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

INTRODUCTION

In this study we investigated the effect of cisplatin-based chemotherapy on hearing loss in children with cancer.

MATERIAL AND METHOD

In this retrospective study, 20 children aged 6 to 17 years with cancer who were treated with cisplatin and had normal results on initial audiometry test were included. The demographic, clinical, and medical information of all children was extracted and recorded. The hearing thresholds were determined for the frequency of >8 kHz by an audiometrist two weeks after receiving the last course of cisplatin. Finally, all data was analyzed.

RESULTS

In this study, 20 children with cancer were included of who 9 were girls (45 %) and 11 were boys (55 %). The patients' mean age at the time of diagnosis was 6.65 years. Results showed that children who received cisplatin ≥70 mg/m2 (P.value = 0.09) and ≥ 7 courses of cisplatin (P.value = 0.01), and a cumulative dose higher than 400 mg/m2 (P.value = 0.02) had higher chance of hearing loss.

CONCLUSION

According to the results it can be concluded that since higher doses caused higher risk of hearing loss and also since lower doses were effective for treatment of the cancer in children therefore to preventing the hearing loss, lower doses of cisplatin are recommended for cancer treatment in children.

The effect of vitamin B12 on idiopathic tinnitus

INTRODUCTION

Tinnitus is one of the most important challenges in the field of ear, nose and throat diseases. The aim of this study was to evaluate the effect of vitamin B12 on idiopathic tinnitus.

MATERIAL AND METHODS

In this double-blind clinical trial study, 140 patients with idiopathic tinnitus were divided into two groups, the group receiving vitamin B12 and the group receiving placebo. The first group received vitamin B12 for a month and the other group received placebo. All patients filled a THI questionnaire before the participation, one month and three months after the participation. VAS evaluation questionnaires were also filled for the patients before the participation, one month and three months after the participation. The effect of vitamin B12 on tinnitus was also assessed according to hearing loss status. The two groups were also compared regarding the side effects.

RESULTS

There was no significant differences between two groups regarding age (p.value = 0.523), gender (females (p.value = 0.810) and males (p.value = 0.789), and hearing loss status (p value = 0.651). According to VAS score, there was no significant statistical differences in tinnitus severity in each group (B12 group, p.value = 0.851 and placebo group, p.value = 0.386). There was no significant statistical differences in tinnitus severity based on VAS score between two groups before the participation (p.value = 0.560), one month (p.value = 0.485) and three months (p.value = 0.254) after the participation. According to THI criterion, there was no significant statistical differences in tinnitus severity in each group (B12 group, p.value = 0.259 and placebo group, p.value = 0.521). There was no significant statistical differences in tinnitus severity based on THI score between two groups before the participation (p.value = 0.651), one month (p.value = 0.125) and three months (p.value = 0.089) after the participation. None of the patients of the two groups had any noticeable side effects. The mean of VAS and THI also had no statistically significant difference before and after the intervention in term of hearing loss status (p.value>0.05). These results were not significantly different between the two groups in term of hearing loss status (p value>0.05).

CONCLUSION

The result of this study indicated that vitamin B12 has no distinctive effect on reducing tinnitus severity.

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

BACKGROUND

Some studies have shown a positive effect of systemic corticosteroid on hearing results after stapedotomy, but its side effects can limit its routine administration.

AIM

The aim of this study was to investigate the effect of local dexamethasone on the results of stapedotomy surgery.

MATERIAL AND METHODS

Fifty two patients undergone stapedotomy surgery for otosclerosis involved. In the case group after stapedotomy we fulfilled the middle ear with dexamethasone and then the placement of the prosthesis was done. In the control group after stapedotomy we did not use dexamethasone in the middle ear.

RESULTS

Gender, age, nausea, vomiting, postoperative vertigo and nystagmus did not significantly differ between the groups. A significant difference was observed in tinnitus rate between two groups. In the case group ABG decrease was higher and bone conduction thresholds improved at frequencies of 1000, 2000, and 4000 three months after surgery.

CONCLUSION

Since local dexamethasone had a positive effect on the results of stapedotomy surgery, it can be used instead of systemic corticosteroids to reduce the side effects and increasing surgery's success rate.

SIGNIFICANCE

If local dexamethasone had a positive influence on the results of stapedotomy surgery, it can be used instead of systemic corticosteroids to reduce the side effects and increasing surgery's success rate.

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

INTRODUCTION

As a novel infectious disease, COVID-19 is caused by SARS-COV-2, spreading rapidly worldwide. ENT specialists have faced this challenging disease in various ways since the emergence of the COVID-19 pandemic. We are currently facing an increase in cases referred due to sinonasal mucormycosis which is a rare but invasive, rapidly progressive, and life-threatening infection. We provide an overview of this disease's incidence rate and clinical features.

METHODS

This descriptive cross-sectional study was conducted on 46 sinonasal mucormycosis patients who were histopathologically confirmed after sinonasal endoscopic surgery in our educational therapeutic hospital during 2 years of the COVID-19 pandemic from March 20, 2020, to March 20, 2022.

RESULTS

There was an increase in the incidence of mucormycosis more than twice as much as before. All patients had a history of COVID-19 and 69.6% were diabetic. The median time to symptom onset from COVID-19 detection was 3.3 weeks. A total of 60.9% received steroids while 85.7% were prescribed during COVID-19 treatment. The most common manifestation was orbital involvement (80.4%). Of the 46 study cases, unfortunately, 17 (37%) died. An exciting point in our study was the incidence of peripheral facial palsy which is associated involvement of multiple other cranial nerves (II, III, IV, V, VI) considered to be the likely occurrence of a rare phenomenon called Garcin's syndrome.

CONCLUSION

Based on the results of this study, during 2 years of the COVID -19 pandemic, there was an increase in the incidence of sinonasal mucormycosis more than twice as much as before.

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

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

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

INTRODUCTION

In this study, we investigated the association between metabolic syndrome and the prognosis of idiopathic sudden sensorineural hearing loss.

METHODS

In this prospective cohort study, 79 patients with idiopathic SSNHL admitted to the ENT ward were involved. Patients were under treatment with two-dose pulse methylprednisolone and then oral corticosteroid (Prednisolone 1 mg/kg for up to 2 weeks and more). In all patients, the mean hearing threshold was measured before treatment and 3 weeks after the treatment. Metabolic syndrome criteria were assessed in all patients too. Then, based on these diagnostic criteria all data in patients with and without metabolic were compared.

RESULTS

There was a significant difference in Hypertension, BMI > 25, high TG and low HDL (p.v = 0.001) between two groups (metabolic syndrome group and non-metabolic syndrome group). The rate of recovered patients was significantly lower in the metabolic syndrome group than in the non-metabolic syndrome group (p.v = 0.001). It was found that metabolic syndrome (OR = 2.02), diabetes mellitus (OR = 7.32), HTN (OR = 4.09), BMI > 25 (OR = 3.24) and high initial hearing threshold (OR = 3.96) were clearly related to the poor prognosis of treatment.

CONCLUSIONS

According to the findings of this study, it was found that metabolic syndrome had a negative effect on hearing improvement in patients with idiopathic SSNHL.

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

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

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

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

Comparing Efficacy of Propofol and Dexmedetomidine in Conscious Sedation During Stapedotomy Surgery

Introduction

We decided to compare dexmedetomidine with propofol regarding several anesthetic and surgical aspects, during stapedotomy done under conscious sedation.

Materials and Method

Thirty patients aged 20-50 years with (American Society of Anesthesiology) ASA class I-II, were assigned to two groups of propofol and dexmedetomidine using a random number table. In dexmedetomidine group, patients received dexmedetomidine infusion (0.5 µg/kg/h) and in the control group, propofol was administered (3 mg/kg/h).Time to reach the desired Ramsey Sedation Score (RSS) and time to reach Aldrete score ≥ 9; incidence of inadvertent movement and amnesia; as well as patients' and surgeons' level of satisfaction and degree of bleeding was recorded. Data on hemodynamic variables were monitored and recorded at several intervals.

Results

The mean time taken to reach the RSS (2-4) was 10.3 ± 2.1 min in dexmedetomidine group and 3.1 ± 1.2 min in propofol group. Time to reach Aldrete score ≥ 9 for patients sedated with dexmedetomidine was 8.6 ± 2.1 min and for propofol group was 4.6 ± 1.4 min (p value < 0.05).There were also significant differences between two groups in terms of surgeon's satisfaction with sedation, and the amount of intra operative bleeding.

Conclusion

According to the results of this study, it can be concluded that dexmedetomidine is a better choice for conscious sedation than propofol. However, the time to reach the required sedation in the dexmedetomidine group was significantly longer.

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

INTRODUCTION

In this study we aimed to investigate the association between thyroid nodule location and the malignancy risk of the nodules in FNA samples.

METHODS

In this cross sectional study, 400 patients with thyroid nodule size >1.5 cm, thyroid nodule size >1 cm with micro-calcification, and thyroid nodule size <1 cm with sonographic or clinical signs of malignancy who referred to a training hospital, were involved. Morphologic characteristics of nodules, including nodule size, laterality and polarity were recorded. In patients with multinodular goiter, the anatomical location was recorded and analyzed.

RESULTS

In our study, 345 female patients (86.3 %) and 55 male patients (13.8 %) with thyroid nodule were involved. The majority of thyroid nodules were identified in the right lobe (n = 182, 45.5 %) and left lobe (n = 177, 44.3 %), respectively. A total of 323 nodules were benign and the remaining (n = 77) were malignant. The frequency of malignancy in the upper pole of the thyroid (31.6 %) was higher compared to that in the middle pole (10.7 %), lower pole (19.1 %), and isthmus region (26.8 %), leading to a significant difference (p.value = 0.001). The mean size of thyroid nodules was 15.68 mm in benign nodules and 20.08 mm in malignant nodules.

CONCLUSION

Our results showed that thyroid nodules found in the upper lobe carried the greatest risk for malignancy. Accordingly, it seems that the location of thyroid nodules can be an independent risk factor in determining the malignancy risk of thyroid nodules and can be used to enhance clinical decision making in thyroid FNA samples.

Papillary Thyroid Carcinoma with Nodular Fasciitis-Like Stroma in a 28-Year-Old Patient

Papillary thyroid carcinoma (PTC) is considered as a relatively common type of malignancy showing a wide morphologic spectrum. Different variants of this tumor have been reported. Among PTC variants, PTC with nodular fasciitis-like stroma (PTCFLS) is rare. This variant consists of stromal components rich in spindle cells and accounts for 60-80% of tumors. In addition, there are small foci of epithelial components in PTCFLS though its features are similar to conventional PTC. In this case study, we present a new case with PTCFLS. The case is a 28-year-old female who was referred to the ENT clinic due to a painless mass on the anterior part of her neck. The mass showed a gradual increase in size over the 6 months prior to her referral. Thyroid test results were normal. Ultrasound imaging demonstrated an 84 × 36 mm heterogeneous nodule in the right thyroid lobe without calcifications but increased vascularity. There were also some reactive lymph nodes in both sub-mandibular areas. An ultrasound-guided fine-needle aspiration (FNA) biopsy of the right thyroid lobe nodule revealed a benign thyroid adenomatoid nodule. Following right thyroid lobectomy, final pathologic studies confirmed a diagnosis of PTC with exuberant fibromatosis-like stroma. In the 20-day post-surgery visit, the patient was found asymptomatic. Re-evaluation of the left thyroid lobe and follow-up were recommended. In this study, a diagnosis of a rare variant of PTC, i.e., PTC-FLS, was made through a combination of ultrasonography, fine needle aspiration cytology, and histological examination.

Endoscopic Surgery Outcomes in Patients With Rhino-Orbito-Sinusal Mucormycosis

The aim of this study is to evaluate the response to endoscopic treatment and treatment outcomes in patients with rhino-orbito-sinusal mucormycosis. In this descriptive cross-sectional study, 19 patients with rhino-orbito-sinusal mucormycosis were involved. Data such as age, gender, the 6-month survival rate of the patients, type of underlying disease, site of involvement, number of endoscopic procedures, history of exenterating of the eye, type of received systemic treatments, and the time interval between the onset of symptoms and the start of treatment were recorded and analyzed. The 6-month outcome analysis showed that 10 out of 19 patients (58.8%) survived. The results also revealed no significant difference in the 6-month survival rate according to parameters such as gender, underlying disease (57.9% of the patients had diabetes and 42.1% had cancer), age, delay in surgery, site of involvement, and the number of surgeries (P>0.05). However, there was a significant difference in the 6-month survival rates of patients with respect to exenterating of the eye (P<0.05). According to our results, uncontrolled diabetes is the most common underlying cause of rhino-orbito-sinusal mucormycosis. It also seems that exenterating of the eye affects the survival rate of patients. This study suggests that timely and early diagnosis as well as correct treatment, endoscopic procedure, if possible, play an important role in the prognosis of the disease and can greatly reduce the mortality rate.

BRAF Gene Mutation (V600E) in Aspiration Cytology of Patients With Suspected Papillary Thyroid Carcinoma

This study was attempted to investigate the prevalence of BRAF gene mutation (V600E) in aspiration cytology of patients with suspected papillary thyroid carcinoma (PTC). Seventy-six patients suspected of having PTC who were referred for fine-needle aspiration (FNA) biopsy were included in this cross-sectional study. Ultrasound-guided FNA was taken from the thyroid masses, and samples were sent for cytologic evaluation. Simultaneously, the samples were sent to a genetic laboratory to check the status of BRAFV600E mutation. Patients with FNA positive for PTC were assigned in one group, and those with FNA negative for PTC were assigned to another group. Cytological and molecular results were compared with those of histopathology and sonography. The results showed that the prevalence of the BRAF gene (V600E) mutation in our study was 21.1% (16 out of 76 patients). In addition, the results showed a significant relationship between gene mutation and pathologic findings so that the highest gene mutation was significantly detected in patients with FNA positive for PTC (P=0.001). Also, our results showed a significant relationship between gene mutation and some sonographic findings (calcification, P=0.004) and no significant relation in the other sonographic findings (hypoechoic changes, P=1.12 and regular changes, P=0.194). According to the results of the present study, BRAF mutation (V600E) can be an effective indicator for definitive diagnosis and primary treatment of PTC in suspected cases.

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

INTRODUCTION

This study aimed to comparing the effect of peritonsillar infiltration of tramadol and dexmedetomidine in relieving post-tonsillectomy pain.

METHODS

In this randomized double blinded clinical trial study, 90 children 5-12 years old undergoing tonsillectomy, involved. Induction of anesthesia was done by fentanyl 1 µg/kg, sodium thiopental 5 mg/kg and atracurium 0.5 mg/kg and intubation was done after 3 min. Anesthesia maintained by nitrous oxide 60% and oxygen 40% with isoflurane (1.2%). Tramadol 2 mg/kg in group A, dexmedetomidine 1 µg/kg in group B, and normal saline in group c were injected into the bed and anterior tonsillar pillar and surgery has begun after 3 min of injection. Time of surgery, all hemodynamic variables, pain intensity and degree of sedation were recorded and evaluated.

RESULTS

The results showed that duration of the surgery (p value = 0.28) and duration of anesthesia (p value = 0.43) were not significantly different between the groups but pain score was significantly lower in dexmedetomidine group in comparison to tramadol and placebo group (p value = 0.001). The first time for analgesic request was longer in dexmedetomidine group (p value = 0.001) and Hemodynamic parameters were significantly lower in tramadol and dexmedetomidine group (p value = 0.001). Sedation level was not significantly different between tramadol and dexmedetomidine group (p value = 0.001).

CONCLUSION

According to the results peritonsillar infiltration of dexmedetomidine is effective and safe in relieving post-tonsillectomy pain.

Comparing the efficacy of peritonsillar injection of bupivacaine and intravenous acetaminophen on post-tonsillectomy pain in children

INTRODUCTION

In this study we aimed to compare the efficacy of peritonsillar injection of bupivacaine and intravenous acetaminophen on post-tonsillectomy pain in children.

MATERIALS AND METHODS

In this randomized double-blind clinical trial study 60 children with ASA = I-II aged 5-12 years undergoing tonsillectomy were involved. The first group received bupivacaine at a dose of 0.1 mg/kg that was injected into the bed and the anterior crease of each tonsil. The second group was given intravenous acetaminophen at a dose of 12.5 mg/kg. The patient's pain score at 10, 30, 60 min after his/her admission to recovery room and 120, 240 and 360 min after the surgery was recorded using CHEOPS. Patient's sedation score, nausea or vomiting, the time of the first request for analgesia and the time of starting oral feeding were recorded and analyzed too.

RESULTS

There was no significant differences in mean age (p value = 0.44), gender (p value = 0.79), weight (p value = 0.36), height (p value = 0.17), anesthesia duration (p.value = 0.85) and surgery duration (p.value = 0.73) between two groups. Postoperative pain was significantly less in the bupivacaine group at 240 and 360 min after the surgery. The mean sedation score was higher in the bupivacaine group but not significantly. There was no significant difference between groups regarding the nausea and vomiting, the first analgesics request time and the start time of oral feeding.

CONCLUSION

According to the results of the present study, since administration of peritonsillar bupivacaine compared to acetaminophen had a better effect on managing postoperative pain and improving sedation and also since no complications were reported; therefore, peritonsillar infiltration with bupivacaine is suggested for pediatric tonsillectomy.

The Effect of Perianal Tramadol Infiltration on Postoperative Pain Following Hemorrhoidectomy

INTRODUCTION

The present study was attempted to evaluate the effect of perianal infiltration of tramadol on postoperative pain in patients undergoing hemorrhoidectomy.

METHOD

This double-blind clinical trial study was carried out on 90 patients with grade 3 and 4 hemorrhoids undergoing hemorrhoidectomy. Patients were randomly assigned into 3 groups of control or bupivacaine or tramadol. Before the surgery, perianal infiltration of .25% bupivacaine or tramadol or normal saline was prescribed to each group, respectively. Data on pain severity (based on the visual analog scale (VAS), the duration of surgery, sedation score, pain at the first defecation, first request time for additional analgesia, nausea and vomiting, and analgesic intakes) were evaluated and analyzed.

RESULTS

Duration of surgery was almost similar in all 3 groups (P = .974). The results showed a significant difference in pain score between 3 groups (P ≤.05) at all times after the surgery. In addition, the means of sedation scores (P = .03), pain score at the first defecation (P = .001), the time to first analgesic request (P = .001), and ketorolac administration times (P = .01) were significantly different between 3 groups. Finally, no complication was reported regarding postoperative nausea and vomiting.

CONCLUSION

Given the notable efficacy of tramadol in reducing pain after hemorrhoidectomy and its minor side effects, this medication is suggested as an effective topical anesthetic to decrease pain after hemorrhoidectomy.

Investigation of Serum Zinc Level in Patients with Hearing Loss and its Association with Tinnitus

Introduction: This study aims to determine the serum zinc level in patients with hearing loss and its relation with tinnitus.  Materials & Methods: In this Cross-Sectional study, 110 patients older than 20 years old with Complaining of hearing loss and tinnitus were involved. Participating patients were first visited by an ear, nose, and throat specialist with a history and physical examination, and were assessed for standard hearing loss as well as the intensity and frequency of tinnitus by standard audiometric tests. Then, fasting blood samples were taken to check serum zinc levels. Results:The mean serum level was 85.32 ± 27 27.62, and the mean frequency of tinnitus was 4.94 ± 2.76, both of which had significant differences between different groups (P = 0.001). The mean intensity of tinnitus was 7.77 ± 4.56, and there was no significant difference between different groups (P = 0.677). Serum zinc level and tinnitus frequency were associated with a correlation coefficient of 0.205 (P = 0.032), and serum zinc level and tinnitus severity were associated with a correlation coefficient of 0.249 (P = 0.009). Conclusion: According to the present study results, the positive effect of serum zinc levels on the severity and frequency of tinnitus has been determined so that with decreasing serum zinc levels, tinnitus occurs at lower frequencies.

The Effect of Preoperative Administration of Duloxetine on Postoperative Pain After Laparoscopic Myomectomy

The purpose of this study was to evaluate the effect of preoperative administration of duloxetine on postoperative pain after laparoscopic myomectomy. In this double-blind clinical trial study, 57 patients aged 18-55 years with ASA I or II undergoing laparoscopic myomectomy involved. The case group received oral duloxetine 60 mg, and the control group received placebo 2 hours before the surgery. Pain scores, total analgesic consumption during 24 hours, recovery discharging time, nausea, vomiting, dizziness, and hemodynamic changes were recorded and compared between two groups. The pain severity was significantly lower in the case group at 2, 12, and 24 hours after the operation (P<0.05). There were no significant differences in dizziness, nausea, vomiting, systolic and diastolic blood pressure, and heart rate of patients between two groups before the surgery, 5 and 30 minutes after the induction, and after the recovery. Duloxetine administration prior to laparoscopic surgery myomectomy can reduce postoperative pain without inducing side effects in patients.

The Effect of Gelfoam Impregnated With Botulinum Toxin on Allergic Rhinitis

INTRODUCTION

This study evaluated the effect of gelfoam impregnated with botulinum toxin on the symptoms induced by allergic rhinitis.

MATERIALS AND METHODS

In total, 30 patients with allergic rhinitis who did not respond to common therapies were included in this clinical trial study. All patients were treated with intranasal gelfoam impregnated with botulinum toxin type a (40 unit in each side) placed in the middle meatus of each nostril. The main symptoms of allergic rhinitis were scored from zero to three by the patients. Symptoms recorded and compared before and two months after the treatment.

RESULT

The mean age of patients was 31.03±6.9 years. The mean score for sneezing was 2.23 before the treatment which significantly decreased to 1.06 after the treatment (P<0.05). The mean scores of rhinorrhea, nasal congestion, and nasal itching were 2.53, 2.03, and 1.93, respectively, before the treatment which significantly decreased to 0.93, 1, and 0.8 after the treatment (P<0.05). No reported side effects was observed in this study.

CONCLUSION

According to the results, treatment with gelfoam impregnated with botulinum toxin is an effective and safe method in patients who have not responded to common therapies for allergic rhinitis. Accordingly, it is recommended to relieve symptoms in patients with seasonal allergic rhinitis in order to maintain the effectiveness of this treatment at least 8 weeks.

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

INTRODUCTION

The present study aimed to compare the effect of cold diet and diet at room temperature on post-tonsillectomy pain in children.

MATERIALS AND METHODS

In the present study a total of 120 children within the age range of 4-12 years who underwent tonsillectomy were randomly assigned to two groups, namely group C with a cold-served diet and group room temperaturewith a room-temperature-served diet postoperatively. Each patient's post-operative pain was evaluated using the Face, Legs, Activity, Cry, Consolability (FLACC) scale prior to oral diet initiation after the operation, before thesecond acetaminophen dose, before the next day breakfast, and before discharge.

RESULTS

Out of 103 children, 48 and 55 children were femaleand male, respectively. The average age of the children was 7 years and 2 months. There was no significant difference in gender and age between the two groups. There were no significant differences in the mean scores of FLACC scale between the two groups at different times, including before starting an oral diet (P>0.15), before the second dose of acetaminophen (P>0.22), before the next day breakfast (P>0.32), and before discharge (P>0.83). In terms of bleedingfrequency, as well as nausea and vomiting, no significant difference was observed between the two groups.

CONCLUSION

The obtained results of this study indicated that using cold liquids and foods after tonsillectomy did not have a significant effect on post-tonsillectomy pain in children. According to the findings, it is not rational to advise the mother or the child about the temperature of fluids and foods consumed post-tonsillectomy.

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

INTRODUCTION

This study was attempted to investigate the relationship between radiologic and endoscopic findings and pre- and post-operative olfactory scores in chronic rhinosinusitis with nasal polyps.

MATERIALS AND METHODS

In this study, 40 patients aged 19-64 years with chronic rhinosinusitis with nasal polyps (CRSwNP) undergoing endoscopic sinus surgery were involved. The patients' olfactory status was evaluated using Smell Identification Test (Iran SIT) before and 3 months after the surgery. Patients' nasal endoscopic signs were recorded using Modified Lund-Kennedy scoring system before and 3 months after the surgery and radiological symptoms were recorded based on Lund-Mackay CT scoring before the surgery. Then the relationship between olfactory status and endoscopic and radiological findings was investigated.

RESULTS

With respect to mean of olfactory score, a significant difference was observed before and after the surgery (p value = 0.001). There was a significant difference between means of pre- and post-operative endoscopy scores (p value = 0.001). Pre-operative endoscopic and CT scan scores had a negative correlation with pre- and post-operative olfactory scores (p value < 0.05). Pre-op. olfactory scores had negative correlation with post-op. endoscopy scores (p value = 0.02). Post-op. olfactory scores had negative correlation with post-op. endoscopy scores but was not statistically significant (p value = 0.22).

CONCLUSION

Our results revealed that pre-operative endoscopy and radiology findings were consistent with the olfactory status of patients with CRSwNP before and after endoscopic sinus surgery.

The Role of Immunological Factors on Sudden Sensoryneural Hearing Loss

INTRODUCTION

In this study, we examined the role of immunological factors on sudden sensory neural hearing loss (SSNHL).

MATERIALS AND METHODS

This prospective case-controlled study was performed in patients with SSNHL who referred to the ear, nose, and throat (ENT) ward. Fifty-six patients with SSNHLoccurring within a 72-hr period were selected as the case group and 56 participants who had no recent history of disease were assigned to the control group. Mean levels of immunological factors including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibody (ANA), anti-neutrophil cytoplasmic antibody (ANCA) (C, P), anti-cyclic citrullinated peptide (anti-CCP), DSM, hemoglobin (Hb), complement component 3 (C3), and complement component 4 (C4) were evaluated in the blood samples in each group.

RESULTS

There were 31 male and 25 female participants in the control group, while the case group had 26 male and 30 female participants. The mean age of the participants was 36.2 ± 13.4 years in the control group and 40.80 ± 13.37 years in the case group. The two groups differed significantly in terms of mean ESR, ANA, C3, C4 and monocytes, with higher levels in the case group (P<0.05). However, differences in mean CRP, anti-Ds DNA, Hb, anti-CCP, white blood cells (WBC), neutrophils, lymphocytes, eosinophils, and platelets were not statistically significant between the case and control groups (P>0.05).

CONCLUSION

Because some of the immunological factors investigated in this study were significantly higher in patients with SSNHL, it can be concluded that there is an association between these immunological factors and SSNHL. Further studies are recommended to accurately determine the effect of these factors on the development of SSNHL and its treatment.

Pneumocephalus after Tympanomastoidectomy: A Case Presentation

INTRODUCTION

Pneumocephalus is the presence of air or gas within the cranial cavity. It can occur following otorhinolaryngological procedures. A small pneumocephalus spontaneously heals without any treatment. In severe cases, conservative therapy includes a 30-degree head elevation, avoidance of the Valsalva maneuver, analgesics, osmotic diuretics, and oxygen therapy.

CASE REPORT

A 56-year-old woman was referred to the emergency department due to a severe headache in the frontal area for 2 days before admission. The patient experienced nausea and vomiting in the morning and had no history of seizures or decreased consciousness. Examination of neurological symptoms was completely normal and showed no symptoms of meningeal irritation. In terms of past history, the patient had undergone tympanomastoidectomy surgery and resection of the cholesteatoma 1 week previously. The Mount Fuji sign was found on the brain computed tomography (CT) scan of the patient. Treatments such as CBR (complete bed rest), 30-degree head elevation, anti-fever, analgesics and oxygen therapy, along with anti-compulsive drug (phenytoin), were prescribed. At the end of 5 days, the patient's pneumocephalus was resolved completely.

CONCLUSION

Pneumocephalus should be considered a post-operative complication of tympanomastoidectomy. In most cases, pneumocephalus responds to conservative therapy. Supplemental oxygen increases the rate of absorption of pneumocephalus. Serial imaging is needed to ensure gradual reduction of the pneumocephalus.

Comparing nasal packing with trans-septal suturing following septoplasty: a randomized clinical trial

It has been shown that nasal packing after septoplasty is associated with several complications. Our aim was to compare post-septoplasty nasal packing and trans-septal suturing, in terms of complications and outcome of operation. This randomized clinical trial was performed on patients with deviated nasal septum who were candidates for septoplasty. Patients were visited three times after operation (on the first 48 h, first week, and third post-operative month). Participants were checked for having common complications. Rhinomanometric evaluation was performed to measure nasal air flow and airway resistance, as indicators of operation efficacy, both prior to and after surgery. A total of 72 patients were allocated into the two trial arms. Patients in nasal pack group reported higher pain scores on the first 48 h (P < 0.001) and one week after surgery (P < 0.001). Epiphora (P = 0.028), sleep disturbance (P = 0.012), and dyspnea (P < 0.001) were also more commonly observed in patients using nasal pack. Objective evaluation of bleeding demonstrated that more severe bleeding occurred in patients with trans-septal sutures (P = 0.001). No differences were found comparing the indices of rhinomanometry between the two groups. Using trans-septal sutures after septoplasty compared to nasal packing, might be associated with lower frequencies of several specific complications and a lower rate of patients' discomfort. Nevertheless, increase in the risk of bleeding and hematoma was noted in the trans-septal suture group. No differences were observed between the nasal air flow and resistance of patients in the two groups.

The Effect of Topical Tranexamic Acid on Bleeding Reduction during Functional Endoscopic Sinus Surgery

INTRODUCTION

Bleeding is a common concern during functional endoscopic sinus surgery (FESS) that can increase the risk of damage to adjacent vital elements by reducing the surgeon's field of view. This study aimed to explore the efficacy of topical tranexamic acid in reducing intraoperative bleeding.

MATERIALS AND METHODS

This double-blind, randomized clinical trial was conducted in 60 patients with chronic rhinosinusitis with polyposis (CRSwP) who underwent FESS. Patients were randomly divided into two groups; tranexamic or saline treatment. During surgery, normal saline (400 mL) or tranexamic acid (2 g) in normal saline with a total volume of 400 mL were used in the saline and tranexamic groups, respectively, for irrigation and suctioning. The surgeons' assessment of field of view during surgery and intraoperative blood loss were recorded.

RESULTS

Mean blood loss was 254.13 mL in the saline group and 235.6 mL in the tranexamic group (P=0.31). No statistically significant differences between the two groups were found in terms of other investigated variables, such as surgical field quality based on Boezzart's scale (P=0.30), surgeon satisfaction based on a Likert scale (P=0.54), or duration of surgery (P=0.22).

CONCLUSION

Use of tranexamic acid (2 g in 400 mL normal saline) through washing of the nasal mucosa during FESS did not significantly reduce blood loss or improve the surgical field of view. Further studies with larger sample sizes and higher drug concentrations, and using other methods of administration, such as spraying or applying pledgets soaked in tranexamic acid, are recommended.

Effect of intravenous vitamin C on postoperative pain in uvulopalatopharyngoplasty with tonsillectomy

BACKGROUND

Postoperative pain is a common problem in hospitals. Adults undergoing uvulopalatopharyngoplasty (UPPP) with tonsillectomy experience an unacceptable level of intense postoperative pain, especially during the first 24 h after surgery. This study investigated the analgesic effects of vitamin C in patients undergoing UPPP and tonsillectomy.

METHOD

This study was done on forty patients that were evaluated in a randomised double-blinded clinical trial. Patients included in the study were within the age range of 25-50 years with BMI<35, physical status I,II according to the American Society of Anesthesia (ASA) and who underwent uvulopalatopharyngoplasty and tonsillectomy. Patients with epilepsy, BMI>35, any neuropsychiatric disorders, a history of chronic pain, liver and/or renal disease, drug allergy, and drug abuse were excluded from the study. All patients underwent the same method of anaesthesia and surgical procedure. During the first 30 min after the beginning of the surgery, group C (vitamin C) received infusion of 3 g vitamin C in 500 mL of Ringer and group P received 6 mL normal saline in 500 mL of Ringer. Measurements of systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate were recorded before and during anaesthesia and at intervals of 0,15,30 and 60 min after extubation. Pain severity was recorded according to VAS score at intervals of 0 (recovery room), 6, 12 and 24 h after the procedure, request for analgesic drugs (iv paracetamol or pethedine) according to total number of times of analgesic request and time of the first dose of analgesic use and dose of pethidine were also recorded by questionnaire.

RESULTS

There was a significant difference in evaluations for mean pain severity between the two groups at recovery room, 6, 12 and 24 h after surgery (P-value = 0.001). There was a significant difference in mean times that patient requested an analgesic, time of first dose of analgesic and pethidine dose between the two groups (P-value< 0.05). There was no significant differences in measurements of systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate in different times between the two groups (P-value> 0.05). Blood loss was similar in the two groups (P-value> 0.05).

CONCLUSION

According to this study, administration of vitamin C 3 g IV intraoperative reduced postoperative pain without increased side-effects in patients undergoing UPPP and tonsillectomy.

Effect of oral gabapentin on haemodynamic variables during microlaryngoscopic surgery

BACKGROUND

Manipulation of the larynx, such as laryngoscopy and tracheal intubation, is associated with haemodynamic and cardiovascular responses. In microlaryngoscopic procedures, these responses are more severe than laryngoscopy for endotracheal intubation because in microlaryngoscopic surgeries laryngoscope fixes for a longer time (15-20 minutes compared to 15-30 seconds in tracheal intubation). This study was performed to evaluate the effect of 800 mg oral gabapentin on the haemodynamic variables during microlaryngoscopic surgery.

METHODS

30 patients aged 30-70 years, ASA physical status I or II, who underwent microlaryngeal surgery were included to the study. The night before surgery, 15 patients (group G) received 100 mg gabapentin and 15 patients (group P) received a placebo. Ninety minutes before the operation, they either received 800 mg gabapentin (group G), or received a placebo (group P).

RESULTS

Heart rate, systolic, diastolic and mean arterial blood pressure were measured on the night before the procedure, the morning before the procedure, at arrival to the operating room as baseline, before and after induction, 1, 3 min after tracheal intubation, 1, 5, 15, 25 min after fixing laryngoscope, before laryngoscope removal, and 1 min after that. Analyses revealed that the systolic blood pressure was lower in group G after induction, 1 and 5 min after fixing laryngoscope and before removing the laryngoscope. Diastolic blood pressure in group G was lower at the time of arriving in the operating room, after induction, 1 min after fixing surgical laryngoscope and before removing the laryngoscope. Mean arterial pressure behaved similarly, and additionally it was lower at 5 min after fixing the laryngoscope. Heart rate was reduced at the time after induction, 1, 3 min after intubation, 5 min after fixing the laryngoscope and before laryngoscope removal in group G. Overall, in the group G, diastolic blood pressure and mean arterial pressure were lower in the first 15 min after microlaryngoscopy compared to group P but there was no difference in mean systolic blood pressure and mean heart rate.

CONCLUSION

800 mg oral gabapentin given 90 min before a procedure attenuates the rise of diastolic blood pressure and mean arterial blood pressure in the first 15 min after microlaryngoscopy surgery, but has no effect on systolic blood pressure or heart rate.