Publication Date: 2023
Advanced Biomedical Research (22779175)12(1)pp. 29-29
Background: Nasal polyp (NP) is the most common benign tumor that can cause nasal obstruction and more annoying problems in patients. Recently, investigators have been focusing on complementary therapies alone or in conjunction with endoscopic nasal and sinus surgery. However, given the association of Vitamin D (VD) deficiency and chronic rhinosinusitis with nasal polyposis (CRSwNP) in previous studies, it may be possible to prevent the recurrence of NP and the development of rhinosinusitis by controlling serum levels of VD and maintaining it at a normal level. The current study aimed to investigate the efficacy of VD supplementation in preventing CRSwNP recurrence after endoscopic surgery. Materials and Methods: This clinical trial composed of vitamin D deficient patients with CRSwNP who were candidates for endoscopic sinus surgery in two groups of cases and controls. After endoscopic sinus surgery for all patients, we administered VD supplementation (50,000 IU) once a week for 8 weeks for cases and no further intervention for controls. The severity of symptoms was assessed using Sino-nasal outcome test (SNOT-22) and NP recurrence and recorded pre- and postintervention. Results: The findings indicated a higher mean change of SNOT-22 in the case group compared to that of the control group (36.03 ± 10.71 vs. 29.90 ± 11.99; P = 0.041). Moreover, the percentage of NP recurrence in cases was lower than controls; so that receiving VD supplementation has significantly reduced the chance of NP recurrence (odd ratio [95% confidence interval]: 0.298 [0.099-0.900]; P = 0.032). Conclusion: According to the result of the study, the administration of VD supplementation after endoscopic sinus surgery can reduce the severity of CRSwNP symptoms and NP recurrence significantly. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
Publication Date: 2020
European Journal of Plastic Surgery (0930343X)43(2)pp. 153-158
Abstract: Background: Psychological functioning of rhinoplasty must be evaluated in the community of Iran as the most prevalent center of rhinoplasty worldwide. Making a realistic public view about rhinoplasty psychological outcomes is necessary. In the present study, quality of life, anxiety, depression, and self-esteem alteration in rhinoplasty patients among the Iranian population were assessed. Methods: This is an observational trial study conducted on 41 patients who underwent rhinoplasty in 2017–2018. The Persian version of standard questionnaires “World Health Organization Quality of Life (WHOQOL-26),” “Hospital Anxiety and Depressive Scale (HADS),” and “Eysenck Self-Esteem Questionnaire” were used for this aim. Therefore, questionnaires were filled pre and within 6 months postoperatively and then compared. Demographics including age, gender, marital status, and educational level association with the mentioned factors were assessed as well. Results: The results revealed that rhinoplasty brought significant improvements in all aspects of QOL, including physical (P value = 0.011), psychological (P value = 0.002), relationships (P value = 0.019), environment (P value = 0.032), and general health (P value = 0.005). Depression (P value = 0.010) and self-esteem (P value = 0.004) scores change significantly in a positive manner as well. Anxiety improvement was the least (6.8%) with no significant change (P value = 0.334). None of the demographics including age, gender, marital status, and educational level showed association with psychological indices (P value > 0.05) except for age association with relationships domain of WHOQOL that was significantly higher among those younger than 30 years old (P value = 0.040). Conclusions: Rhinoplasty can improve most of the psychological indices in the Iranian population, regardless of the candidate’s gender, marriage status, educational level, or age group. Level of evidence: Level II, therapeutic study. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
Publication Date: 2019
International Journal Of Preventive Medicine (20088213)10(1)
Background: Tongue cancer is the most common malignancy of the mouth. In recent decades, reported tongue cancer incidence and mortality rates have increased all over the world while survival has not improved that sometimes is related to mutation, especially in gene P53 (such R249, R248 mutations). Hence, this study aimed to identification of R249 mutation in P53 gene of tumor tissue in tongue cancer. Methods: In a cross-sectional study, 48 patients with squamous cell carcinoma (SCC) of tongue were selected, and mutation of R249 was investigated in sample of tumors. In addition, demographic data and medical history of patients were determined and registered in a collected data form. Finally added data were entered to computer and analyzed by SPSS software. Results: Polymerase-chain reaction test done on tissue samples from cancer patients showed that in a studied sample of 48 patients, 4 of them (8.3%) had R249 mutation. After selecting the codon 249 as a hotspot in oral cancer, forward and reverse primers for amplification of exon 7 were obtained from the articles. Conclusions: Considering the findings of our study, R249 mutation in P53 gene in patients with SCC is relatively high. Age and alcohol consumption were factors affecting incidence of the mutation. It is necessary to take an early treatment with a single lesion of tongue to prevent severe disease and prevent disease in patient's family with screening test and prevent cancer in future with gene therapy. © 2019 Wolters Kluwer Medknow Publications. All rights reserved.
Publication Date: 2017
Journal Of Research In Medical Sciences (17357136)22(2)
Background: Fungal sinusitis is increasing worldwide in the past two decades. It is divided into two types including invasive and noninvasive. Noninvasive types contain allergic fungal sinusitis (AFS) and fungus ball. AFS is a hypersensitivity reaction to fungal allergens in the mucosa of the sinonasal tract in atopic individuals. The fungus ball is a different type of noninvasive fungal rhinosinusitis which is delineated as an accumulation of debris and fungal elements inside a paranasal sinus. Fungal sinusitis caused by various fungi such as Aspergillus species, Penicillium, Mucor, Rhizopus, and phaeohyphomycetes. The aim of the present study is to identify fungal species isolated from noninvasive fungal sinusitis by molecular methods. Materials and Methods: During 2015–2016, a total of 100 suspected patients were examined for fungal sinusitis. Functional endoscopic sinus surgery was performed using the Messerklinger technique. Clinical samples were identified by phenotypic and molecular methods. Polymerase chain reaction (PCR) sequencing of ITS1-5.8S-ITS2 region and PCR-restriction fragment length polymorphism with MspI restriction enzyme was performed for molecular identification of molds and yeasts, respectively. Results: Twenty-seven out of 100 suspected cases (27%) had fungal sinusitis. Nasal congestion (59%) and headache (19%) were the most common clinical signs among patients. Fifteen patients (55.5%) were male and 12 patients (44.5%) were female. Aspergillus flavus was the most prevalent fungal species (26%), followed by Penicillium chrysogenum (18.5%) and Candida glabrata species complex (15%). Conclusion: Since clinical manifestations, computed tomography scan, endoscopy, and histopathological findings are very nonspecific in AFS and fungus ball; therefore, molecular investigations are compulsory for precise identification of etiologic agents and appropriate management of these fungal infections. © 2017 Journal of Research in Medical Sciences.
Publication Date: 2017
Journal Of Research In Medical Sciences (17357136)22(1)
Background: This study was designed to determine the prevalence of concomitant anatomic variation of paranasal sinuses in patients with antrochoanal polyp (ACP). Materials and Methods: Among patients referred by their clinicians for standard computed tomography scan of paranasal sinuses septal deviation, concha bullosa, and retention cyst were evaluated in both patients with ACP as well as in a control group. Results: Of the 17 patients with ACP, fifteen patients (88.2%) had septal deviation and two patients (11.8%) had concha bullosa. None of the patients with ACP had retention cyst or hypertrophic turbinate. Of the 78 patients in control group, twenty‑nine (37.2%) had septal deviation, six (7.7%) had concha bullosa, seven (8.9%) had retention cyst, and one (1.2%) had hypertrophic turbinate. Septal deviation in patients with ACP has higher incidence (P < 0.001). Conclusion: This study showed that septal deviation is an anatomic variation which is significantly concomitant with ACP. Larger studies are needed to show the role of other anatomic variations in patients with ACP. © 2017 Journal of Research in Medical Sciences.
Publication Date: 2017
International Journal Of Preventive Medicine (20088213)8
Background: Tinnitus is the perception of noise or ringing without external acoustic stimulants which affects almost 10% of general population. Many therapies have been recommended including diet modifications, herbal remedies, and chemical drugs. Most common utilized drugs for tinnitus are melatonin and antidepressants such as sertraline which have been proven in different studies. In this study, we aimed to compare the efficacy of melatonin and sertraline in treating tinnitus for the first time. Methods: In this clinical trial, 70 patients with tinnitus according to inclusion and exclusion criteria were included and randomly divided into two groups: melatonin group, taking melatonin 3 mg once daily and sertraline group taking sertraline 50 mg once daily, all treating for 3 months. Before and after treatments, every patient received Tinnitus Handicap Inventory (THI) questionnaire and severity of tinnitus was assessed, and data analysis was performed. Results: Before treatments, the mean of THI score for melatonin and sertraline groups were 45.02 ± 17.67 and 44.85 ± 20.57, respectively. There was no significant difference between both groups THI score (P = 0.23). After 3 months, the mean of THI scores for melatonin and sertraline groups were 30.29 ± 19.62 and 36.96 ± 25.03, respectively which the mean of THI scores in two groups was decreased significantly (P < 0.01, for‑both). In addition, indicated the significant decline in THI score of melatonin group who were under treatments with melatonin 3 mg once daily (P = 0.02). Conclusions: Here in this clinical trial, we demonstrated that both melatonin and sertraline are efficient in treating tinnitus, but the usage of melatonin 3 mg once daily is more effective. © 2017 International Journal of Preventive Medicine.
Publication Date: 2015
Iranian Journal Of Otorhinolaryngology (22517251)27(5)pp. 395-399
Introduction: Aneurysmal Bone cysts (ABC) are extremely rare in the head and neck region and even rarer in sinuses. ABC is a benign multicystic mass that is locally-destructive and rapidly expandable. Hemorrhagic fluid content (like in this case) and septated appearance are the characteristic feature of ABC. Established treatment options for ABCs include sclerotherapy, embolization, radiotherapy, simple curettage, surgical excision, or a combination of methods. Case Report: In this article, a 5 year-old boy with a recurrent nasal mass is presented. The patient was finally diagnosed with this rare entity: ABC of the paranasal sinuses. The patient was treated through complete surgical removal. Conclusion: ABC can be considered as a rare differential diagnosis of recurrent nasal hemorrhagic mass in a pediatric population. © 2015 Mashhad University of Medical Sciences. All rights reserved.
Publication Date: 2015
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.
Publication Date: 2014
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.
Publication Date: 2013
Allergology International (14401592)62(2)pp. 245-249
Background: There are few reports on the effects of intranasal Botulinum Toxin-A (BTX-A) as a treatment of allergic rhinitis (AR). In this study, we compared the efficacy of intranasal BTX-A to cetirizine in the treatment of AR. Methods: Fifty AR patients at the age of 26.2 ± 9.1 years (64% females), were recruited to the trial according to the Allergic Rhinitis and its Impact on Asthma (ARIA) criteria. Participants randomly received either intranasal injection of BTX-A (75 IU Dyspor® or cetirizine (10 mg/day). Symptoms (based on the ARIA) and side effects were assessed every two weeks for two months. Quality of life was evaluated before and after the study using the Rhinasthma questionnaire. Results: Total symptom severity score of patients significantly decreased (P < 0.001) and quality of life signifi-cantly improved (P < 0.001) at the same level in both groups. Side effects included nasal dryness (4%) and epistaxis (4%) in the BTX-A group. In the cetirizine group 44% sleepiness and 4% blurred vision was reported. Conclusions: Nasal injection of BTX-A shows the same therapeutic effects as cetirizine in the management of AR. Since BTX is expensive, we do not suggest it in the first line of treatment for AR. However, BTX-A is a potential treatment for patients who are resistant or not compliant to the routine medications of AR. Further studies are required to investigate implications and limitations of BTX-A in the treatment of AR. © 2013 Japanese Society of Allergology.
Publication Date: 2013
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.
Publication Date: 2013
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.
Publication Date: 2013
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.
Publication Date: 2012
Iranian Journal Of Pediatrics (20082150)22(1)pp. 92-96
Objective: Thyroid hormone is necessary for normal development of the auditory system. The aim of this study was to investigate the rate of hearing impairment in congenitally hypothyroid (CH) patients, and its relation with factors such as CH severity and age at starting treatment, during CH screening program in Isfahan. Methods: Hearing acuity was assessed in two groups of children with (94 patients aged 4 months - 3 years) and without CH (450), between 2000-2006. Otoacostic emission (OAE) was performed by a two step method. After two tests without OAE signals bilaterally, they were referred for auditory brainstem response (ABR) test. Subjects with both OAE and ABR abnormal test results were considered to have hearing problem. Obtained data was compared in case and control group and also CH patients with and without hearing impairment. Findings: Three (3.2%) of patients and 1 of control group (0.2%) were diagnosed with sensorineural hearing loss. The rate of hearing loss was not different significantly in two studied groups (P>0.05). There was no difference between age of starting treatment and first T4 and TSH level in CH patients with and without hearing loss (P>0.05). CH neonates with hearing impairment had thyroid dyshormonogenesis according to the follow up results. Conclusion: The rate of hearing loss was low among our studied CH patients. It may be due to proper management of CH patients. In view of the fact that all CH neonates were dyshormonogentic and considering the relation between certain gene mutations and hearing impairment in CH patients, further studies with larger sample size, with regard to different etiologies of CH should be investigated to indicate the possible gene mutations related to hearing loss in CH. © 2012 by Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, All rights reserved.
Publication Date: 2012
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.
Publication Date: 2011
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.
Publication Date: 2011
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.
Publication Date: 2011
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.
Publication Date: 2011
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.
Publication Date: 2010
Journal of Isfahan Medical School (10277595)27(103)
Background: We report the diagnosis, treatment and follow–up process of 22 cases of fungal sinusitis. Methods: This case- series study was carried out on 22 patients with fungal sinusitis that had treatment of endoscopy and antifungal drug. Past medical history, pathology, CT scan findings and treatment of patients were evaluated. Data analysis was done using SPSS. Findings: Twelve male (57%) and 10 female (43%) patients with the age of 16-73 years were a ssessed. Mucormycosis was seen in 18 (82%) and Aspergilosis in 4 (18%) patients. Diabetic mellitus (71%), chronic renal failure (CRF) (14.3%), and leukemia (9.6%) were reported as the most common underlying diseases. Maxillary and etmoid sinuses were the site of involvement. The most common sign was unilateral periorbital edema and proptosis (95%), and the most common symptom was unilateral change of visual acuity and cheek sensation (95%). All the patients had endoscopy surgery and treated with amphotricine B or ithraconazole and ceftrinaxone, metronidazole and vancomycine. Death was reported in 5 patients (22%) and renewed functional endoscopic sinus surgery (FESS) in 1 (4.8%). Conclusion: Functional endoscopic sinus surgery with amphotncine B or ithraconazole and follow-up are effective for fungal sinusitis. © 2010, Isfahan University of Medical Sciences(IUMS). All rights reserved.
Publication Date: 2009
Journal of Isfahan Medical School (10277595)27(98)
Background: Intratympanic steroid injection is an effective method in treatment of sudden sensorineural hearing loss in cases resisted to systemic therapy. The purpose of this study was to determine the efficacy of intratympanic injection. Methods: This case-series study was carried out on fifteen patients with sudden sensorineural hearing loss that had failed systemic therapy. Audiometric evaluation (PTA) performed before and after treatment and intratympanic dexametasone injection performed and the amount of improvement evaluated. Data Analysis was done using SPSS11. Findings: In male patients, 33.3% partial and 33.3% complete improvement and in female patients, 18.6% partial and 50% complete improvement was reported. In cases with lower degrees of hearing loss, total improvement was 66.7%; also earlier time of treatment had better results. Conclusion: Intratympanic injection of steroid is one effective modality in treatment of sudden sensorineural hearing loss in cases with no response to standard systemic therapy. It can improve the hearing level of patients while its complication rate is low and as degree of hearing loss increases the results decrease earlier treatment have a better results. © 2009, Isfahan University of Medical Sciences(IUMS). All rights reserved.
Publication Date: 2008
Tehran University Medical Journal (17357322)66(6)pp. 402-407
Background: Post-tonsillectomy pain is often severe and usually prevents patients from routine eating and drinking. A new option for reducing postoperative pain is "preemptive analgesia", the pre-, intra-or post-operative administration of analgesic agents. Ketamine, an N-methyl D-aspartate receptor antagonist, has recently received attention for this aim. Herein, we study the effect of submucosal injection of ketamine in the tonsillar bed for the reduction of post-tonsillectomy pain. Methods: In this double-blind clinical trial, three groups of patients underwent infiltration of 0.5mg/kg ketamine, 1mg/kg ketamine or normal saline in their tonsillar bed. Age, sex and weight of patients, duration of surgery, systolic and diastolic blood pressure (before and after surgery), volume of blood loss, reoccurrence of bleeding, time to initiation of oral intake, nausea, vomiting, pain score and dysphasia were recorded in information sheet. Data analysis was performed by one-way ANOVA and chi squared tests, with significance at a P value of <0.5. Results: There is no significant difference between the three groups with regard to age, sex, weight, duration of surgery, blood pressure (before surgery), volume of blood loss, nausea and vomiting. However, for the ketamine groups, pain score, dysphasia, need for opioid administration and time to initiation of oral intake is significantly lower (P<0.00). Reoccurrence of bleeding was observed in one patient in the lower-dose ketamine group, which is not statistically significant. The effectiveness of the two doses of ketamine is similar, with no statistical difference between the two groups (P=0.84). Conclusions: This study demonstrated that a submucosal injection of ketamine into the tonsillar bed preoperatively is a safe option for reducing post-tonsillectomy pain, dysphasia, need for opioid and time to initiation of oral intake, without increasing the risk of excessive bleeding, reoccurrence of bleeding, nausea and vomiting. © 2008, Tehran University of Medical Sciences. All rights reserved.
Publication Date: 2007
Journal of Isfahan Medical School (10277595)25(87)pp. 53-59
Background: Congenital hypothyroidism (CH) has a considerably high prevalence in our country, and without early treatment, it would lead to irreversible sequelae like hearing impairment. This study was aimed to investigate the prevalence of hearing loss in children with CH in comparison with healthy children. Methods: This case-control study was conducted in two groups of children; the case group consisted of 94 children with CH aged more than 4 months under follow up in Isfahan endocrine research center; the control group included 450 healthy infants underwent routine neonatal hearing screening in a private hospital. First, Otto Acoustic Emission (OAE) test was performed, and in the case of being abnormal, then auditory brain stem response (ABR) test was conducted. Children with abnormal ABR were considered to have hearing impairment. Findings: The prevalence of hearing impairment was not significantly different between children with CH and controls (3.2% vs. 0.2%, respectively; p>0.05). The mean age of beginning the treatment for CH was not significantly different between children with or without hearing impairment (13.6±8.3 vs. 16.4±8.05 days, respectively; p>0.05).The mean T4 and TSH was not significantly different between children with CH with and without hearing impairment (5.6±4.2 mg/dl and 133.7±80.3 MIU/l vs. 6.2±3.7 mg/dl and 116.5±92.1 MIU/l, respectively; p>0.05). Conclusion: We did not document any difference in the prevalence of hearing impairment in children with CH and controls; this finding might be because of limited number of subjects studied and the short duration of follow up. There was no difference neither between the age of beginning the treatment for CH and hearing impairment, nor between the mean T4 and TSH at birth and hearing impairment. Hearing loss has no relationship with age at treatment onset and primary T4 and TSH level at diagnoses. © 2007, Isfahan University of Medical Sciences(IUMS). All rights reserved.
Publication Date: 2007
Journal of Isfahan Medical School (10277595)25(87)pp. 97-101
Background: This retrospective study was conducted to determine the prevalence of nasopharyngeal angiofibroma according to age, stage, clinical signs and average blood transfusion during surgery in educational hospitals affiliated to Isfahan University of Medical Sciences. Methods: This retrospective study was conducted on 250 records of patients suffering from angiofibroma and hospitalized from 1988 to 2003 in Al-zahra and Ayatollah Kashani hospitals, affiliated to Isfahan University of Medical Sciences. Findings: All cases were male, and the mean age was 16 years with a range of 7 to 41; the highest prevalence was found in the 11-20-year-age group. The most frequent sign was epistaxis (80%) and nasal obstruction (70%). The average volume of blood transfusion during the surgery was 4-5 units. The most frequent stage at the time of diagnosis was IIB and IIC (complete invasion of petrygomandibular fossa and protrusion to infratemporal fossa) and the rarest stage was IA and IIA according to Session classification. Conclusion: Angiofibroma is a rare tumor; however it is the most frequent nasopharyngeal tumor in young adults. Although it has benign histology, but can have important side effects. Its early diagnosis and treatment can prevent its side effects and may facilitate the surgery; hence it should be considered in the differential diagnosis of nasopharyngeal disorders. © 2007, Isfahan University of Medical Sciences(IUMS). All rights reserved.
Publication Date: 2006
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.
Publication Date: 2005
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.
Publication Date: 2005
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.
Publication Date: 2005
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.
Publication Date: 2005
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.
