwent functional endoscopic sinus surgery. The author-devised questionnaire relating to the four major symptoms of chronic rhinosinusitis were answered by patients at the pre-operative visit and at 1, 3, 6, 12, and 24 months after surgery. Patients were followed up with serial endoscopic examinations, and a computed tomography (CT) scan was performed if indicated. RESULTS: All 62 patients (37 male, 25 female) completed the study. The mean age was 41.24 ± 12.47 years. All major symptoms showed significant improvement after surgery (P=0.000); however, the severity of symptoms gradually increased in patients with a recurrence of polyposis, but at different points in time (P= 0.008). Sense of smell was the first symptom to deteriorate in patients with relapse (mean, 6 months) followed by nasal secretion (12 months), obstruction and pain(24 months). Patients with asthma, Samter's triad, allergic fungal rhinosinusitis (AFRS) and allergic rhinitis showed symptoms of recurrence sooner than other patients (P<0.05). CONCLUSION: The most sensitive symptom for the early detection of recurrence of nasal polyposis is a decrease in the sense of smell. Nasal obstruction and facial pain were observed in the late stage of relapse when frank polyposis formation was established.

Comparison of Obturation Quality in Modified Continuous Wave Compaction, Continuous Wave Compaction, Lateral Compaction and Warm Vertical Compaction Techniques.

OBJECTIVES: The aim of this study was to introduce modified continuous wave compaction (MCWC) technique and compare its obturation quality with that of lateral compaction (LC), warm vertical compaction (WVC) and continuous wave compaction techniques (CWC). The obturation time was also compared among the four techniques. MATERIALS AND METHODS: Sixty-four single-rooted teeth with 0-5° root canal curve and 64 artificially created root canals with 15° curves in acrylic blocks were evaluated. The teeth and acrylic specimens were each divided into four subgroups of 16 for testing the obturation quality of four techniques namely LC, WVC, CWC and MCWC. Canals were prepared using the Mtwo rotary system and filled with respect to their group allocation. Obturation time was recorded. On digital radiographs, the ratio of area of voids to the total area of filled canals was calculated using the Image J software. Adaptation of the filling materials to the canal walls was assessed at three cross-sections under a stereomicroscope (X30). Data were statistically analyzed using ANOVA, Tukey's post hoc HSD test, the Kruskal Wallis test and t-test. RESULTS: No significant difference existed in adaptation of filling materials to canal walls among the four subgroups in teeth samples (P ≥ 0.139); but, in artificially created canals in acrylic blocks, the frequency of areas not adapted to the canal walls was significantly higher in LC technique compared to MCWC (P ≤ 0.02). The void areas were significantly more in the LC technique than in other techniques in teeth (P < 0.001). The longest obturation time belonged to WVC technique followed by LC, CW and MCWC techniques (P<0.05). The difference between the artificially created canals in blocks and teeth regarding the obturation time was not significant (P = 0.41). CONCLUSION: Within the limitations of this in vitro study, MCWC technique resulted in better adaptation of gutta-percha to canal walls than LC at all cross-sections with fewer voids and faster obturation time compared to other techniques.

Effect of Different Obturation Materials on Residual Antimicrobial Activity of 2% Chlorhexidine in Dentin at Different Time Intervals: An Ex Vivo Study.

OBJECTIVES: The aim of this study was to evaluate the effect of gutta percha/AH26 and Resilon/RealSeal SE on residual antimicrobial activity of chlorhexidine (CHX) in human root dentin and suggest the best filling material when CHX is used as final irrigant. MATERIALS AND METHODS: One-hundred and forty-four single-rooted human teeth were selected for this study. Canals were instrumented to the apical size #35. Smear layer was removed using 5.25% NaOCl and 17% EDTA and then 108 teeth were irrigated with 2% CHX and randomly divided into three groups of gutta percha/AH26, Resilon/RealSeal SE and positive controls. Each group was divided into three subgroups for different time intervals (one, three and six weeks). Thirty-six teeth, as negative controls, were irrigated with saline and obturated with gutta percha/AH26 and Resilon/RealSeal SE. Dentin powder was prepared at the afore-mentioned intervals. After exposure to Enterococcus faecalis for 24 hours, colony forming units (CFUs) were counted and residual antimicrobial activity was calculated. The data were analyzed using the Kruskal Wallis test and one-way ANOVA. The significance level was set at P<0.05. RESULTS: The antimicrobial activity of CHX gradually decreased in a time-dependent manner but it maintained over 95% of its antimicrobial activity after six weeks. Moreover, Resilon/RealSeal SE significantly decreased the antimicrobial activity of CHX in comparison with gutta-percha/AH26 (P<0.05). CONCLUSION: After a final irrigation with CHX, gutta-percha/AH26 is a better choice for root canal obturation.

INF- α and ototoxicity.

INTRODUCTION: INF- α is a common drug for the treatment of hepatitis B and C. Although a variety of related complications are discussed, possible ototoxic effects of this mediation are not well described. METHODS AND MATERIALS: In a before-after control study, 24 patients who received INF- α for the treatment of hepatitis B and C and 30 normal controls were included. Subjective and objective ototoxicity evaluations via questionnaire, high frequency audiometry, and measuring transiently evoked otoacoustic emissions (TEOAEs) were performed one week before and one month after the prescription of the drug. Results. Subjective hearing complaint, tinnitus, and vertigo were seen in just 3 cases, which was not statistically significant (P = 0.083). In the frequency range of 4000 to 8000 Hz before (9.38 ± 1.0 and 10.7 ± 1.2, resp.) and after (17.9 ± 2.6 and 17.6 ± 2.6, resp.) one month of treatment, a significant difference (P = 0.083) was detected. Progressive decreases in amplitude of the OAE during TEOAE measurement in 1, 2, and 4 frequencies among 41.66%, 18.75 %, and 43.75% were observed, respectively. The hearing loss was seen more among older and male cases significantly. Conclusion. The results showed ototoxicity of INF- α that may encourage planning hearing monitoring in patients receiving this drug.

Assessing the efficacy of citrus aurantifolia extract on smear layer removal with scanning electron microscope.

INTRODUCTION: The purpose of this study was to determine the effects of citrus aurantifolia (CA) extract on smear layer removal in different parts of root canals. MATERIALS AND METHODS: Thirty-nine single-rooted human teeth were randomly divided into three experimental (n=12) and one control (n=3) groups. Teeth were instrumented using MTwo rotary instruments. Root canals were irrigated with NaOCl during instrumentation. The canals in each group were irrigated with one of the following: completed mixture of citrus aurantifolia extracts, 17% EDTA, and alcoholic extract of CA. Distilled water was used for the control group. The irrigants were left within the canal for 20 minutes, and then rinsed with normal saline solution. Teeth were subsequently split longitudinally into 2 halves, and the canals were examined by a scanning electron-microscope. Cleanliness was evaluated using a five point scoring system. RESULTS: Statistical significant difference was found between groups (P<0.05). The smear layer was more effectively removed with 17% EDTA compared to alcoholic CA extract. However, they were both able to remove the smear layer in the coronal segment. Completed CA extract removed more smear layer in coronal and middle parts compared with the alcoholic extract (P=0.001); however, there was no significant difference in the apical part. CONCLUSION: Both of the alcoholic and completed mixtures of citrus aurantifolia extracts were not able to effectively remove smear layer compared with 17% EDTA during root canal therapy.

Antibacterial substantivity of Carvacrol and sodium hypochlorite in infected bovine root dentin.

INTRODUCTION: Various methods commonly used for cleaning and shaping root canals have not been successful in completely eradicating bacteria due to anatomic complexity and root canals irregularities. Disinfecting the canals with intracanal irrigants in addition to proper cleaning and shaping can produce a successful outcome. Antimicrobials with sustained antibacterial activity would be desirable for irrigation. The purpose of this study was to compare the antimicrobial substantivity of Carvacrol and 5.25% NaOCl in infected bovine root dentin. MATERIALS AND METHODS: One hundred and twenty dentin tubes prepared from bovine incisors were infected in vitro for 14 days with Enterococcus (E) faecalis. The specimens were divided into four groups including 1) Carvacrol, 2) NaOCl, 3) infected dentin tubes (positive control); and 4) sterile dentin tubes (negative control). Dentin chips were collected at five intervals (days 0, 1, 3, 7 and 28) using round burs with sequentially increasing diameters (which includes five layers of dentin) into Brain Heart Infusion (BHI) broth. In order to compare the pre- and post-irrigation antimicrobial activity of the irrigants the colony-forming units (CFU) were counted and classified as 'CFU-before' and 'CFU-after'. After culturing, the number of CFU with the various experimental time and dentinal layers was recounted. Two-way ANOVA test was used to analyze the effects of time and materials. One-way ANOVA and supplemental Tukey HSD test were used for pair comparison. RESULTS: CFU was significantly reduced in NaOCl group when compared to all other experimental groups (P<0.05). CONCLUSION: The substantivity of NaOCl was significantly greater than Carvacrol. Further studies are required to investigate and approve Carvacrol as a final irrigant.

The effect of Carvacrol on Enterococcus faecalis as a final irrigant.

INTRODUCTION: Sodium hypochlorite (NaOCl) is an effective antimicrobial irrigant, however its toxic effects and deterrent odor are not ideal. Carvacrol is an edible plant extract with anti-inflammatory and anti-bacterial properties that is effective against Enterococcus (E) faecalis. The aim of this study was to evaluate Carvacrol's antibacterial efficacy against E. faecalis bacteria as a final irrigant. MATERIALS AND METHODS: Forty extracted single-rooted human teeth were utilized. After mechanical preparations, samples were randomly divided into three experimental (A, B and C) and two control groups. E. faecalis was cultured in both experimental and positive control groups. After bacterial counting in all canals, 5.25% NaOCl, 0.6% Carvacrol emulsion and MTAD were used as final irrigants in groups A, B and C respectively. Data were analyzed using Kruskal-Wallis and Mann-Whitney U tests. RESULTS: There was no meaningful difference in bacterial reduction between groups A and B; however, group C showed significantly lower efficacy compared to other groups (P<0.05). CONCLUSION: The 0.6% Carvacrol disinfects root canals effectively. It also has anti-inflammatory qualities and therefore may be an acceptable alternative for NaOCl.

In vitro comparison of the effectiveness of chlorhexidine and two calcium hydroxide formulations on enterococcus faecalis.

INTRODUCTION: The aim of this in vitro study was to compare the effectiveness of three intracanal medicaments in disinfecting the root canal and dentin of experimentally infected human teeth with Enterococcus faecalis (EF). MATERIALS AND METHODS: One hundred extracted human single-rooted teeth were used. After root canal preparation, teeth were mounted in epoxy resin. Following sterilization, the teeth were infected for 28 days with EF. Then root canals were filled with one of three different disinfectants: viscous 2% Chlorhexidine (CHX), calcium hydroxide paste (CH) or a mixture of CH and CHX (n=30 in each group). Antimicrobial assessments were performed at 1, 3 and 7 days (n=10 in each time period). Microbial samples were obtained from root canals before and after the experiment. Also dentin samples were examined. The data was analyzed using Two- Way ANOVA test. RESULTS: The findings showed that there was no difference between experimental groups at different time periods. The mixture of CH/CHX in 7 days was able to eliminate EF completely from root canal system. The most elimination of EF was from dentinal tubules. CONCLUSION: According to the results of this in vitro study, viscous 2% CHX, mixture of CH with distilled water and 2% CHX are all effective disinfectants.

Cytotoxicity Evaluation of Proroot MTA, Root MTA and Portland Cement on Human Gingival Fibroblasts.

INTRODUCTION: The aim of this study was to compare the cytotoxicity of ProRoot MTA (PMTA), Root MTA (RMTA) and Portland cement (PC) on human gingival fibroblasts (HGFs). MATERIALS AND METHODS: The extracts of the test materials were placed close to human gingival fibroblasts (HGFs) within 96-well plates. Cellular viability was assessed using MTT assay in different intervals (freshly mixed, 4, 24, and 168 hours after mixing). The data were analyzed using the One-way ANOVA and Tukey's test at 95% significance level. RESULTS: It was indicated that there was not a significant difference in cytotoxicity of test materials (p>0.05). In addition, there was not a statistically significant difference between different time intervals within each group (p>0.05). CONCLUSION: PMTA, RMTA and PC showed comparative biocompatibility while evaluated in-vitro.