Vestibular function in meniere's patients

Meniere's disease [MD] is a disorder of the inner ear characterized by episodic attacks of vertigo with hearing loss, tinnitus, and aural fullness. Vertigo is a common feature in MD patients, but the pathophysiology is still largely unknown. Videonystagmography [VNG] is a sensitive tool for oculomotor system and differential diagnosis and treatment monitoring of vestibular system disturbances. The aim of the present study was to explore the VNG findings in patients with severe MD. In a cross-sectional design, we examined 75 [45 males and SO females] 22-47 years-old patients with severe MD who were referred to ENT clinics of Imam Khomeini and Apadana Hospitals, Ahwaz. Balance function was assessed using VNG test-battery comprising of oculomotor [optokinetics, smooth pursuit, saccade and gaze], caloric and positional tests. The results of gaze,optokinetic and smooth pursuit and saccadic eye movement [accuracy, latency and velocity] were within normal limits. Positional evaluation in eye-covered condition was abnormal in 14MD patients. Directional preponderance and unilateral weakness indexes were abnormal in 13.33% and 88.10% of patients, respectively. Fixation index was also normal in all patients. Our findings revealed thatVNG isa suitabletool for vestibular function assessment in Meniere's patients and among its subcomponents, caloric irrigation constitute the most sensitive test

[Survey of indication and early complications of tracheostomy in patients hospitalized in Ahvaz imam Khomeini hospital]

Tracheostomy, is one of the ways to manage major problems in the upper airways, in which a hole is performed in the anterior tracheal wall to establish a temporary airway. In the past tracheostomy was performed because of upper airway obstruction due to infectious disease. Now the reasons have changed. This study was conducted to assess indications and early complications of tracheostomy in patients hospitalized in Imam Khomeini Hospital, Ahvaz, for a 5 years period. This cross sectional and retrospective study was performed on 151 patients in Ahvaz Imam Khomeini Hospital during 2001- 2006. Patients were assessed for indication, timeing and early complication of the procedure. Factors such as age, sex, causes and complications of tracheostomy and mortality has been analysis. 104 males [68.9%] and 47 females [31.1%] with a sex ratio of 2.26 to 1, males to females and mean age of 47.8 mean assessed. The youngest one was 1.5 and oldest one 85 years old. The commonest indications for tracheostomy were laryngeal cancer in 69 cases [45.7%] and then prolonged intubation in 53 patients [35.1%]. 49 patients had carly complications with the most common one subcutaneous emphysema in 20 patients [13.5%]. Death occured in 11 cases which were related to underlying disease without any relation to tracheostomy itself. Tracheostomy is a procedure that can be life-saving and when necessary, surgeon skill and knowledge can decrease it's side-effects

Prevalence of auditory neuropathy in a population of children with severe to profound hearing loss

The purpose of this investigation is to determine auditory neuropathy in the students with severe to profound hearing losses in Ahwaz. In this cross-sectional study, 212 children of 7-11 year old with severe to profound hearing loss performed ordinary audiometric evaluations as well as ABR and OAE. The patients with normal DPOAE who had no record of acoustic reflex having normal ABR, were considered as the patients with auditory neuropathy. The neuropathic complication found in 14 children was appeared in 8 ones as one-sided [57.14%] and in 6 ones [42.86%] as two-sided. 68% of the patients as diagnosed had a very low Speech Discrimination Score [SDS]. We must be very vigilant in auditory neuropathy diagnosis for the purpose to be successful in appropriate treatment of severe to profound hearing losses

Thyroid hormones level before and after radiotherapy of neck in Imam Khomeini hospital of Ahvaz

Because of prevalence of head and neck cancer and extensive surgery in this area, complementary therapies in these patients are of particular importance. One of the most important complementary therapies is head and neck radiation therapy after surgery. Radiation therapy in head and neck can interfere on the thyroid gland function. The aim of this study is to determine the relationship between head and neck cancer radiotherapy and thyroid function after surgery. This study is an analytical epidemiological study on all patients who admitted for head and neck surgery in Imam Khomini hospital in 2007-2008. These patients candidate for complementary radiotherapy postoperatively. Exclusion criteria include: total for partial thyroidectomy, impaired thyroid function before radiotherapy and patients with a history of thyroid dysfunction. Levels of thyroid hormones [T3, T4, TSH] is recorded before and after radiotherapy. Age, sex, hormone levels before and after radiotherapy and the number of patients with hypothyroidism are reviewed. There was 60 patients, 34 women [56.6%] and 26 male [43.3%]. The mean age was 58.5 years, SD was 12.3. Thyroid tests in all patients were reported normal. Average amount of Total T3 before radiation therapy was 2.83 +/- 1.2 and after radiation therapy 1.74 +/- 0.9. P value level was 0.012. Average Total T4 levels before radiotherapy was 87.5 +/- 23.4 and after radiotherapy was 65.3 +/- 26.2. P value level was 0.003. Mean TSH levels before radiotherapy was 2.45 +/- 1.7 and after radiotherapy was 5.7 +/- 3.3. P value level was 0.000. 23 patients of 60 patients were hypothyroid [38%].There is a relationship between head and neck radiotherapy and hypothyroidism. We recommended controlling thyroid hormone function before and after treatment and then annually and also treating hypothyroidism if it occurred

Treatment efficacy of children with acute otitis media by otoacoustic emissions

It is well documented that children exhibit a high prevalence and incidence of otitis media. Otoacoustic emissions [OAEs] offer great potential for clinical testing of cochlear function in children. The aim of the present study was to determine the applicability of OAEs to assess hearing acuity in children with acute otitis media who were scheduled for middle ear treatment. In a analytic cross-sectional design, 54 children with acute otitis media were evaluated by pure tone audiometry [PTA], tympanometry and distortion-product otoacoustic emissions [DPOAEs]. PTA thresholds and, DPOAE amplitudes and signal to noise ratios were compared before and after treatment course. The data were analyzed by SPSS 16 software. Air conduction thresholds were significantly different from post-treatment thresholds [p<0.05] We found significant differences between pre treatment and post- treatment DPOAE amplitude and signal to noise ratios at 500 Hz - 5000 Hz [p<0.05]. Although we found any air-bone gap in 10 patients after treatment course, but DPOAEs were seriously affected in these patients. Acute otitis media can be monitored by DPOAE measurement pre- and post-treatment. In addition, DPOAE is more sensitive than pure tone audiometry for assessment of these subjects

Pharyngocutaneous fistula after laryngectomy: incidence, predisposing factors, and outcome

fistula is a common and troublesome postoperative complication after total laryngectomy. The objective of this report was to determine the incidence, predisposing factors, and outcome of postlaryngectomy pharyngocutaneous fistula in patients operated on in our department and to describe the management of the complication. The medical records of 146 consecutive patients who underwent laryngeal surgery for squamous cell carcinoma of the larynx between 1990 and 2005 were assessed. All patients had similar preoperative/postoperative care. We studied a number of factors that could influence fistula formation such as age, gender, smoking, systemic disease, preoperative radiotherapy, previous tracheotomy, site of tumor, surgical procedure, positive surgical margins, type of closure [T vs. vertical], concurrent neck dissection, suture material, clinical stage, histologic grade, and experience of surgeon [consultant vs. resident]. A pharyngocutaneous fistula was observed in 13% [19/146] of the patients within a mean time of 9.6 days from surgery. Spontaneous closure with local wound care was noted in 17 [89%] patients whereas a surgical closure was necessary in two. One patient required surgical closure by direct suture of the pharyngeal mucosa. Pectoralis major myocutaneous flap was used in another one. Our findings showed that fistula formation was significantly more common in patients who received previous radiotherapy or who had positive surgical resection margins or had a systemic disease. The mean healing time was 26 days. We concluded that pharyngocutaneous fistula remains a troublesome complication of the early postoperative period after total laryngectomy. There are many conflicting reports in the literature concerning the predisposing factors, but our data showed that the presence of systemic diseases, previous radiotherapy, and positive surgical margins can all be important predisposing factors, or at least underlying causes. Our experience confirmed that most fistulas can be successfully managed with conservative treatment

Esophageal foreign bodies in children

Foreign bodies occasionally become lodged in the esophagus because of the object's size or shape, narrowing of the esophagus lumen, or anatomic abnormalities. The objective was to review our experience with esophageal foreign bodies removal in Ahawaz Imam Khomeini Hospital, Ahwaz, Iran. A retrospective review was completed of the 240 charts of patients admitted with the final diagnosis of esophageal foreign body during 10 years [March 20, 1993 - March 21, 2002]. Sex, age, diagnosis on admission, estimated duration and site of impaction, type and number of foreign body removed and complication were recorded. One hundred fifty six boys and 84 girls aged of 3 months and 14 years were admitted with the diagnosis of esophageal foreign body. Sixty- five percent of patients were four years or less in age, 2.9% had a history of esophageal anomalies requiring operation. The duration of impaction in 85.4% was less than 24 hours. Management consisted of rigid endoscopic removal in 238 patients and open surgical removal in two patients. Postcricoid area was the commonest site of impaction, and more than half [131 cases] of the foreign bodies were coins. Complications were noted in 10%. Foreign bodies of the esophagus are common in young children and are likely to occur whenever a child puts an inedible object in the mouth. A foreign body is removed more safely with a rigid esophagoscope and under general anesthesia

Rhabdomyosarcoma of the larynx

Rhabdomyosarcoma of the larynx is a very unusual neoplasm and delays in diagnosis are common because the presenting symptoms are often mistaken for inflammatory or benign laryngeal disease, therefore a high index of suspicion is necessary to make diagnosis. We report a 13 years old girl with diagnosis of laryngeal Rhabdomyosarcoma. The optimum treatment of head and neck rhabdomyosarcoma has not been defined. Therapeutic modalities include an aggressive surgery without major morbidity. Radiotherapy and chemotherapy is also preferred for the treatment of rhabdomyosarcoma

[Ossicular chain reconstruction compare incus-TQRP and plastpore TORP or PORP]

The ideal tissue substitute for middle ear reconstruction has not been found. Techniques involving the use of ossicular autografts; homografts; cortical bone alloplastic prostheses; and wire have not been uniformly successful. This study includes 390 patients operated between1366-1377 employing incus autograft of homograft and plastipore TORP or PORP. Hearing results were analyzed pre, and postoperatively. Good hearing results in incus group was 83.7% and plastipore TOPR or PORP was 55.2%. The extrusion rate was extremely high with plastipore TOPR 24.5% and for incus group was 3.4%

[Functional endoscopic sinus surgery for fungal sinusitis [three years experience]]

Chronic noninvasive fungal sinusitis has three forms: mycetoma, allergic fungal sinusitis and superficial sinonasal mycosis. Symptoms are usually nonspecific with the same clinical manifestation of chronic bacterial sinusitis, allergic polypoid sinusitis and tumor like findings. Endoscopic surgery is the choice of treatment with good results. In this study 340 Pt's with diagnosis of chronic rhinosinusitis underwent endonasal endoscopic surgery. Based on clinical findings, staining, cultures and pathology 39 pt's had fungal sinusitis. 21 Pt's had allergic fungal sinusitis, 11 pt's had maxillary mycetoma, 6 cases sphenoid sinus mycetoma and one case had frontal mycetoma. Prevalence of fungal infection on our pt's was 11 5%. All cultures were aspergillus and mean follow up time was 26 months; excent for three pt's no recurrence was