Endoscopy findings affect subjective smell rehabilitation in post-laryngectomy patients using the nasal airflow-inducing manoeuvre.

OBJECTIVE: To evaluate the characteristics of post-laryngectomy patients, including nasal endoscopy findings, that affect subjective smell improvement in the post-surgical period. METHODS: Thirty patients who had undergone total laryngectomy participated in at least three sessions of a smell rehabilitation programme involving the nasal airflow-inducing manoeuvre, under the supervision of a speech-language pathologist. Patient characteristics and nasal endoscopy findings were evaluated. RESULTS: Participants experienced a mean improvement in sense of smell of 61 per cent (p < 0.001) and a significant improvement in appetite (p = 0.002). Male patients and patients with a nasal discharge had a significantly better outcome. CONCLUSION: The nasal airflow-inducing manoeuvre is an effective method for improving smell perception and appetite in laryngectomy patients. There was no relationship between nasal endoscopy findings and outcome of the nasal airflow-inducing manoeuvre rehabilitation programme in our case series.

Thyroid involvement by laryngeal cancer among Iranian patients.

OBJECTIVE: Asian patients with laryngeal cancer have been reported to have a high prevalence of thyroid involvement. This study aimed to investigate the prevalence of thyroid invasion in Iranian patients with laryngeal cancer. METHODS: Hospital records for all patients with a definite diagnosis of laryngeal cancer between 1996 and 2009 (351 patients) were reviewed, and the prevalence of thyroid invasion was established based on the pathology report at the time of surgery. RESULTS: Thyroid invasion was found in 16 patients (4.55 percent), and was limited to one thyroid lobe in two-thirds of cases. All instances of thyroid invasion occurred in patients with stage III (81.25 percent) or IV (18.75 percent) cancer. No case of metastasis was reported. The glottic region was identified as the tumour origin in most cases of thyroid invasion (56.25 percent). CONCLUSION: Most cases of thyroid invasion by laryngeal cancer occurred in cancer stage III, at grades G1 and G2, among male patients, and arose from tumours of the glottic region.

Olfactory function after nasal plastic surgery.

OBJECTIVE: Nasal plastic surgery is a common procedure, which may cause complications. Many patients are concerned about possible changes in the ability to smell. This study aimed to investigate the impact of nasal surgery, by itself, on the sense of smell in a group of patients with minimal endonasal pathologies and no pre-operative olfactory alterations. METHODOLOGY: In this prospective study from January 2009 until January 2011, we evaluated post-rhinoplasty olfactory changes in a series of 100 rhinoplasty candidates. Olfactory evaluation was performed both subjectively and objectively. The subjective evaluation contained a 0-to-100 Visual Analogue Scale and a five-choice qualitative questionnaire; while, the objective evaluation was performed using the same odor variant of the University of Pennsylvania Smell Identification Test (UPSIT40). Then, the results were analyzed by age, sex, operation method, symptoms, and time-interval groups. RESULTS: Subjective and objective scoring revealed no significant change in terms of postsurgical olfactory outcome. According to subjective grading, 26 patients had improvement, 61 had no change, and 13 had deterioration of the smell sense. Closed rhinoplasty resulted in a better smell outcome after surgery according to the Visual Analogue Quantitative Score (P = 0.034). CONCLUSION: Rhinoplasty does not appear to significantly change the preexisting olfactory status.

The clinical manifestation, evaluation and surgical management of sphenoid sinus mucoceles: a case series and literature review.

OBJECTIVE: This study was designed to describe clinical manifestation, treatment and outcomes in patients with sphenoid sinus mucocele presenting to Amiralam Hospital, Tehran, Iran. METHODS: A review of 43280 medical records covering a period of 10 years included just 12 patients with sphenoid sinus mucocele presenting to our teaching centre. RESULTS: The mean age of the patients was 35 years (ranging from 19 to 52 years). Headache was the most frequent symptom in 9 of the 12 patients. Visual disorders were noted in five patients. Two patients underwent external ethmoidectomy accompanied by intranasal sphenoidotomy while transseptal sphenoidotomy was performed for five patients and five patients underwent endoscopic endonasal sphenoidotomy. Wide spectrum antibiotics were given to all the patients for 3 to 5 days in order to prevent any iatrogenic infection. All patients did well after surgery without postoperative complications. CONCLUSIONS: Sphenoid sinus mucocele should be considered in the differential diagnosis of cystic lesions presenting as visual disturbance. Retro-orbital headache with or without visual symptoms is a leading symptom. CT and MRI are essential in the diagnosis of sphenoid disease.

Prevalence of fungal infection among Iranian patients with chronic sinusitis.

Chronic sinusitis is a major cause of morbidity today. Regional variations in the incidence of this disease have been reported. The aim of this study was to evaluate the incidence of fungal infection as the causative agent of chronic sinusitis among Iranian patients. A cross sectional hospital based study was designed; the patients underwent paranasal sinus washing and maxillary sinus biopsy. All specimens were studied by light microscopy. Fungal culturing was employed to confirm diagnosis. The patients underwent Computed Tomography for sinus evaluation. Of 162 participants, 12 samples from patients showed fungal elements, 2 of them Aspergillus fulvous (1.2%), 9 of them Alternaria species (5.56%) and 1 of them Psilomysis (0.6%). All patients presented radiologic evidence of sinusitis, ranging from mucosal thickening to total opacity. In conclusion, results obtained showed a low prevalence of fungal sinusitis among Iranian patients with chronic sinusitis. Findings also showed that Alternaria is the most causative agent.

Surgical outcomes in head and neck cancer patients 80 years of age and older.

BACKGROUND: Elderly patients over 80 years of age represent a growing population, some of whom have complex medical problems that are compounded by the presence of upper aerodigestive tract cancer. METHODS: Forty-three patients, aged 80 years and older, who were initially seen with head and neck squamous cell carcinoma from 1986 to 1992 at a tertiary-care center were compared with 79 similar patients, aged 65 years or younger, in a retrospective, case-control study. RESULTS: Median overall survival for the patients over 80 years of age was significantly lower than that for the controls (p = .001). However, their overall survival was similar to the actuarial survival for the general octogenarian population. Advanced age also adversely affected local control (p < .001) and disease-specific survival (p = .041). Although the older age group had a higher frequency of morbid preoperative conditions, there were no significant differences in perioperative or postoperative complications between the two groups. CONCLUSIONS: Careful preoperative staging and evaluation of associated medical illnesses, as well as skillful perioperative and postoperative management, are essential for reducing operative morbidity and mortality in the octogenarian patient. Successful outcome depends upon appropriate surgical management, treatment of concurrent illnesses, and minimization of postoperative complications. Individualized surgical management of the elderly head and neck cancer patient is effective, well tolerated, and clinically indicated for upper aerodigestive tract malignancies.