Frequency of hearing impairment among full-term newborns in Yazd, Iran

Permanent congenital hearing loss, a common congenital anomaly, may affect speech and language acquisition, academic achievement and social development. Current standards emphasize early recognition of congenital hearing loss. This study was conducted to find the prevalence of hearing impairment in term newborns in Yazd, Iran. This was a descriptive-analytic study conducted in Yazd on 7250 term newborns. Otoacoustic emissions [OAEs] test was performed in all newborns during the first 24 hours after birth. Those who failed to respond at the first step were retested 15 days later. Those who failed to respond at the second step too, were tested by acoustic brainstem responses [ABR] test. Chi square test was used for data analysis. From 7250 newborns in the first step 598 [8.2%] and 682 [9.4%] ears [right and left, respectively] failed. In the second step 51 [0.7%] and 58 [0.8%] ears [right and left, respectively] failed. Consanguinity and route of delivery had significant effect on the frequency of hearing loss. The overall frequency of congenital hearing loss in this study was found high

Radiofrequency uvulopalatoplasty for primary snoring

Simple snoring is a social problem, one that can gravely affect the patient's married life. About 40% of men and 20% of women are affected, and it often goes along with sleep-disordered breathing. Up to now various surgical techniques have been defined such as UPPP[uvulopalatopharyngo plasty], and laserassisted uvulopalatoplasty [LAUP]. Among the surgical methods, RAUP [radiofrequency assisted uvulopalatoplasty] is a minimal invasive, an easy performed, and time and cost effective one. We designed a before and after a clinical trial. The inclusion criteria were age >18 years, complaint of nocturnal snoring, have a bed partner to assess snoring, AHI<5 events per hour in the polysomnography, malampathy score [soft palate position] one or two, an elongated uvula, grade one and two of pharyngeal webbing and patient consent was needed too. A 10-score visual analog scale [VAS] of snoring severity was completed by bed partner. All of 35 included patients underwent RAUP under local anesthesia by the same expert surgeon. After 3 months, 6 months and one year, subjective snoring decreased significantly compared to the preoperative period. The decline in VAS in 6 month compared to 3 months postoperatively, was not significant [P=0.223]. When comparing 1 year and 6 months after treatment, the VAS scores were increased, but they were not significant [From 1.8 to 1.9, P=0.78]. Three months after treatment minor complications consisted of: nasal regurgitation in 2 patients [5.7%], nasal speech in 2 [5.7%] and exacerbation of snoring in 2 [5.7%] patients.There was no major complication including mucosal laceration, uvular damage and obstruction of the airway. The rate of snoring decrease did not correlate with age, sex and BMI. Based on this study and literature review, it seems RAUP is a safe surgery, which may decrease symptoms of snoring, at least, in short-term follow-up.

Effect of adenotonsillectomy on adhd symptoms of children with adenotonsillar hypertrophy

Adenotonsillar hypertrophy and obstructive sleep disordered breathing can lead to attention deficit/hyperactivity disorder [ADHD]. The purpose of this study was to evaluate effect of adenotonsillectomy on improvement of ADHD symptoms in a quasi-experimental [before and after] study. The efficacy of adenotonsillectomy on improvement of ADHD symptoms of 35 children aged 5-12 years with adenotonsillar hypertrophy and ADHD was evaluated six months after surgery. Diagnosis of ADHD was based on the DSM-IV criteria in three subtypes [predominantly inattentive type, predominantly hyperactiveimpulsive type and combined type]. Seventeen boys [49%] and eighteen girls [51%] with mean [ +/- SD] age of 7.4 +/- 3.8 years [range: 1-10 years] were evaluated. Frequency of combined type of ADHD decreased significantly six months after adenotonsillectomy [54.3% versus 22.9%, P=0.003]. ADHD inattention score [2.26 +/- 1.93 versus 0.96 +/- 0.45, P=0.005], hyperactivity score [4.23 +/- 3.57 versus 3.57 +/- 8, P=0.03] as well as ADHD combined score [9.66 +/- 2.58 versus 7.2 +/- 3.67, P=0.0001] improved significantly after surgery. Upper air way obstruction due to adenotonsillar hypertrophy might be an important and treatable cause of ADHD and should be considered in evaluation of affected children. Adenotonsillectomy in these children is associated with improvements in ADHD symptoms.

Lymphatic metastasis in head and neck squamous cell carcinoma

Squamous cell carcinoma is the common type of malignancy in head and neck area and it metastasis into the regional lymphnodes. The objective of this study was to evaluate the detection of this metastasis via lymphatic channels around the tumor or via newly formed lymphatics inside the tumor. This case series included twenty patients specimens with head and neck squamous cell carcinoma. They were evaluated for lymphangiogenesis by using Vascular Endothelial Growth Factor 3 and KI67 immunohistochemical markers and then the data was correlated with clinicopatological criterias. High intratumoral and peritumoral lymphatic densities were both found significantly associated with the poor histological differentiation [Exact test p= 0.023]. There was no association between intratumoral lymphatic density, peritumoral lymphatic density and the presence of lymph node metastasis, location of the tumor, age, and sex. There was however a significant association between intratumoral lymphatic density and peritumoral lymphatic density [Fisher exact test p=0.001]. This study reveals the existence of intratumoral and peritumoral proliferating lymphatics, but these lymphatics have no correlation with the lymph node metastasis in all the head and neck squamous cell carcinoma cases such as larynx and oral cavity

Prevention of adhesion after endoscopic sinus surgery: role of mitomycin C

Adhesions after endoscopic sinus surgery [ESS] are a potential cause of surgical failure. Mitomycin-C [MMC] is recently proposed as a solution for these adhesions. This study was performed to investigate the effect of Mitomycin C in reducing scar formation and adhesion in the nasal mucosa after endoscopic nasal surgery. This double blind randomized clinical trial study was performed on 37 patients with bilateral chronic rhinosinusitis. At the end of ESS, randomly impregnated mesh with MMC was placed in one side and another mesh impregnated with saline in the opposite side for 5 minutes. Patients were followed at least for three months, and the results of diagnostic endoscopy were recorded. Post operative adhesion occurred in 12 [32.4%] patients [2 bilateral/10 unilateral]. Among total of 14 adhesions, 4 [10.8%] were in the MMC side and 10 [27%] in the control side. This differences was close to statistically significant [P=0.058]. MMC may reduce adhesions after ESS, but further studies with different doses, sample size and frequent use of topical MMC is recommended

Hearing status in neonatal hyperbilirubinemia by auditory brain stem evoked response and transient evoked otoacoustic emission

Hyperbilirubinemia at neonatal period is one of the major deteriorating factors of the auditory system. If left untreated, it may cause certain cerebral damage. This study aims to evaluate the impact of hyperbilirubinemia on the hearing of neonate. This study was conducted on 35 newborn babies with jaundice [bilirubin more than 20 mg/dL]. Auditory brainstem response [ABR] and transient evoked otoacoustic emission [TEOAE] tests were performed, after treatment and one year after. ABR test results indicated that 26 children [74.3%] had normal hearing but 9 [25.7%] suffered from an impairment. As for TEOAE test, 30 children [85.7%] passed whereas the remaining [14.3%] seemed to be failures. The comparative results of the two tests pointed to autonomic neuropathy /autonomic dysreflexia symptoms in 5 babies. Due to the high incidence of Autonomic neuropathy/autonomic dysreflexia among hyperbilirubinemic babies, screening in this regard seems reasonable. Our result emphasizes the necessity of more experiments on the afflicted areas

Endoscopic endonasal surgery for resection of benign sinonasal tumors experience with 107 patients

The use of endoscopic surgery for nasal and sinus pathologies has revolutionized our approaches towards the diseases of these areas. To report our experience with endoscopic surgery of benign tumors and tumor-like conditions of the nose and paranasal sinuses. The medical records of 105 patients with benign sinonasal tumor, who had undergone endoscopic surgery for removal of their neoplasm between 1997 and 2003, were retrospectively studied. The studied patients included 32 with juvenile nasopharyngeal angiofibroma, 24 with inverted papilloma, 23 with benign fibroosseous lesions, 18 with pyogenic granuloma, 6 with intranasal hemangioma, and 2 with pleomorphic adenoma. The patients had a follow-up ranging from 9 to 73 [mean: 41] months. During the follow-up period, the patients were under close observation by performing serial endoscopy and yearly CT scan. Eight cases of recurrent tumor-2 angiofibroma, 4 inverted papilloma, 1 fibrous dysplasia, and 1 osteoma-were noted and managed endoscopically alone or in combination with Caldwell-Luc approach. The major complication encountered in this study was cerebrospinal fluid leakage [2 cases] that was sealed intra-operatively with local tissue flaps without any further sequela. Endoscopic surgery is a valuable tool for removal of benign tumors of the nose and paranasal sinuses in the hands of an experienced surgeon