Endoscopic Access to Brain Abscess Due to Sinonasal Infection.

BACKGROUND: Brain abscesses caused by sinonasal infections have become more common during the coronavirus pandemic, particularly due to the increase in sinonasal mucormycosis. This study aimed to evaluate the efficacy and safety of endoscopic endonasal brain abscess drainage as a therapeutic technique for these cases. METHODS: Clinical outcomes and retrospective evaluations were performed in patients who underwent endoscopic endonasal brain abscess drainage between May 2019 and August 2022. A total of 7 patients diagnosed with 9 brain abscesses caused by sinonasal infections were included in the study. The main outcome of this study was to evaluate the success and safety of this technique. RESULTS: The average age of the patients was 40.71 ± 14.17 years. The most common symptom observed in these patients was nasal discharge, and the frontal lobe was the most common site of abscess. Notably, the majority of cases were associated with COVID-19. CONCLUSIONS: Based on the results of this study, endoscopic endonasal brain abscess drainage is considered a viable treatment option for skull base brain abscesses caused by sinonasal infections. Further research in this field can help establish this technique as a mainstay approach for managing brain abscesses at the skull base.

The effect of injection of 1:100 000 adrenaline solution in the pterygopalatine fossa on intra-operative bleeding during endoscopic sinonasal surgical procedures in chronic sinusitis: a blinded clinical trial.

OBJECTIVE: Rhinosinusitis is one of the most common reasons for a visit to otolaryngology clinics. Some patients are candidates for sinus surgery. Infiltration of 1:100 000 adrenaline in the pterygopalatine fossa was studied, with the aim of evaluating the effect on bleeding in the surgical field. METHODS: This double-blind clinical trial was conducted in 2021-2022 on 40 candidates for endoscopic sinus surgery. For each patient, one side of the pterygopalatine fossa was randomly selected to be infiltrated with a vasoconstrictor. Surgical field bleeding on each side was evaluated. RESULTS: Blood loss was 35.8 ± 20.9 ml in the study group and 38.4 ± 23.7 ml for the control group, with no statistically significant difference between groups (p = 0.49). In addition, there was no difference between the two groups in terms of the surgical field based on Boezaart scores. CONCLUSION: Although there are some recommendations on the usage of vasoconstrictors via the pterygopalatine foramen, debate remains.

The Association Between Choroidal Thickness and Meniere's Disease: A Cross-Sectional Study.

OBJECTIVE: To evaluate and compare choroidal thickness (CT) between patients with Meniere's disease (MD) and a control group. METHODS: This case-control analytical study was conducted on 37 subjects with MD and 37 healthy subjects. Subfoveal CT (SCT), large choroidal vessel (LCV) layer thickness, and mean subfoveal LCV thickness/mean SCT ratio were measured using enhanced-depth imaging optical coherence tomography (EDI-OCT) in the eyes on the MD side (ipsilateral), the contralateral eyes, and the control group. RESULTS: A statistically significant difference was observed in the mean SCT values between the ipsilateral and control groups after adjustment for age, sex, and migraine (p = 0.04). Moreover, there was a statistically significant difference between the mean subfoveal LCV thickness values and the mean subfoveal LCV thickness/mean SCT ratio between the ipsilateral and control groups (p = 0.006, and p < 0.001, respectively). Patients with a duration of disease over three years had a greater mean subfoveal LCV thickness/mean SCT ratio (67.35 ± 11.56 and 60.66 ± 11.27, respectively), which was statistically insignificant (p = 0.08). CONCLUSION: We found a thicker choroid and Haller layer, and a greater subfoveal LCV thickness/SCT ratio on the MD side compared to the controls. Furthermore, patients with a greater duration of disease had a lower subfoveal LCV thickness/SCT ratio. These findings may reflect the role of the trigeminal vascular system (TVS) and neurovascular pathophysiology in MD patients. More extensive studies are required to reach more definitive conclusions about the association between CT and MD. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:1889-1893, 2024.

Rhinocerebral mucormycosis in immunocompetent patients: a case report and review of literature.

INTRODUCTION: Mucormycosis of the head and neck region is a rare but aggressive fungal infection that usually involves immunocompromised patients. More infrequently, this infection can also occur in people with no otherwise known underlying immunological deficit. This rarity usually causes a delay in diagnosis and may severely decrease the chance of survival in these patients. In this study, we present an extreme case of mucormycosis in an immunocompetent patient. By conducting a thorough review of the literature, we aim to increase our knowledge on this matter. Our goal is to improve diagnosis and start treatment at an earlier stage. CASE PRESENTATION AND METHODS: Our patient was a 31-year-old man who presented with bilateral face numbness, neck pain, headache, and a necrotic palatal lesion 45 days after a dental root canal procedure. There was extensive involvement of facial and skull base bony and soft tissues. Through two debridement sessions and intravenous antifungal treatment, the patient was discharged with near-complete disease resolution. We identified 48 cases in the literature that matched our study criteria. We searched the current literature for proven cases of mucormycosis in the head and neck region who didn't have any underlying disease. We extracted their data and added the data of our patient. Then, we re-analyzed them using descriptive analysis, chi-square, and binary logistic regression to better understand the different factors for survival and disease burden in these patients. RESULTS: 49 patients were analyzed in this study. The mean age was 46.93 ± 15.75 (min 16 and max78 years old). The most prevalent subsite to be involved was the sino-nasal mucosa, followed by the surrounding soft tissues and the orbit. While both orbit and intracranial tissue involvement differed significantly between surviving and deceased patients, only intracranial tissue involvement could be used to predict survival. The overall survival rate was 91.8%. CONCLUSION: Although very rare, mucormycosis can occur in immunocompetent patients. Physicians should consider mucormycosis when faced with refractory conditions and unusual symptoms such as exposed bones, facial numbness, headaches, and intractable pain. Complementary imaging (CT scan with or without MRI) and histopathological examination are critical for timely diagnosis or exclusion of this potentially fatal yet treatable disease.

Investigation of the effects of intranasal desmopressin on the bleeding of the patients during open septorhinoplasty: A randomized double-blind clinical trial.

Objectives: Rhinoplasty is one of the most common cosmetic surgeries in the world. Lack of adequate local homeostasis may lead to excessive bleeding during the operation, which increases the time of operation and recovery period, and the prevalence of complications. This study investigated the effects of nasal desmopressin on the quality of the surgical field and the volume of bleeding during rhinoplasty. Materials and methods: This double-blind randomized clinical trial was performed on 120 patients aged 18-40 years who were candidates for rhinoplasty. Patients were randomly divided into three groups: low-dose desmopressin group and high-dose desmopressin group and placebo group. Hemodynamic changes and surgical field based on BOEZAART criteria, and the volume of bleeding were calculated. Results: In this study 115 women (95.8%) and 5 men (4.2%) participated. The mean age of patients was (27 ± 6.8). Bleeding volume in high dose desmopressin group was (21.7 cc ± 12.3), (27.7 cc ± 12.3) in low dose group, and (38.3 cc ± 12.3) in the placebo group, The difference in blood volume among the three groups was statistically significant with p < 0.005. Clean surgical field according to BOEZAART classification was marginally significant in both desmopressin groups. The differences in blood pressure, heart rate, blood and urine sodium, and hemoglobin before and after surgery between groups there not statistically significant. Conclusion: Based on the results of the present study topical nasal spray desmopressin can reduce surgical field bleeding during rhinoplasty. To generalize the results to other surgeries in the ENT field it is recommended to conduct studies.

Evaluation of the relationship between prestin serum biomarker and sensorineural hearing loss: a case-control study.

RESEARCH BACKGROUND AND AIM: There is not any routine serum biomarker for diagnosing hearing loss (HL). An inner ear-specific protein, prestin can be measured as a serum biochemical marker for HL diagnosis. The present study investigates, for the first time, the relationship between prestin serum levels and sensorineural HL (SNHL) in an Iranian population. MATERIALS AND METHODS: In this case-control study, 176 samples were examined in four groups including two control and two SNHL groups of 20-50 and ≥ 50 years with different severities of SNHL. Plasma prestin concentration was measured using Human Prestin (SLC26A5) ELISA Kit. Data analysis was conducted using SPSS v.23 with level of significance as 0.05. RESULTS: Groups with SNHL had higher prestin levels (Mean = 182.29, SD = 71.24) compared to the control groups (Mean = 122.50, SD = 57.1) (P < 0.001). Results of the multinomial logistic regression of relationship between prestin level and SNHL remained significant after controlling intervening variables (P < 0.001 and odds ratio = 1.017 and 95% CI OR: 1.01-1.024). Results of the ordinal logistic regression model revealed that prestin level was significantly associated with the degree of HL (P < 0.001 and Odds ratio = 1.009 and 95% CI and OR: 1.005-1.013), so that the likelihood of HL increased with the rise in prestin levels. The best cutoff point for the 20-50 group was the prestin content of 132.5 pg/ml (sensitivity: 75%, specificity: 70.05%), while for the group of ≥ 50 was as 130 pg/ml (sensitivity: 84.1%, specificity: 68.2%). CONCLUSIONS: Results of the present study revealed that prestin acts as a valuable biomarker for SNHL.

Prevalence of anxiety and depression in Meniere's disease; a comparative analytical study.

BACKGROUND: Psychological problems are of most significant issues in patients with Meniere's disease (MD). This study aimed to reveal the frequency of anxiety and depression in MD patients compared to healthy individuals and patients with benign positional paroxysmal vertigo (BPPV) referred to a university hospital. METHODS: This case-control study was conducted on individuals between 18 and 65 years old assigned to three groups: the control, MD, and BPPV groups. The data collecting instruments included a demographic information form, along with Beck Anxiety Inventory (BAI) and Beck Depression Inventory-II (BDI-II) questionnaires. Data were analyzed using SPSS software v.23, and the significance level was considered as p < 0.05. RESULTS: A total of 177 participants enrolled. The average scores of anxiety and depression and the severity of anxiety and depression were higher in MD and BPPV groups than in the control group (P < 0.001). The average anxiety score and anxiety severity in the MD group was higher than in the BPPV group (P < 0.001). However, in the case of depression, only severity was higher in the MD group (P < 0.001), and the average depression score showed no significant difference between MD and BPPV groups. After controlling for underlying variables, the impacts of MD (P < 0.001; regression coefficient = 16.5) and also BPPV (P = 0.025; regression coefficient = 4.6) on anxiety were significant compared to the control group. CONCLUSION: Our results suggest that the prevalence of anxiety and depression is higher in MD and BPPV patients than the healthy people, and MD has a higher effect on the incidence of depression and anxiety compared to BPPV.

Effect of desmopressin on bleeding during endoscopic sinus surgery: A randomized clinical trial.

Background: This study aimed to evaluate the effect of local nasal desmopressin premedication on blood loss and the quality of surgical field in Functional Endoscopic Sinus Surgery (FESS). Material and methods: In a randomized clinical trial, patients referred for FESS to treat their bilateral chronic rhinosinusitis were recruited. The participants were adults (≥18 years). They were randomly assigned (1:1:1) to receive low-dose (20 µg) or high-dose (40 µg) intranasal desmopressin (DDAVP) or placebo 60 min before the induction of general anesthesia. Standard FESS was performed by the same surgeon. The primary outcomes were volume of intraoperative bleeding and the quality of surgical field. Clean surgical field was defined as a score ≤2 on the Boezaart grading system. Results: A total of 120 patients were included on an intention-to-treat basis (mean age: 41.0 years; 40 women, 80 men). There were no significant differences in primary outcomes between low-dose DDAVP and placebo. As for the volume of blood loss, however, there was a significant difference between high-dose DDAVP and placebo (mean difference: 29.6 ml; adjusted Cohen's d: -1.02; p < .001). Also, in the high-dose DDAVP, the probability of having a good surgical field over time was about two times higher than in the placebo group (RRs for first and second surgical sides: 1.89 and 2.18). The number needed to treat for the two time points was 1.6 and 1.3, respectively. Conclusion: The present study showed that the use of desmopressin at a dose of 40 µg 1 h before surgery can reduce bleeding and improve the quality of the surgical field. Further studies are recommended to be able to generalize these findings to other ENT surgeries. Level of evidence: 1b.

Olfactory function trends in COVID-19 patients: a prospective cohort study.

BACKGROUND: One of the most common symptoms in COVID-19 patients is olfactory and taste dysfunction. AIMS/OBJECTIVES: This study aimed to evaluate the olfactory threshold, and identification using objective tests in the Iranian population. MATERIAL AND METHODS: The present study was a prospective cohort study conducted in 2020-2021 on clinically recovering COVID-19 patients. Olfactory function was evaluated at the baseline, 4-6 weeks, and 12 weeks later. Olfactory threshold assessment was performed using the Saba Sabalan kit. The Iranian version of the Pennsylvania Smell Identification Test (IR-SIT) was used for olfactory identification. The olfactory threshold was categorized as poor (<8) and good olfaction (≥8). RESULTS: In the present study, 111 patients were examined, including 55 men and 56 women (mean age 41.4 and 53.4 years, respectively). The mean olfactory threshold was better for men (7.2) than for women (6.6). Analysis showed age to have a negative relationship with good olfaction at baseline (OR = 0.93, p = .05). Using IR-SIT, only 29.7% had normal olfactory function. Using linear regression, smoking was found to be significantly related to baseline IR-SIT score (adjusted Beta <0.001, p = .03). CONCLUSIONS AND SIGNIFICANCE: Objective tests are appropriate methods for assessing olfactory dysfunction in COVID-19 patients. Further studies are recommended.

Comparing the Effect of Zinc-impregnated Pharyngeal Packs with Conventional Methods on the Level of Sore Throat Among Patients Undergoing Septorhinoplasty.

Background: Postoperative sore throat (POST) syndrome commonly occurs after general anesthesia and surgery, leading to patient discomfort. Objectives: This essay aims to assess the effect of using zinc-impregnated packs on sore throat and post-op nausea and vomiting after general anesthesia among patients undergoing septorhinoplasty. Methods: The sampling method was based on the patients' gradual referral, and encompassing was performed using the randomized block. The participants were divided into four groups by random allocation technique considering the type of pharyngeal packs: (1) normal saline-impregnated vibril, (2) normal saline-impregnated gauze, (3) zinc solution-impregnated vibril, (4) zinc solution-impregnated gauze. The sample size required to compare the incidence of sore throat after septorhinoplasty was determined to be 220 patients. Results: Out of 220 patients undergoing septorhinoplasty, 55 were assigned to each group. According to A.S.A., most of the patients belonged to class I. In total, 5.5% and 15.1% had a history of gastroesophageal reflux disease (GERD) and smoking, respectively. There was no statistically significant difference among the four groups in terms of the sore throat immediately (P = 0.227), two h (P = 0.527), four h (P = 0.505), six h (P = 0.564) and 24 h (P = 0.481) after surgery. Results of pairwise comparison revealed no statistical difference between the groups receiving zinc and other groups. There was no statistically significant difference between the four groups in terms of the severity of sore throat. A statistically significant difference was observed between the gauze + zinc and gauze + normal saline groups regarding the incidence of nausea two hours after surgery (P = 0.0045). Conclusions: This study showed that applying topical zinc to the pack had no significant effect on reducing sore throat. However, there was a significant difference between the groups receiving zinc solution-impregnated gauze and normal saline-impregnated gauze in terms of the severity of nausea two h after surgery.