Low-dose preoperative pregabalin improves postoperative pain management in septorhinoplasty surgery: a double-blind randomized clinical trial.

PURPOSE: To evaluate the efficacy of single low dose (75 mg) preoperative pregabalin in reducing post-operative pain of septorhinoplasty. METHODS: A double blind single center Randomized controlled trial based on block randomization. In the pregabalin group (PG) 34 participants received 75 mg pregabalin orally one hour before anesthesia induction while in control group (CG) 34 participants received a placebo. Pain and sedation were repeatedly measured with Visual Analouge Scale (VAS) and Riker Sedation-Agitation Scale (RSAS) respectively, 0.5, 1, 2, 6, 24 hours postextubation. Cumulative doses of fentanyl and ibuprofen received in both groups were compared. RESULTS: Thirty-two of the participants in PG and 33 of the participants in CG completed the study. The Mean VAS pain score was less in PG versus CG 30 min postoperatively (2.30 ± 1.30 vs. 4.85 ± 1.17), one hour (2.28 ± 0.92 vs. 4.27 ± 0.78), two hours (2.11 ± 0.88 vs. 3.60 ± 0.61) and six hours (1.47 0.62 vs. 2.76 ± 0.91) but not 24-hours postoperatively (0.84 ± 0.62 vs. 1.09 ± 0.92). Participants in the PG were less agitated during early post-extubation period (at 10 min: RSAS 3.93 ± 0.43 vs. 4.42 ± 0.50) and more alert during the first hour post-extubation (at 60 min: RSAS 3.90 ± 0.29 vs. 3.36 ± 0.69). The total dose of rescue fentanyl and ibuprofen was lower in the PG compared to the CG. CONCLUSIONS: A single dose of 75 mg pregabalin is very effective for pain control after septorhinoplasty procedure when administered one hour before anesthesia induction. Side effects are rare and opioid sparing was noted. TRIAL REGISTRATION: Clinical trial number: IRCT2017043033706N1.

Meatoplasty in Canal wall down Surgery: Our Experience and Literature Review.

INTRODUCTION: Meatoplasty is the final and essential step in performing effective canal wall down surgery for chronic otitis media. In this article we review some previous techniques and discuss our preferred method. MATERIALS AND METHODS: In this observational case series study, we used this technique in 53 patients (28 male and 25 female) between January 2005 and January 2008. Our survey was completed in 31 patients. RESULTS: Twenty-six patients (83.9%) said their ear appeared normal after the procedure, but five patients (16.1%) complained of some minor change in the shape of their ear. Twenty-nine patients (93.5%) had a completely wide ear canal. The ear canal had some degree of stenosis in two patients (6.5%) post-operatively. CONCLUSION: This technique offers good functional and cosmetic results with minimal manipulation and minimal anatomic disruption.

Surgical Outcomes of Cerebellopontine angle Tumors in 50 Cases.

INTRODUCTION: To report our experience with a large series of surgical procedures for removal of cerebellopontine angle (CPA) tumors using different approaches. MATERIALS AND METHODS: This was a retrospective analysis of 50 patients (mean age, 49 years) with CPA tumors (predominantly acoustic neuroma) who underwent surgical removal using appropriate techniques (principally a translabyrinthine approach) during a 4-year period. RESULTS: One death occurred during this study. There were nine cases (18%) of cerebrospinal fluid leak, and five patients (10%) were diagnosed as having bacterial meningitis. Complete gross tumor removal was not achieved in four patients (8%). Facial nerve function as measured by the House Brackmann system was recorded in all patients 1 year following surgery: 32% had a score of 1 or 2; 26% had a score of 3 or 4; and 8% had a score of 5 or 6. Other complications included four cases of wound infection. CONCLUSION: The translabyrinthine approach was predominantly used in our series of CPA tumors, and complication rates were comparable with other large case series.

Effect of Intratympanic Dexamethasone on Controlling Tinnitus and Hearing loss in Meniere's Disease [corrected].

INTRODUCTION: We investigated the effect of intratympanic dexamethasone on control of tinnitus and hearing loss in patients with Menier's disease. MATERIALS AND METHODS: 100 consecutive patients with a diagnosis of Menier's disease according to the 1995 criteria of The American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) who remained symptomatic despite medical therapy were assigned to receive intratympanic dexamethasone. The results were assessed with respect to changes in hearing symptoms and tinnitus. RESULTS: Hearing improvement and improvement in SDS was observed in 52% and 35% of patients, respectively. Tinnitus score was improved in 57% of patients. There was no relationship between age, sex, duration of disease, unilaterality of disease, or response to therapy. CONCLUSION: Intratympanic dexamethasone may be effective in the symptomatic control of hearing loss and tinnitus in Menier's disease.

Myringoplasty using rotation flap of canal skin for total tympanic membrane perforation.

OBJECTIVE: To evaluate the efficacy of a novel technique of using rotation flap of canal skin in patients with total or subtotal tympanic membrane (TM) perforation with no anterior residual tympanic membrane. METHODS: A retrospective study of 50 patients with total or subtotal perforation repaired with rotation flap of canal skin. Clinical and audiometric data were recorded. RESULTS: The overall perforation closure rate was 96%. A statistically significant shortened healing time was observed. CONCLUSION: The rotation flap of canal skin could be an effective and safe technique for perforations with no anterior residual TM.

Detection of helicobacter pylori in benign laryngeal lesions by polymerase chain reaction: a cross sectional study.

BACKGROUND: Although Helicobacter Pylori (HP) was detected in some cases of chronic laryngitis, the results were not confirmed by polymerase chain reaction (PCR). By this time, it has not been found in laryngeal lesions by in house PCR, the most sensitive method for detecting the genome tracks. Regarding the previous results and also few numbers of studies about the presence of HP in benign laryngeal lesions, specifically by PCR, we aimed to investigate the presence of HP in benign laryngeal lesions by in-house PCR. METHODS: The samples were taken from 55 patients with benign laryngeal lesions and frozen in -20°C. One milliliter (ml) of lysis buffer was added to 100 mg (mg) of each sample and the tube was placed in 56°C overnight. Then DNA extraction was carried out. RESULTS: To find HP DNA, in-house PCR was performed that revealed 5 positive results among 55 patients with benign laryngeal lesions. Of them, 3 were polyp, 1 was nodule and 1 was papilloma. CONCLUSION: Although the number of positive results was not a lot in this study, it was in contrast with previous studies which could not find any HP tracks in benign laryngeal lesions by other methods. More studies about the prevalence of HP in benign laryngeal lesions improve judging about the effect of this infection on benign laryngeal lesions.

Congenital aural atresia surgery: transmastoid approach, complications and outcomes.

Repair of complete congenital aural atresia (CAA) could be a challenging procedure due to complications reported with CAA surgery such as facial nerve palsy, canal stenosis, graft lateralization, sensorineural hearing loss or the difficulty involved in the surgical technique. From 2006 to 2009, we used a one stage-modified transmastoid approach for surgical repair of 33 ears with complete CAA via a non-randomized controlled clinical trial. Some modifications in the technique of mastoidectomy, ossiculoplasty, fascia and skin grafting and meatoplasty have been described. Patients were followed up for 12 months to assess audiometric results and post-operative complications. Changes in air-bone gap and need for revision surgery or hearing aids were assessed at follow-up. There were no cases of facial weakness, dead ear or bony canal stenosis. Hearing success in 2 months follow-up was achieved in 72.7% of all patients. Success rate increased to 92.3% in patients with Jahrsdoefer's scores of 8 and above. Overall success rate decreased to 63.6% at 12 months follow-up. There were no significant difference in Jahrsdoerfer score of patients with successful first surgical attempt and those who needed revision surgery (P value >0.056). Also patients of lower age (less than 5-years-old) did not have more need for revision surgery when compared with older patients (P value >0.36). However, being a syndromic patient did increase the need for revision surgery (P value <0.04). Age was not a predictor of meatal/canal stenosis and patients with lower Jahrsdoerfer scores could also achieve good results.

Safety and patient selection of totally implantable hearing aid surgery: Envoy system, Esteem.

Patient's low compliance of conventional hearing aids has lead to innovation of totally implantable hearing devices such as Esteem, Envoy system. This study was designed to evaluate safety of device implantation, patient's hearing gain, importance of anatomic landmarks, and to describe suitable criteria for patient selection. Via a non-randomized controlled clinical trial, ten patients with moderate-to-severe sensorineural hearing loss were implanted from 2007 to 2009. Mean follow-up period was 29.4 months. Correlation of pre-operative temporal bone CT scan anatomy with postoperative outcome was evaluated. Except one, all other implanted devices are active and patients' overall average hearing gain are similar to conventional hearing aids (10-22 dB), but patients reported relatively better subjective sound quality compared with their pre-operative conventional hearing aids. One implanted device was explanted in a patient due to facial weakness and low-hearing gain. Revision surgery was done successfully in another patient secondary to excessive bone growth. Totally implantable hearing device surgery seems to be relatively safe and correct patient selection could lead to good outcomes. Lateral location of facial nerve, sclerotic mastoid air cells and narrow facial recess space seems to be related to postoperative complications.

The butterfly procedure: a new technique and review of the literature for treating anterior laryngeal webs.

Congenital laryngeal webs, subglottic stenosis, and laryngeal atresia result from various degrees of failure of airway recanalization as a spectrum. The symptoms also range from asymptomatic to dysphonia and severe airway obstruction. There are a number of methods for management of symptomatic patients. In this article, we discuss a new procedure that was used in the management of two anterior laryngeal web patients with relatively acceptable results.

Transpetrosal approach: an anatomical study of temporal bone.

Resection of the petrous temporal bone to various degrees provides different levels of access to lesions of the posterior fossa. However, regarding the numerous variations, precise distances of petrosal bone are not still clearly described. This may lead to serious complications during transpetrosal surgeries. Our objective was to evaluate different distances of temporal bone landmarks in order to assess their variations and the possible correlations between them. This anatomical study was performed on 60 temporal bones from 60 human cadavers in the years 2006 and 2007. All the bones contained an adequate portion of the petrous apex and attached fossa dura. Twelve landmarks were defined and 27 different distances were measured for each temporal bone using two-point caliper. Less variation was observed in the superoinferior diameter of horizontal carotid canal with the less coefficient of variation (CV) of 9.29; whereas, the most variation was detected in the inferior (axial) plane of posterior semicircular canal to superior plane of jugular bulb (CV = 57.65). There was a significant correlation between vertical intratemporal diameter of carotid in pyramidal direction, and superior-inferior diameter of horizontal carotid canal (r (Pearson) = 0.500, P < 0.001). Other significant correlations were also found between other distances. The variations of different distances and landmarks were evaluated and many significant correlations were demonstrated between them which could potentially aid ENT specialists and neurosurgeons in order to approach anatomical landmarks and cranial fossas more safely during otologic and neurotologic surgeries. It could also help the design of middle ear prosthesis.

Werner's syndrome: a rare cause of hoarseness.

Werner's syndrome (WS) is a rare hereditary disorder which is characterized by clinical signs of premature aging. A 31-year-old man presented with a 12-year history of hoarseness. Also noted were diabetes mellitus, cataracts, scleroderma-like skin atrophy, osteoporosis, and hypogonadism. A clinical diagnosis of WS was made. Laryngoscopy revealed bowed vocal folds resulting in a spindle-shaped closure with glottal incompetence during phonation. We used Gortex for medialization of the middle part of vocal fold to correct the glottal gap in this patient. Despite correction of glottal incompetence in patients with WS, quality of voice could not be improved to that of age-matched normal individuals.