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.

The Role of Metabolic Syndrome Components in Sensorineural Hearing Loss in Adolescents: A Case-Control Study

Abstract Introduction Metabolic syndrome (MetS) and its associated components were reported as a possible cause of inner ear dysfunction. However, research about the influence of cardiovascular risk factors on hearing thresholds are conducted mainly in adult patients. Objective The aim of the present study was to investigate auditory function in adolescents with MetS compared with healthy controls. Methods One hundred adolescents with metabolic syndrome and 200 sex- and age-matched controls were recruited from a university pediatric endocrine clinic from May 2018 to July 2020. Hearing loss was defined as hearing level ≥ 15 dB at speech frequency (SFHL) or high frequency (HFHL) in one or both ears. A multivariable conditional logistic regression analysis examined the correlation between MetS components and several important demographic characteristics, and hearing loss. Results A total of 165 (55.0%) boys and 135 (45.0%) girls participated in this study. The rates of SFHL and HFHL in adolescents with MetS were 32.0% and 51.0%, respectively. Those values for controls were 5.0% and 15.5%, respectively. The regression analysis showed high triglycerides as a significant predictor for SFHL (odds ratio 10.87; 95% confidence interval: 1.98, 59.74). Neither predictor of interest was significant for HFHL. Conclusion Hypertriglyceridemia may be an important factor in the pathogenesis of SFHL. However, the strength of the association was not significant with a wide confidence interval. Also, we were unable to find an association between predictors and HFHL with the current sample size. Larger and prospective studies are recommended.

The Role of Metabolic Syndrome Components in Sensorineural Hearing Loss in Adolescents: A Case-Control Study.

Introduction Metabolic syndrome (MetS) and its associated components were reported as a possible cause of inner ear dysfunction. However, research about the influence of cardiovascular risk factors on hearing thresholds are conducted mainly in adult patients. Objective The aim of the present study was to investigate auditory function in adolescents with MetS compared with healthy controls. Methods One hundred adolescents with metabolic syndrome and 200 sex- and age-matched controls were recruited from a university pediatric endocrine clinic from May 2018 to July 2020. Hearing loss was defined as hearing level ≥ 15 dB at speech frequency (SFHL) or high frequency (HFHL) in one or both ears. A multivariable conditional logistic regression analysis examined the correlation between MetS components and several important demographic characteristics, and hearing loss. Results A total of 165 (55.0%) boys and 135 (45.0%) girls participated in this study. The rates of SFHL and HFHL in adolescents with MetS were 32.0% and 51.0%, respectively. Those values for controls were 5.0% and 15.5%, respectively. The regression analysis showed high triglycerides as a significant predictor for SFHL (odds ratio 10.87; 95% confidence interval: 1.98, 59.74). Neither predictor of interest was significant for HFHL. Conclusion Hypertriglyceridemia may be an important factor in the pathogenesis of SFHL. However, the strength of the association was not significant with a wide confidence interval. Also, we were unable to find an association between predictors and HFHL with the current sample size. Larger and prospective studies are recommended.

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.

Cavernous Hemangioma of the Sternocleidomastoid Muscle: A Case Report.

Introduction: Cavernous hemangioma is a venous malformation and intramuscular hemangioma is a rare type of hemangioma. Most of these cases are reported in masseter and temporalis muscles, and the number of patients with hemangioma involving sternocleidomastoid (SCM) muscle is relatively less. The present study reported a case of intramuscular hemangioma and a literature review regarding hemangioma in the sternocleidomastoid muscle. Case Report: The present case was a 24-year-old woman with intramuscular hemangioma of the sternocleidomastoid muscle, manifesting a mass in the right supraclavicular region involving the sternocleidomastoid muscle. The woman was treated with surgery and achieved complete treatment. After surgery, the patient was kept under regular follow-up for the last six months without any evidence of recurrence. Conclusion: Intramuscular hemangioma of the sternocleidomastoid muscle is a rare entity that can present as a mass in the neck region. The treatment approach should be considered according to the diagnosis and site of vascular malformation.

Prevalence of Tinnitus and Its Associated Factors in the PERSIAN Guilan Cohort Study.

Introduction: Tinnitus can be associated with many auditory and non-auditory factors, and its prevalence varies widely in the literature. There is no large sample of published data on tinnitus prevalence and its associated factors in Iran. Here, we analyzed the PERSIAN Guilan Cohort Study (PGCS) data and reported the prevalence of tinnitus and some of the risk factors related to tinnitus in the Iranian population. Materials and Methods: This cross-sectional study was conducted on 10520 men and women between 35 and 70 years old. The prevalence of tinnitus and associations between tinnitus and age, sex, habitat, marital status, employment status, socioeconomic status, educational level, lifestyle habits, and comorbid diseases were examined using simple and multiple logistic regression analyses. Results: The prevalence of tinnitus was 6.4% in this study. Based on the adjusted analysis, only older age (odds ratio: 2.60, 95% confidence interval: 1.88 - 3.60), residency in a rural area (odds ratio: 1.22, 95% confidence interval: 1.03 - 1.44), cigarette smoking (odds ratio:1.33, 95% confidence interval: 1.04 - 1.72), and having other comorbidities (odds ratio: 2.75, 95% confidence interval: 2.19 - 3.44) were related to tinnitus. In addition, the results of subgroup analyses by sex were mostly consistent with the overall analysis. Conclusions: Our results revealed that the prevalence of tinnitus in the north of Iran is comparable with other communities. Age and other comorbidities were among the most related factors to tinnitus.

Computed Tomographic Comparison of Length, Width and Angulation of Ethmoidal Infundibulum in Patients With and Without Maxillary Sinusitis.

Ethmoidal infundibulum (EI) is an important part of the osteomeatal complex, which provides the main pathway for the maxillary sinus drainage. This study aimed to compare the length, width, and angulation of EI in patients with/without maxillary sinusitis using computed tomography (CT). This cross-sectional study evaluated 818 spiral CT scans of patients with/without maxillary sinusitis (n = 409 maxillary sinuses in each group) classified according to the clinical symptoms and the Lund-Mackay score for mucosal thickening. The degree of mucosal thickening (on axial and coronal sections), anatomical variations namely concha bullosa (CB), ethmoidal bulla (EB), and Haller cells (HCs), the form of EI (on coronal sections), the length, width and angulation of EI, and degree of nasal septal deviation (on coronal sections) were all evaluated. Data were analyzed by parametric and non-parametric tests (alpha = 0.05). The frequency of EB (P < 0.001), EI form (P < 0.001) and HC (P = 0.011), and the length and width of EI (P < 0.001) were significantly different in patients with and without maxillary sinusitis. The length and width of EI were significantly correlated with the degree of mucosal thickening (P < 0.01). The frequency of CB (P = 0.002), EB (P < 0.001), and HC (P = 0.002), and the EI form (P < 0.001) were significantly different in groups with different degrees of mucosal thickening. EI was wider and shorter in patients with maxillary sinusitis. By an increase in mucosal thickness, the length of EI decreased while its width increased. Also, the frequency of EB and HC, and the EI form were significantly different in the two groups.

The Relationship Between Temporal Bone Pneumatization Pattern and Sinus Mucosal Thickness Grading on Computed Tomography Scans of Paranasal Sinuses.

The relationship between temporal bone pneumatization (TBP) pattern and sinus mucous thickness grading on computed tomography scans of paranasal sinuses was investigated. In this cross-sectional study, a total of 200 temporal bones and paranasal sinuses were evaluated in CT scans of 100 patients with chronic sinusitis (CRS). The mucosal thickness of paranasal sinuses was classified into two groups (0-6 and 7-12) according to the Lund-Mackay (LM) staging system. Also, pneumatization patterns of petrous apex and perilabyrinthine regions were classified according to Jadvah et al. method. Data were analyzed using Chi-square and Fisher's exact tests. The most common pneumatization pattern in the petrous apex was pattern A (49.5%) and in the perilabyrinthine region was pattern B (50%). In the petrous apex, the highest frequencies of pattern A (51.7%) and pattern C (24.6%), among other pneumatization patterns, were found in score range of 7-12 and 0-6, respectively, which was statistically significant (P = 0.017). Although in the perilabyrinthine region, the highest frequencies of pattern A (24.1%) and pattern C (32.7%) were in LM score ranges of 7-12 and 0-6, respectively, no significant difference was found (P = 0.589). The petrous apex pneumatization decreases with an increase in the severity of CRS, which can be in response to the eustachian tube dysfunction and common pathogens with CRS. A similar relationship was also found in the perilabyrinthine region, although it was not statistically significant. No significant relationship between TBP and severity of CRS was found in the age and sex groups.

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.

Evaluation of applying topical tranexamic acid to control septorhinoplasy - induced hemorrhage.

OBJECTIVES: Hemorrhagic events related to surgical field is a common disturbing complication which could worsen the outcomes of operation. This study aimed to evaluate how applying of topical tranexamic acid (TXA) could affect bleeding related to septorhinoplasty operation. MATERIAL AND METHODS: This double-blind controlled trial study finally evaluated 198 candidates for septorhinoplasty repair who were randomly allocated to two groups: TXA receivers (5 mg/kg) and control group (received 5 mg/kg of saline 0.9 %). Then cumulative volume of hemorrhage was calculated by adding total volume of suctioned blood and numbers of fully blood-filled surgical gauzes (15 mL in each). Additionally postoperative 24 h volume of hemorrhage was measured by counting number of bloody surgical gauzes. RESULTS: Of all participants, 90 % were female. The mean age was 26 ± 7 years. Total cumulative volume of hemorrhage during surgery was significantly diminished when topical TXA was applied (p < 0.0001). Additionally drier field of operation was illustrated postoperatively in patients received topical TXA (2 % & 28 % in TXA and saline 0.9 % receivers, respectively) (p < 0.001). CONCLUSION: Using topical TXA could decrease bleeding volume and make surgical field of septorhinoplasty drier either during surgery or postoperatively.

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.

Association of different severity of diabetic retinopathy and hearing loss in type 2 diabetes mellitus.

PURPOSE: Microvascular involvement in patients with diabetes mellitus is one of the causes of retinopathy, nephropathy, and neuropathy. The same pathologic processes may occur in the inner ear structures. This case-control study aimed to evaluate the hearing thresholds in type 2 diabetic patients with different severity of diabetic retinopathy (DR) and to compare these findings with controls. MATERIALS AND METHODS: We evaluated the hearing threshold in four groups of eligible subjects aged 20-70 years. These groups were controls, diabetic patients with no-DR, with mild-moderate non-proliferative DR (NPDR), and with severe NPDR/proliferative DR (PDR). Each group consisted of 105 subjects. Speech-frequency and high-frequency hearing levels (SFHL and HFHL, respectively) were measured and log-transformed. Analysis of covariance was used. The prevalence rate of moderate or more hearing loss in the groups was estimated. RESULTS: In total, 194 men and 226 women participated. The ratio of means of SFHL and HFHL between PDR and controls was 0.18 and 0.20, respectively. Hearing loss was prevalent in severe NPDR/PDR (adjusted prevalence ratio 3.36 for SFHL and 1.51 for HFHL) compared to controls. Also, the prevalence of high-frequency hearing loss was more in mild-moderate NPDR (adjusted prevalence ratio 1.33). CONCLUSIONS: The magnitude of the increase in hearing impairment prevalence between the severe NPDR/PDR patients and controls was about 24% for both SFHL and HFHL. We recommend hearing assessment in the screening of the DR patients.

Effect of cisplatin chemotherapy on the inner ear function and serum prestin concentration.

PURPOSE: One of the main side effects of chemotherapy with cisplatin is irreversible sensorineural hearing loss. This study was conducted to assess the correlation between the serum prestin concentration as a potential cochlear biomarker and audiologic findings in patients after cisplatin chemotherapy. METHODS: A total of 52 patients aged 18-75 years were included in this prospective study. All the subjects were recruited from the radiotherapy and oncology center of a tertiary hospital in Rasht, Iran. Audiologic parameters evaluations and serum prestin concentrations were measured at baseline and after 1-3 weeks of chemotherapy. The inner ear function was evaluated by pure-tone audiometry (PTA) and distortion product of otoacoustic emission (DPOAE). A repeated-measure analysis of variance was performed to evaluate the relationship between the PTA, DPOAE, serum prestin concentration and cumulative cisplatin dose. RESULTS: Fifty-two patients (36 females) participated in this study. The PTA results showed that ototoxicity was more frequent among the patients with a high cumulative dose of cisplatin (χ2 trend = 15.25; P < 0.001). DPOAE responses revealed that 38.5% of the patients had ototoxicity change after 40-80 mg of cisplatin administration. After receiving 40-80 mg of cisplatin, serum prestin concentration increased from 130 to 230 pg/ml. There is a significant positive correlation between prestin concentration after receiving more than 80 mg of cisplatin and the ototoxic changes in the DPOAE response. CONCLUSION: The present study showed correlations between prestin concentrations and ototoxicity diagnosis by DPOAE findings. An early rise in prestin concentration is particularly important and an early sign of hearing loss. Future studies are recommended to investigate the effect of varying doses of cisplatin on prestin concentration and any association between ototoxicity and clinicopathological features.

Pharmacological Treatments of Bell's Palsy in Adults: A Systematic Review and Network Meta-Analysis.

OBJECTIVE: We aimed to simultaneously compare all available medical treatments for Bell's palsy using both direct and indirect data. METHODS: The literature was searched from January 1, 1990, until March 1, 2020, with no language restrictions. Randomized clinical trials comparing pharmacological interventions were included in the current network meta-analysis. We estimated summary risk ratios (RRs), 95% credible interval (CrI), and the surface under the cumulative ranking curve (SUCRA) using network meta-analyses with random effects in a Bayesian framework. The primary outcomes were complete recovery in short-term (≤3 months) and intermediate/long-term (>3 months) after randomization. The secondary outcome was synkinesis. RESULTS: In total, 21 trials comprising 2,839 participants were retrieved. In terms of good recovery, corticosteroids plus antivirals were the most effective treatment compared to placebo, with RRs ranging between 1.25 (95% CrI: 1.10, 1.43) for the short-term and 1.26 (95% CrI: 1.11, 1.45) for the intermediate/long-term recovery. For synkinesis, only corticosteroids plus antivirals (RR 0.35; 95% CrI: 0.19, 0.65) were associated with fewer synkinesis rates than placebo. The certainty of the evidence for good recovery and synkinesis was very low-low and moderate-high, respectively. CONCLUSIONS: This network meta-analysis showed that combined therapy remains the best regimen for a good recovery outcome and the only efficacious regimen for synkinesis. More research is needed to confirm these findings. Laryngoscope, 131:1615-1625, 2021.

Predictors of Olfactory Impairment among Northern Iranian Population.

INTRODUCTION: The performance in most smell identification tests is subjected to cultural variations. This study aimed to evaluate age, gender, and smoking-related effects on the test performance in the North of Iran. MATERIALS AND METHODS: The olfactory function of 1470 eligible subjects was assessed in this study. Moreover, this study evaluated the influence of age, gender, and education on the test scores. RESULTS: According to the results, females obtained higher mean test scores, compared to males (18.4 vs. 17.6). In general, the elderly obtained lower scores, and about 30% of the subjects who were ≥65 years of age had severe hyposmia or anosmia. Furthermore, the olfactory impairment frequency in smoker subjects was significantly more than non-smokers (P<0.001). Test scores were generally higher in subjects with higher education levels. Logistic regression analysis revealed that the total number of cigarette doses in smokers and age had a significant association with olfactory dysfunction (P value <0.001 and 0.004, respectively). Cronbach's α of Iran-SIT was obtained at 0.78 which was more than an acceptable value of 0.7. CONCLUSION: The findings of this study revealed that a low score in the Iran-SIT correlated with smoking, older age, low education level, and gender (male).

Prevalence of Hearing Loss among School-Age Children in the North of Iran.

INTRODUCTION: The present study aimed to investigate the audiological profiles of elementary school-age children in Rasht, Iran, and estimate the prevalence of hearing impairments in this population. MATERIALS AND METHODS: In this cross-sectional descriptive-analytical study, the hearing threshold was screened using pure tone audiometry (PTA). Hearing impairment was defined as equal to or higher than 20 dB HL. Results of the hearing thresholds were separately reported in the left or right ears and better or worse ears. Logistic regression tests were used to investigate the association between hearing loss and possible risk factors. In this study, all the analyses were conducted using SPSS software (version 21). RESULTS: The present study was carried out on a total of 2019 children. Mean age of the participants was reported as 9.66±1.66 years. Based on low-frequency pure-tone average, the prevalence rates of hearing loss > 15 dB in the right and left ears were reported as 1.94% and 1.68%, respectively. The high-frequency hearing loss > 15 dB in the right and left ears was obtained at 1.14% and 1.04%, respectively. Prevalence rate of hearing loss (in all frequencies) in boys was higher than that in girls. There was a strong association between a history of otitis media and sensorineural or conductive hearing loss (adjusted odds ratio reported as 12.2 and 8.1, respectively). CONCLUSION: In this study, the rate of hearing loss in the participants was approximately 2%. It was concluded that the screening of hearing loss in children is necessary for the identification and management of these children as early as possible. It is recommended to perform further trials to investigate the impact of different causes on childhood hearing impairment.

Metabolic syndrome components and sudden sensorineural hearing loss: a case-control study.

PURPOSE: Cardiovascular risk factors, including metabolic syndrome (MetS) components, were reported as possible risk factors of sudden sensorineural hearing loss (SSNHL). The objective of this study was to evaluate the relationship between MetS (and its components) and SSNHL. METHODS: Eighty-one SSNHL patients and 243 sex-, aged-matched controls participated from January 2018 to July 2019. The participants included 176 (54.3%) men and 148 (45.7%) women. The correlation between Mets components, total cholesterol, low-density lipoprotein-cholesterol, and the onset of SSNHL was analyzed using used multivariate conditional logistic regression analysis. RESULTS: A total 12 patients (14.8%) with SSNHL and 27 subjects (11.1%) in control group had MetS (p > 0.05). The rate of low levels of high-density lipoprotein-cholesterol (HDL-C), hypertriglyceridemia, and hypertension was significantly higher in the SSNHL group than those in the control group (p < 0.05). A trend of odds SSNHL was observed with increasing the number of MetS components (p < 0.001). The multivariable analysis revealed that the rate of hypertriglyceridemia and low HDL-C concentration was significantly higher in the SSNHL groups compared to the controls. CONCLUSIONS: Hypertriglyceridemia and low levels of HDL-C may be important factors in the pathogenesis of SSNHL, and should be assessed during the investigation of patients with this condition.

The Impact of Betahistine versus Dimenhydrinate in the Resolution of Residual Dizziness in Patients with Benign Paroxysmal Positional Vertigo: A Randomized Clinical Trial.

OBJECTIVES: The aim of this study was to compare the effects of betahistine with dimenhydrinate on the resolution of residual dizziness (RD) of patients with benign paroxysmal positional vertigo (BPPV) after successful Epley maneuver. METHODS: In this double-blind, randomized clinical trial, patients with posterior semicircular canal type of BPPV were included. After execution of the Epley maneuver, patients were assigned randomly to one group for 1 week: betahistine, dimenhydrinate or placebo. The primary outcomes were scores of the Dizziness Handicap Inventory (DHI) and the modified Berg balance scale (mBBS). All patients were asked to describe the characteristics of their subjective residual symptoms. Binary logistic regression analysis was performed to examine the predictors of improved RD. All analyses were conducted using SPSS 19.0. RESULTS: In total, 117 patients (age range: 20-65 years) participated in this study. After the Epley maneuver, 88 participants had RD. After the intervention, 38 patients exhibited an improved RD. Less than 50% of participants in the three groups showed mild to moderate dizziness handicap. However, there was no significant difference between mBBS scores of groups before or after the intervention. Logistic regression was shown that patients with receiving betahistine were 3.18 times more likely to have no RD than the placebo group. Increasing age was associated with a decreased likelihood of improving RD (P = .05). CONCLUSION: The analysis of data showed that the use of betahistine had more effect on improving RD symptoms. We recommended future studies using objective indicators of residual dizziness.

Predictors of Fear of Falling among Iranian Older Adults with Hip Fracture and Controls.

OBJECTIVES: To investigate predictors of fear of falling (FOF) among older people with or without hip fracture. METHODS: The FOF was assessed by the Visual Analogue Scale (VAS-FOF), anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). The modified Berg Balance Scale (mBBS) to evaluate functional balance was used. All people were asked to complete the dizziness Handicap Inventory (DHI) and the 36-item Short Form Health Survey (SF-36) for evaluating quality of life. RESULTS: Eighty-eight older adults (44 cases; 44 controls) took part in this study. The case group had received surgical intervention for femoral neck or trochanteric fracture resulting from a fall. The results showed significantly more intensity of FOF in hip fracture patients than controls (p < .001). The FOF was significantly correlated with anxiety, DHI, mBBS, and SF-36. The results of the multiple linear regression showed that four predictors explained about 44% of the variance of the FOF. It was found that mBBS and DHI significantly predicted FOF (p < .001 and < .001, respectively). CONCLUSIONS: The hip fracture patients had a high degree of the fear of falling, low quality of life and low functional capacity. The mBBS and DHI were significant predictors of the FOF in older adults. CLINICAL IMPLICATIONS: It may be useful to employ an inter-disciplinary approach to addressing fear of falling to best understand physiological and psychological contributions.