Surgical Approaches to Benign Parapharyngeal Space Tumors-5-Year Experience.

INTRODUCTION: Various surgical approaches to parapharyngeal space (PPS) tumors are introduced to obtain complete removal with the preservation of the surrounding structures in parapharyngealneoplasms. Here, we will discuss the main techniques and their outcome. MATERIALS AND METHODS: This retrospective study was conducted on 78 patients undergone either transoral, transcervical or a combination of these two approaches for the resection of PSS tumors from January 2010 to January 2015. RESULTS: A number of 33 male and 45 female patients with the mean age of 40.9 ± 9.1 were evaluated. 42.3% of the patients were asymptomatic at the initial presentation. Pleomorphic adenoma and schwannoma were a permanent diagnosis in 61(78.2%) and 11(14.1%) patients, respectively. PPS tumors were resected using transoral, transcervical and combined approaches in 35(44.8%), 33(42.3%) and 10 (12.9%) cases, respectively. Recurrence occurred in 10 patients all of whom had apre-styloid pleomorphic adenoma, operated transcervical (P< 0.0001).Three cases of tenth nerve palsy occurred in schwannomas which were operatedtranscervically (P=0.04). Mean hospital stays were 2.11,3.69, and 4.9 days after transoral, transcervical and combined approaches, respectively (P= 0.001). CONCLUSION: Transoral, transcervical and combined approaches are all able to provide adequate visualization with comparable outcomes.

Efficacy of systemic and intratympanic corticosteroid combination therapy versus intratympanic or systemic therapy in patients with idiopathic sudden sensorineural hearing loss: a randomized controlled trial.

OBJECTIVE: The present study was conducted to compare the rates of recovery from idiopathic sudden deafness after the treatment with oral and intratympanic corticosteroids in both mono and combination therapies. STUDY DESIGN: Triple-blind randomized clinical trial. SETTINGS: Tertiary referral hospital. SUBJECTS AND METHODS: A total of 112 patients who were admitted to the ENT emergency department randomly divided into three groups: an oral corticosteroid plus intratympanic placebo (systemic corticosteroid monotherapy group); an intratympanic corticosteroid plus oral placebo group (IT monotherapy group); and a combination therapy group (IT plus systemic combination group). All patients were treated additionally with antiviral and proton pomp inhibitor. An audiometry was performed once before beginning the therapies and again at the end of the therapy. RESULTS: Of the total of 112 patients, 32 received intratympanic (IT) corticosteroids, 45 were receiving systemic corticosteroids, and 35 were receiving a combination of the two. A total of 74 patients (66.1%) responded positively [response to treatment was calculated as gain of at least 10 dB in 10 dB in average threshold or with the minimum improvement of 15% in speech discrimination scores (SDS)] to corticosteroid therapy. No significant differences were observed between the three groups (IT, systemic group, and combination therapy group) in their overall response to treatment (p = 0.5). Patients who suffered from concomitant tinnitus and dizziness responded less positively to the treatment (p < 0.002). Positive family history of SSNHL seems to be negative prognostic factors in the response to treatment (p < 0.001). The response to treatment was not related to the pattern (p = 0.04) and initial severity of hearing loss (p = 0.9). CONCLUSION: This study did not find any difference in the rate of hearing improvement between systemic, intratympanic, and combined corticosteroid therapy for sudden hearing loss. LEVEL OF EVIDENCE: 1b.

A Treatment Protocol for Management of Bacterial and Fungal Malignant External Otitis: A Large Cohort in Tehran, Iran.

AIMS: High rates of negative microbiologic test results highlight the potential role of empiric antimicrobial agents in management of malignant otitis externa (MOE). This study investigates the clinical presentation, laboratory findings, and response to empiric treatment in a large group of patients admitted to a tertiary academic hospital in Tehran, Iran. METHODS AND MATERIALS: We recruited 224 patients diagnosed with MOE in a prospective observation from 2009 through 2015. All patients received a 2-agent antibacterial regimen at baseline (phase I). Patients with no improvement within 10 days and/or nonresponders to a second course of antibacterials were switched to antifungals (phase II). Response to treatment was observed and documented in both groups. RESULTS: All patients had physical symptoms for more than 12 weeks before admission. In total, 127 patients responded well to antibacterials. Eighty-seven out of 97 patients who were switched to antifungals had complete response to treatment; patients in the latter group had significantly higher A1C levels at baseline. CONCLUSION: Our findings provide evidence to develop clinical guidelines that accelerate diagnosis and treatment of MOE to improve patient outcomes.

Sex-specific association of RANTES gene -403 variant in Meniere's disease.

Several studies have shown the correlation between RANTES gene and inflammatory disorders; the aim of the present study was to investigate the association between RANTES promoter gene polymorphism and Meniere's disease (MD) in an Iranian population. In this study patients with MD comprising definite MD (N = 56) and probable MD (N = 15) were selected according to diagnostic criteria of AAO-HNS. The control group (N = 101) were healthy normal subjects who did not have a history of ear disease and vertigo. PCR-RFLP for RANTES -403G>A has been performed. We found a protective role for RANTES -403A allele in male group in our population. None of the male patients with MD were carrier of allele A which was significantly different from the presence of allele A in the male control group (AA+GA vs. GG: p = 0.0004, OR 0.05, 95 % CI 0.001-0.39). This difference was not significant in female group. There was no significant association between RANTES gene polymorphism and the level of hearing loss. our results showed a sex-specific association between RANTES gene polymorphism and MD but more studies are necessary to further assess this association.

Survivin gene polymorphism association with tongue squamous cell carcinoma.

SUBJECT: Survivin expression is correlated with tumor aggressiveness and severity in head and neck carcinoma. A polymorphism at position -31 (G/C) (rs 9904341) has been associated with cancer risk in several studies. We evaluated the correlation of this polymorphism with clinical manifestation of patients with tongue squamous cell carcinoma (SCC) in an Irananian population. METHODS: Paraffin-embedded tissue sections from patients with tongue SCC (n=91) were evaluated for association between the survivin -31 (G/C) polymorphism and tumor staging, pathological grade, lymph node metastasis, tumor size, and recurrence of tumor. RESULTS: There was a significant increase of presence of allele C in patients who were at stages III and IV compared to patients with lower stages [GC+CC vs. GG, p=0.025, odds ratio [OR] 2.76, 95% confidence interval [CI] [1.03-7.4]). In addition, presence of allele C was significantly decreased in patients with T1 tumor size compared to patients with larger tumor size (p=0.03, OR 0.6, 95% CI [0.2-2.03]). CONCLUSION: Presence of the C allele was significantly associated with tumor stage and size; therefore, survivin might be an important marker in the prognosis of tongue SCC that requires further investigation.

Lateral semicircular canal fenestration for congenital conductive hearing loss: Solution for a dilemma.

OBJECTIVE: To determine functional results after lateral semicircular canal fenestration on congenital conductive hearing loss. STUDY DESIGN: Case series with chart review. SETTING: Amir-Alam otolaryngology tertiary referral center. SUBJECTS AND METHODS: Twenty patients with congenital oval window malformations who were not candidates for ossicular reconstruction underwent lateral semicircular canal fenestration. A skin graft was placed over the perforated fascial graft on the fenestrated area. RESULTS: The median preoperative mean air conduction (MAC) was 56.9 dB (50.0 dB median air-bone). Postoperative median MAC gain of 34.3 dB (P < 0.001) and the median air-bone gap of 18.8 dB were observed. The mean bone conduction (MBC) did not show any significant changes postoperatively (P = 0.12). No sensorineural hearing loss, tinnitus, or imbalance was observed. CONCLUSION: We demonstrated hearing improvement after lateral semicircular canal fenestration. This technique can be considered as an alternative for patients with middle ear anomalies who are not candidates for ossicular reconstruction.

Improvement of bone conduction after stapes surgery in otosclerosis patients with mixed hearing loss depending from surgical technique.

This study investigate the effect of stapes surgery on bone conduction (BC) improvement in otosclerotic patients with mixed hearing loss and also compare the effect of three different types of surgery (complete stapedectomy, partial stapedectomy and microfenestration stapedotomy) on this improvement. We retrospectively reviewed surgical database of 84 otosclerotic patients with mixed hearing loss. Sixty-two patients (75%) had significant improvement in BC after surgery (P = 0.03). In 85% of patients with follow-up time longer than 1 year, this improvement had remained. Improvement in BC after surgery was better in partial stapedectomy group (82.6%) and complete stapedectomy group (80.8%) in comparison with microfenestration stapedotomy group (63%) (P = 0.052).