[Assessment of surgical success rate and acoustic test findings in children after tympanostomy tube insertion]

Otoacoustic emissions are low density sounds produced from intact cochlea measurable in the presence of an intact conduction structure. The goal of this study was to assess the surgical success rate after tympanostomy tube insertion by Distortion Product Otoacoustic Emission [DPOAE] and Transient Evoked Otoacoustic Emission [TEOAE] as methods of evaluation of postoperative hearing. A descriptive-analytic study was conducted on 130 patients with OME. Audiometrical tests included TEOAE, DPOAE that were performed before, one month and three months after surgery on patients and results were compared. Prior to surgery, TEOAE and DPOAE responses were not recordable in any of the patients, whereas after surgery, the responses were significant. OAE tests can be used as objective, simple tests in children, especially in toddlers who are not able to cooperate in performing PTA before surgery. These tests can be also be used for follow up of patients for hearing loss improvement and resolvement of middle ear effusion

Anatomic variations of paranasal sinuses in patients with chronic sinusitis and their correlation with ct scan staging

The presence of anatomic variations of paranasal sinuses must be noted in order to attain a full understanding and accurate diagnosis of chronic sinusitis. The frequency of anatomic variations in chronic sinusitis is different in various studies. The purpose of this study is to assess the frequency of anatomic variations in chronic sinusitis patients admitted to Otolaryngology ward of Shahid Sadoughi hospital in the year 2004 and underwent functional endoscopic sinus surgery. Based on preoperative paranasal sinus CT scan the extent of patients diseases on a scale of 0-IV and the presence of anatomic variations was determined. A total of 120 patients were included. We found Agger Nasi cells in 43[36%], Haller cells in 5 [4.17%] conchae bullosa in 15[12.5%], paradoxical middle turbinate in 2 [1.67%] and septal deviation in 54 patients [45%]. Patients with Agger Nasi [P value: 0.015] and conchae bullosa [P Value: 0.024] demonstrated significantly higher scores on sinus CT scan compared with patients without Agger Nasi cells and conchae bullosa respectively. Three months postoperatively we observed significantly less resolution of nasal congestion [P Value: 0.006] in patients with septal deviation than patients without it. No significant difference was seen among patients with and without other anatomic variations with regard to resolution of rhinorrhea and nasal congestion three months postoperatively

[Assessment of spontaneous healing rate of traumatic tympanic membrane perforations and three months follow up; Yazd Forensic Medicine]

Traumatic tympanic membrane [TM] perforation is a common injury of the ear with a high rate of spontaneous healing if the patients strictly adhere to water precautions. The purpose of this study was to determine the factors involved in the spontaneous healing of traumatic TM perforations in order to ascertain the best treatment plan including observation, paper patch and finally surgery. In this correlative-descriptive study, we recorded the outcome of each patient with three-month follow up. Included in this study were a total of 202 forensic medicine patients from the Dept. of Otolaryngology Head and Neck Surgery at the Yazd University of Medical Sciences, Yazd, Iran. All patients included in this study had traumatic TM perforation. Based on otoscopic examination, the perforations were classified as pinpoint or large. All patients received an audiometry exam and were followed for three months. The data was collected using a special form and analyzed by chi-square test, Fisher exact test and ANOVA. This study consisted of 118 male and 84 female patients with a mean age of 23.6 years [6-48 years]. The types of trauma included compression injury [104 patients], instrumental injury [59 patients], burn-slag injury [2 patients] and blast injury [1 patient]. One hundred and eighty patients had pinpoint TM perforations, 99.4% of which healed spontaneously by the second month, and 32 patients had large TM perforations, 50% of which healed spontaneously by the second month. During the first month, 87.3% of the patients observing water precautions had healed, however the healing rate was only 5.6% in patients not adhering to water precautions, who suffered from otorrhea. Therefore, during this study, 185 [91.58%] patients had spontaneous healing by two months and only 6 patients of remaining 17 patients healed with paper patch. The mean hearing loss at 500, 1000 and 2000 Hz was 10.55 dB [5-30 dB]. In our experience, patients with traumatic TM perforations have higher spontaneous healing rate when observing water precautions. Furthermore, we recommend observation and paper patching for three months before attempting any surgical intervention in such patients

Multiple mucoceles in cystic fibrosis and Role of endoscopic sinus surgery in its treatment

Cystic Fibrosis [CF] is a hereditary disorder of mucous glands which due to impairment of sodium and chloride secretion affects mucosal surfaces. Although sinonasal complaints are common in CF patients, it presents usually as sinusitis or nasal polyposis and mucocele formation is a rare presentation of CF. Here we present a six year-old boy presenting with telecanthus and progressive nasal deformity as a result of multiple mucoceles in ethmoid, maxillary and sphenoid sinuses. This article discuss about this patient and reviews the role of endoscopic sinus surgery in CF patients

Visceral leishmaniasis [kala-azar] with a rare manifestation of submental adenopathy

Visceral leishmaniasis is a protozoal disease caused by L. donovani. Transmission to humans [incidental host] occurs via insect bite and the phlebotomous [female sand-fly] transmits the disease. Common presentations of the disease include hepatomegaly and splenomegaly, but fever, chills and night sweats may be part of the disease's symptoms. Lymphadenopathy without systemic manifestations is a very rare presentation of the disease. We hereby present a 9 year old boy in whom the only presentation of visceral leishmaniasis was a 2'1.5cm submental mass without any signs or symptoms. After excisional biopsy Leishmaniasis was confirmed and the patient underwent medical management that resulted in complete recovery. Visceral leishmaniasis must be considered as a cause of lymphadenopathy in endemic areas

Outcome of corneal scleral laceration in Yazd

The aim of this study is to define the epidemiologic characteristics and clinical profile and evaluation of final visual outcome of corneal scleral laceration. A prospective survey was conducted over a two year period from March 2000 to March 2002 on 79 consecutively admitted patients who underwent corneal scleral repairment at Yazd Eye Hospitals. This study included 79 eye injuries. Fifty nine of cases [74.7%] occurred in males and 20 cases [25.3%] in females. Mean age was 17.08 years. Left eye was more commonly involved [57%]. Initial VA was an important predictor of final VA. Good initial VA > 20/200 leading to excellent final VA. 40.6% of traumas occurred in the first decade of life. Injuries less than 10 mm and related to zone I and II predicted a good visual outcome. In this study endophthalmitis [5.1%] was much less likely to develop in eyes with primary repairment within 24 hours from the injury [1.5%] than in eyes being repaired after 24 hours [21.4%] and the difference was significant [P==0.016]. Significant predictive factors for final VA after corneal scleral injury include: initial VA, wound length, wound and location,, and the time of primary repair