Journal of Isfahan Medical School (10277595)38(586)pp. 563-568
Background: Recently, spray cryotherapy has been used in otorhinolaryngology surgeries. Therefore, due to limited studies in this field, this study aimed to evaluate the effect of spray cryotherapy on tissue repair after endoscopic sinus surgery in patients with nasal polyposis, and compare this method with fluticasone and normal saline spray.Methods: In this clinical trial study, 45 patients with nasal polyps were enrolled according to the inclusion criteria of the study. Then, the patients were randomly assigned into three equal groups. The first group was treated with spray cryotherapy, the second group was treated with fluticasone spray, and the third group received normal saline spray after the operation with four puffs for each group. It should be noted that fluticasone spray was maintained for two weeks after surgery for the three groups. Subsequently, the results of this study were evaluated using Sino-nasal Outcome Test (SNOT-22) questionnaire at intervals of one and three months after the surgical operation.Findings: The mean SNOT-22 score after the surgery significantly decreased in the three groups. There was a significant difference between the three groups concerning the SNOT-22 scores at intervals of one and three months after the surgery, as the SNOT-22 score in the cryotherapy group was lower than the other groups (P < 0.05).Conclusion: Using spray cryotherapy is a safe and effective method after endoscopic sinus surgery compared to the corticosteroid and normal saline spray.
Hashemi, S.M., Berjis, N., Eshaghian, A., Nejadnic, M., Samani, A.F.
Iranian Journal Of Otorhinolaryngology (22517251)27(80)pp. 213-217
Introduction: Dacryocystorhinostomy (DCR), a popular surgical procedure, has been performed using an endoscopic approach over recent years. Excellent anatomical knowledge is required for this endoscopic surgical approach. This study was performed in order to better evaluate the anatomical features of the lacrimal apparatus from cadavers in the Isfahan forensic center as a sample of the Iranian population. Materials and Methods: DCR was performed using a standard method on 26 cadaver eyes from the forensic center of Isfahan. The lacrimal sac was exposed completely, then the anatomical features of the lacrimal sac and canaliculus were measured using a specified ruler. Results: A total of 26 male cadaveric eyes were used, of which four (16.7%) were probably non-Caucasian. Two (8%) of the eyes needed septoplasty, one (4%) needed uncinectomy, and none needed turbinoplasty. Four (16%) lacrimal sacs were anterior to axilla, one (4%) was posterior and 20 (80%) were at the level of the axilla of the middle turbinate. The mean difference of distance from the nasal sill to the anterior edge of the lacrimal sac (from its mid-height) was 39.04 (±4.92) mm. The mean difference of distance from the nasal sill to the posterior edge of the lacrimal sac (from its mid-height) was 45.50 (±4.47) mm. The mean of width and length of the lacrimal sac was 7.54 (±1.44) mm and 13.16 (±5.37) mm, respectively. The mean difference of distance from the anterior edge of the lacrimal sac to the posterior edge of the uncinate process was 14.06 (±3.00) mm, while the mean difference of distance from the anterior nasal spine to the anterior edge of the lacrimal sac (from its mid-height) was 37.20 (±5.37) mm. The mean height of the fundus was 3.26 (±1.09) mm. The mean difference of distance from the superior punctum to the fundus was 12.70 (±1.45) mm, and from the inferior punctum to the fundus was 11.10 (±2.02) mm. Conclusion: Given the differences between the various studies conducted in order to evaluate the position of the lacrimal sac, studies such as this can help to better identify the position of lacrimal sac during surgery based on ethnic differences. In addition, these studies can help novice surgeons to better navigate in a surgical scenario.
Rogha, M., Hashemi, S.M., Mokhtarinejad, F., Eshaghian, A., Dadgostar, A.
Iranian Journal Of Otorhinolaryngology (22517251)26(74)pp. 7-12
Introduction: Cholesteatoma is traditionally diagnosed by otoscopic examination and treated by surgery. The necessity for imaging in an uncomplicated case is controversial. This study was planned to investigate the usefulness of a preoperative high-resolution computed tomography (HRCT) scan in depicting the status of middle ear structures in the presence of cholesteatoma dna also to compare the correspondence between pre- and intraoperative CT findings in patients with cholesteatoma. Materials and Methods: This prospective descriptive study was performed from January 2009 to May 2011 in 36 patients with cholesteatoma who were referred to the Kashani and Al-Zahra Clinics of Otolaryngology. Preoperative high-resolution temporal bone CT scans (axial and coronal views) were carried out and compared with intraoperative findings. Results: Evaluation of 36 patients and their CT scans revealed excellent correlation for sigmoid plate erosion, widening of aditus, and erosion of scutum; good correlation for erosion of malleus and tegmen; moderate correlation for lateral canal fistula (LCF) and erosion of mastoid air cells; and poor correlation for facial nerve dehiscence (FND), incus, and stapes erosion. Conclusion: A preoperative CT scan may be helpful in relation to diagnosis and decision making for surgery in cases of cholesteatoma and ossicular erosion. The CT scan can accurately predict the extent of disease and is helpful for detection of lateral canal fistula, erosions of dural plate, and ossicular erosions. However it is not able to distinguish between cholesteatoma and mucosal disease, facial nerve dehiscency, incus, and stapes erosion.
Najafizade, N., Hemmati, S., Gookizade, A., Berjis, N., Hashemi, S.M., Vejdani, S., Ghannadi, A., Shahsanaee, A., Arbab, N.
Journal Of Research In Medical Sciences (17357136)18(2)pp. 123-126
Background: Taste abnormalities are common among cancer patients after starting radiotherapy or chemotherapy. Considering the role of zinc and reports on its beneficial effects in taste perception, we evaluated the preventive effects of zinc sulfate on radiation-induced taste alterations. Materials and Methods: In a randomized, placebo-controlled trial, adult patients with head and neck cancers who were on schedule for radiotherapy, with or without chemotherapy, were allocated to receive zinc sulfate (50mg, three times a day) or placebo; started with beginning of radiotherapy and continued for one month later. Taste acuity was determined by measuring detection and recognition thresholds for four taste qualities at baseline, at the end of radiotherapy, and a month later using the Henkin method. Results: Thirty-five patients (mean age = 59.2 ± 16.5, 60% male) completed the trial. The two groups were similar at baseline. After radiotherapy, and one month later, there was a significant increase in taste perception threshold for bitter, salty, sweet, and sour tastes in the placebo group (P = 0.001). In those who received zinc, there was only slight increase in threshold for perception of the salty taste (P = 0.046). No relevant side effects due to zinc sulfate were reported. Conclusion: Zinc supplementation in head/neck cancer patients under radiotherapy can prevent radiation-induced taste alterations. Further studies with longer follow-ups and with different doses of zinc supplementation are warranted in this regard.
Abtahi, S.M., Hashemi, S.M., Abtahi, S.H., Bastani, B.
Journal Of Research In Medical Sciences (17357136)18(5)pp. 400-404
Background: Botulinum toxin A (BTA) is a promising therapeutic option in the treatment of allergic rhinitis (AR). Although recent studies have introduced BTA septal injection as an alternative method, the conventional localization for the injection of BTA in patients with AR is still the nasal turbinates. This study was designed to compare the effectiveness and safety of septal BTA injection with turbinal BTA injection in patients with AR. Materials and Methods: This open-label study was performed on 50 patients with AR who were randomly allocated to septal and turbinal BTA injection groups. All patients received an injection of 40 U of BTA (Dysport®, Ipsen Ltd, Maidenhead, UK) in each side of the nose and were followed for 8 weeks. Prior to the intervention and 8 weeks later, symptom severity and quality of life scores were calculated using the AR symptom severity and Rhinasthma questionnaires respectively. Results: Comparison of pre- and post-treatment symptom severity scores within each group showed a significant reduction of total symptom severity score and severity of sneezing, rhinorrhea, and congestion in both groups (P < 0.05). However, post-treatment sysmptom severity scores were not significantly different between two groups (P > 0.05). Both methods have improved the quality of life of subjects significantly (P < 0.05). Significantly more patients in the turbinal injection group reported adverse effects (four patient's vs. one, P < 0.05). Conclusion: Although both septal and turbinal BTA injections are effective on patients with AR, septal administration of BTA could be safer and easier method. However, further investigations are required to achieve more accurate results.
Barati, B., Abtahi, S.H., Hashemi, S.M., Okhovat, A., Poorqasemian, M., Tabrizi, A.G.
Journal Of Research In Medical Sciences (17357136)18(2)pp. 99-102
Background: Considering the presence of squamous epithelial cells and fibroblasts in the tympanic membrane (TM), topical estrogen application may influence the repair of TM perforations. Therefore, this study was designed to investigate the healing effect of topical estrogen on chronic TM perforations and improvement in hearing threshold. Materials and Methods: Sixty patients were enrolled in a randomized clinical trial. Thirty patients were treated with paper patch and 30 with estrogen-impinged paper patch. Complete closure of the TM perforation and hearing threshold were evaluated in both groups. Chronic unilateral perforations of the TM involving less than 40% of the total area of the TM without active disease in the middle ear were selected. The margin of the perforation was chemically trimmed using 15% trichloroacetic acid and patching performed under an operating microscope. Microscopic examination was performed after 14days and repeated after 30days. Complete closure of the TM perforation was considered as successful repair. Hearing threshold was determined before the start of the trial and 30days after treatment. Results: No significant difference was found between the two groups after 14days in complete closure of the perforation (P=0.310). After 30days, patients treated with estrogen-impinged paper patch showed a significantly higher rate of closure of the perforation (63.4%) and improvement in hearing threshold (P=0.017). Conclusion: Topical estrogen may have a healing effect on chronic TM perforations and improvement in hearing threshold.
Iranian Journal Of Otorhinolaryngology (22517251)24(69)pp. 181-186
Introduction: To study the long-term complications of tympanostomy tube insertion in young children 10 years after surgery. Materials and Methods: In September 2011, the medical records of all patients who had undergone myringotomy with tympanostomy tube insertion between February 2000 and March 2001 at the two general hospitals of Isfahan University of Medical Sciences were studied. Of the 98 patients who fulfilled the inclusion criteria, 82 patients agreed to participate and were enrolled in the study. The complications of the operation were evaluated in these patients. Results: Of the 164 ears that were operated on, myringosclerosis was found in 17.1%, atrophy of the tympanic membrane in 1.2%, permanent perforation of the tympanic membrane in 0.6% and tympanic membrane atelectasis in 0.6%. None of the patients developed cholesteatoma as a complication of tympanostomy tube insertion. Conclusion: Considering the low risk of serious complications after 10 years, tympanostomy tube insertion is a safe and effective treatment option in the treatment of otitis media with effusion.
Moafi, A., Rahgozar, S., Ghias, M., Ahar, E.V., Borumand, A., Sabbaghi, A., Sameti, A., Hashemi, S.M.
International Journal Of Preventive Medicine (20088213)2(4)pp. 280-285
Objectives: Obesity and increased blood pressure are identified as risk factors for cardiac and pulmonary disorders. On the other hand, iron deficiency (another preventable disease) is common in adolescence and considered as associated with health impairment. The present study evaluates body mass index (BMI) and its association with blood pressure and hematological indices in freshman students entering the University of Isfahan in 2009. Methods: All the 1675 students who entered the University of Isfahan in September 2009 were examined. Height, weight, BMI, blood pressure, hemoglobin (Hb) and red blood cell (RBC) indices of these students were measured. The prevalence of high blood pressure, its association with BMI and the relation between BMI and anemia, iron deficiency and educational achievement were assessed. Results: All participants, including 514 males and 1161 females, went under clinical observations. The average age was 20.7 ± 3.8. year Among the students, 18.2% of males and 20% of females were underweight. High systolic blood pressure was more common in the students with BMI > 25 kg/m2 (p < 0.001). Anemia was seen in 8.7% of females. In males, however, a relation between anemia frequency and BMI < 18.5 kg/m2 was more distinct (p = 0.002). There was no association between anemia and students' average test scores. Conclusions: High incidence of abnormal BMI in the study population, and its association with systolic blood pressure indicate the importance of nutritional guidelines and counseling programs for freshman students. On the other hand, high incidence of anemia in this population ascertains the necessity of anemia screening programs before academic studies.
Hashemi, S.M., Mokhtarinejad, F., Karim, M., Okhovat, S.H.
Journal Of Research In Medical Sciences (17357136)16(1)pp. 74-78
BACKGROUND: Recurrence of nasal polyposis following surgical intervention is very common. Antifungal therapy has been an appealing alternative to reduce its recurrence and severity. Early studies showed definite positive response, but recent studies have raised doubts about its efficacy in treatment of polyposis. METHODS: This prospective case-control clinical trial was conducted on 50 patients suffering from nasal polyposis in Isfahan university of medical sciences. All patients underwent functional endoscopic sinus surgery. CT scanning of paranasal sinuses was done preoperatively and 6 months postoperatively to stage the disease. Patients were assigned to two groups: amphotericine B group were instructed to irrigate the nasal cavity with a solution of amphotericine B, while the normal saline group used the physiologic normal saline for 6 months. RESULTS: 68% of patients in Normal saline and 84% of cases in amphotericine B group reported history of allergies. In amphotericine B group, stage of the disease improved in 84% of patients and remained unchanged in the rest. In normal saline group, imaging stage improved in 22 patients and remained unchanged in 3. The two cohorts were compared for reduction in imaging stage and no significant difference was found between them. CONCLUSIONS: This study showed no benefits for topical amphotericin B solution over normal saline. It might be better to retreat to the traditional normal saline nasal douching following functional endoscopic sinus surgery in the treatment of polyposis.
Barati, B., Omrani, M.R., Okhovat, A., Kelishadi, R., Hashemi, S.M., Hassanzadeh, A., Abtah, M., Omidifar, N., Okhovat, H.
Journal Of Research In Medical Sciences (17357136)16(4)pp. 509-515
Background: Antimicrobials treatment of Otitis media (OM) reduces some complications, but some of chronic complications, and specially otitis media with effusion (OME), seem to increase. Theoretically the usage of nasal corticosteroid sprays may prevent this problem by reducing the local inflammation around the eustachian tube. So, this study aimed to evaluate the role of nasal corticosteroid spray as an adjuvant for the treatment of OME. Methods: In a randomized, prospective clinical trial, 2 groups of 46 subjects who had OME were recruited. A questionnaire containing patients' characters, history, complaints, otologic examinations, and the report of tympanometries was filled for all before and after treatment. We administered a period of amoxicillin and a decongestant for both group and nasal beclomethasone spray only for case group. Results: Thirty five of cases (76.1%) and 22 (47.8%) of controls had an improvement in their symptoms or the quality of hearing (p = 0.005). Partial remission was the most common finding in 52.2% of the patients in the case group but for control group there was no change (p = 0.024). The higher improvement in the tympanic retraction in the case group was significant (p < 0.05). A significant better tympanometric result has showed in the treatment of left ear in the patients of the case group (p = 0.038) but not for right ear (p = 0.136). Conclusions: We concluded that the administration of nasal beclomethasone spray as an adjuvant for the treatment of OME not only improved the results treatment but also increased the resolution of symptoms and the patients' quality of hearing.
Journal Of Research In Medical Sciences (17357136)16(12)pp. 1590-1597
BACKGROUND: The aim of this study was to compare the efficacy of azithromycin vs. fluticasone in treatment of adenotonsillar hypertrophy (AH). METHODS: In a clinical trial, 39 AH patients were selected using a convenient time-based sequential sampling method. The subjects were randomized into two treatment groups. Patients in group A (fluticasone) and B (azithromycin) were respectively treated with fluticasone spray and azithromycin suspension for a 6-week period. Data regarding the grade of obstruction (based on tonsillar size), level of adenotonsillar hypertrophy, and obstructive sleep apnea (OSA) symptoms (including mouth breathing, snoring, hyponasal speech, and sleep apnea) were collected by a self-administrated questionnaire before treatment, as well as 1 week and 8 weeks after treatment. RESULTS: Twenty AH patients in group A and 19 AH patients in group B were studied. AH related symptoms, including mouth breathing, snoring, hyponasal speech and sleep apnea, improved significantly in both groups (p < 0.05). We also found a statistically significant reduced grade of obstruction among patients in both groups. However, fluticasone was not effective on adenotonsillar hypertrophy. One week after treatment, outcomes related to apnea and hyponasal speech were better in group B than group A. Decreases in mouth breathing and snoring were not significantly different between group A and B. CONCLUSIONS: It could explain that though both of the improved and mentioned symptoms comparing within initial status, Azithromycin seems to be more effective than fluticasone in improving AH-related symptoms. Short term efficacy of the antibiotic is much significant than its long term effect.
Amiridavan, M., Nemati, S., Hashemi, S.M., Jamshidi m., M., Saberi, A., Asadi, M.
Journal Of Research In Medical Sciences (17357136)11(4)pp. 263-269
Background: Sudden sensorineural hearing loss (SSNHL) is a perplexing condition for patients and there are many controversies about its etiology, audiologic characteristics, prognostic factors, and treatment. Methods: In this prospective study, we performed some audiologic tests, including PTA, IA, ABR, and OAE (TEOAE) before beginning treatment of 53 patients with SSNHL. We assigned the patients randomly to two treatment groups: oral steroids + acyclovir vs. intravenous urographin. Twenty-eight patients underwent Magnetic Resonance Imaging (MRI) of the Brain. Results: Of 53 patients (22 female and 31 male), 22 (41.5%) had negative or no signal to noise ratio and overall correlation in TEOAE. Twenty-six patients (49%) had positive overall correlations less than 50%, and 5 patients (4.4%) had overall correlations >50%. Fifteen patients (28.3%) responded completely or well, 20 (37.7%) responded partially, and 18 (33.9%) had poor or no response to the treatment. The mean values for overall correlation in 3 subgroups of patients (no response, partial response, and complete response) were - 3.5% (± 1/16%), +11% (± 1/ 99%), and +36.6% (± 3/07%), respectively (P = 0.01). Twenty out of 52 patients had no reproducible wave in ABR (38.5%), and waves I, III, and V were absent in 40 (77%), 31 (59.6%) and 21 (40%) patients, respectively. There were some limitations (false positive and false negative results) in ABR use in our cases, but it may be useful in detecting site of lesion in SSNHL. Overall, according to the results of OAE, ABR, and brain MRI of these patients, 3 were affected by acoustic neurinomas, at least 1 had auditory neuropathy, and the site of lesion was cochlear in 6, and cochlear + retrocochlear in 13 patients. Conclusions: ABR has limitations for use in SSNHL and seems not to obviate the need for brain MRI, but may help in determining the site of lesions such as ischemia or neuropathy. Overall correlation (and S/N ratio) in TEOAE is a valuable prognostic factor in SSNHL, hence we recommend performing TEOAE in every patient with SSNHL.
Journal Of Research In Medical Sciences (17357136)10(1)pp. 10-15
Background: Lateral osteotomy is a major part of rhinoplasty for remodeling external facet of the nose and narrowing of nasal base and dorsum after removal of the hump. There are two techniques for lateral osteotomy known as external and internal. Each of these provide advantages and impose limitations. The purpose of our study was to compare the severity of postoperative edema and ecchymosis between internal and external osteotomy techniques. Methods: This study was designed as a clinical trial on 30 cases. With randomization, one side of the nasal bone was selected for internal approach, and the other side, for external approach. Then, on the 1st and 7th days after surgery, the patients were scored for the severity of edema and ecchymosis. Results: On the first day after surgery, not only edema, but also ecchymosis was lower with the external osteotomy than with the internal approach (P = 0.037, P = 0.002, respectively). The severity of ecchymosis, on the 7th postoperative day, was lower with the external approach, and the difference was significant (P = 0.011). The severity of both edema and ecchymosis on the first postoperative day was evaluated higher in females, with statistically significant differences (P = 0.05 for edema and P = 0.003 for ecchymosis). The extension of ecchymosis on the 7th postoperative day was higher in women (P = 0.05). There were no significant differences between the two approaches in medialization of the involved bones and no apparent asymmetries either. Conclusion: According to the results of this study, external osteotomy seems to be the approach of choice, provided that the surgeon has enough experience in doing it.
Journal Of Research In Medical Sciences (17357136)10(3)pp. 167-171
Background: The purpose of this study was microbiology of chronic resistant rhino sinusitis with or without nasal polyp in patients undergoing functional endoscopic sinus surgery and antimicrobial resistance testing. Patients and methods: In a cross-sectional study during December 2000 to June 2002, 94 CRS patients with or without nasal polyp were sampled through FESS for microbiology culture and In-vivo antimicrobial resistance was tested in both groups. Results: In CRS group with polyps (42 patients), the most common isolated organisms were Staph. coagulase-negative (26.2%), Staph. areous (23.8%), E-Coli (16.7%), Klebsiella (14.3%) and Enterobacter (7.1%). In CRS group without polyps (52 patients), the most common isolated organisms were Staph. coagulase-negative (25%), Staph. areous (11.5%), Klebsiella (9.6%), E-Coli (7.7%) and Strep. Non-group A (7.7%). Normal flora grew in 5 cultures (9.6%). In only one culture of CRS group without polyp, Pseudomonas was isolated. No resistance was reported from gram-positive bacteria against vancomycin and gram-negative rods were sensitive to ciprofloxacin, ceftriaxon and ceftizoxim. Conclusion: Despite of some previous studies, the most common micro- organisms in the cultures of CRS cases, regardless of having nasal polyps or not, were Staph. coagulase-negative, Staph. aureus and gram-negative rods, respectively. The incidence of GNRs in CRS group with nasal polyps is higher which may lead to special antibiotic therapy in them. Increasing In Vivo resistance of these bacteria to antibiotics is problematic and the routine old antimicrobial therapy may not be effective enough to control these pathogens and avoid surgical therapy. However, In Vivo evaluations are recommended to reveal a better interpretation.
Jabalameli, M., Hashemi, S.M., Soltani h., , Hashemi j.,
Journal Of Research In Medical Sciences (17357136)10(1)pp. 25-30
Introduction: The antihypertensive drug, clonidine, is a centrally acting alpha 2 agonist, useful as a premedication because of its sedative and analgesic properties. We examined the effect of clonidine given as an oral premedication in producing a bloodless surgical field in patients undergoing endoscopic sinus surgery. We also evaluated the relation between bleeding volume and consumption of fentanyl and hydralazine to control hypotension. Methods: This prospective double - blinded clinical trial was performed on 113 patients (ASA I, ASA II). Fifty-two patients received oral clonidine (5, μ g/kg) while the other 61 patients received placebo. During general anesthesia, the hemodynamic endpoint of the anesthetic management was maintenance of hypotension (MAP) at 70 mmHg for producing a bloodless surgical field. The direct control of MAP was attained with inspired concentration increments of halothane up to maximum of 1.5 vol % as needed. When it was unsuccessful, an intravenous fentanyl bolus of 2, μ g/kg was also added. When both drugs failed, hydralazine, was given intravenously as a bolus and intermittently, 0.1mg/kg up to a maximum dose of 40 mg. Intraoperative bleeding was assessed on a six - point scale from 0 (= no bleeding) to 5 (= severe bleeding). Data were compared with chisquare test, fisher's exact test and Student t-test. Results: There was less bleeding volume in the clonidine group (mean ± SD) than in the placebo group (144 ± 75 Vs 225 ± 72 ml, P<0.05). Frequency of bleeding severity scores 3 and 4 (troublesome with repeated suction) were lower in the clonidine group than in the placebo group (12% Vs 35%, P< 0.05). Fentanyl requirement was significantly lower (112 ± 18 Vs 142 ± 21 μ g, P < 0.05) in the clonidine group. Hydralazine requirement was significantly lower (0.45 ± 1.68 Vs 2.67 ± 4.33 mg, P<0.05) as well. Conclusion: Premedication with oral clonidine reduces bleeding in endoscopic sinus surgery and also decreases fentanyl, and hydralazine consumption for controlling hypotension.
Journal Of Research In Medical Sciences (17357136)10(6)pp. 381-383
Background: One of the most common techniques of nasal tip surgery in rhinoplasty is conservative resection of cephalic portion of nasal alar cartilage; although, there is a controversy about its effectiveness on nasal tip rotation in textbooks and articles. Therefore, in this research, we have studied the effect of conservative resection of cephalic portion of alar cartilage on nasal tip rotation. Methods: 35 patients were selected from the patients who were candidates for septoplasty, after getting their agreement. In surgery we performed conservative resection of cephalic portion of alar cartilage. Nasolabial angles were calculated, using the lateral photographs of the patients before and six monthes after surgery. The means of these angles were analyzed with t-paired test. Results: The means and standard deviations of nasolabial angles before and six months after surgery were 91.49±7.35 and 91.57±7.04, respectively. Calculated P-value was 0.52. Conclusion: There was no meaningful difference between means of nasolabial angles before and six months after surgery (P-value was greater than 0.05). Therefore, in this research we concluded that conservative resection of cephalic portion of alar cartilage has no effect on nasal tip rotation.
