Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725131220190301Preventive Effect of Dexamethasone Therapy on the Transient Hypoparathyroidism through Total Thyroidectomy73801237410.22038/ijorl.2018.26541.1866ENMohsen KolahdouzanIsfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.Bijan IrajIsfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.Mohammad EslamianIsfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.Mohammad HarandizadehIsfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.Rokhsareh MeamarIsfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.361910267000000-0002Journal Article20171002Introduction:<br /> This study aimed to investigate whether pre-operative dexamethasone could ameliorate transient hypoparathyroidism outcome through total thyroidectomy.<br /> <br /> Materials and Methods:<br /> This randomized clinical trial study was conducted on 128 patients underwent total thyroidectomy from March 2014 to April 2015. Patients were randomly assigned to two groups of experimental receiving 8 mg IV of intravenous dexamethasone (n=45) 45 min before skin incision treatment and control (n=83). After the surgery, all patients were evaluated for clinical and laboratory hypocalcaemia.<br /> <br /> Results:<br /> Post-operative transient biochemical hypoparathyroidism and hypocalcaemia did not occur more often in the control group, compared to the dexamethasone group while controlling for the baseline variables. However, there was a significant difference in phosphorus level between the dexamethasone and control groups (P=0.028). A total of 50 (39.1%) patients developed hypocalcaemia after surgery. Moreover, post-operative symptomatic hypocalcemia occurred more frequently in the control group (68%) compared to the dexamethasone group (32%); however, this difference was not statistically significant (P=0.54).<br /> <br /> <strong><em>Conclusion</em></strong><strong><em>: </em></strong><br /> The pre-operative administration of dexamethasone reduced post-operative hypocalcemia rate. It is essential to conduct future studies with validated means for better results.Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725131220190301Effect of Cold Diet and Diet at Room Temperature on Post-Tonsillectomy Pain in Children81861237510.22038/ijorl.2018.31204.2022ENMojtaba MeybodianDepartment of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.Mohammadhossein DadgarniaDepartment of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.0000-0002-2802-9601Mohammadhossein BaradaranfarDepartment of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.0000-0002-3995-6822Sedighe VaziribozorgDepartment of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.0000-0001-7749-6196Mahzad MansourimaneshDepartment of Anesthesiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.Mohammad MandegariDepartment of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.Nasir Saeidi EslamiDepartment of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.0000-0001-9472-9393Journal Article20180426Introduction:<br /> The present study aimed to compare the effect of cold diet and diet at room temperature on post-tonsillectomy pain in children.<br /> <br /> Materials and Methods:<br /> In the present study a total of 120 children within the age range of 4-12 years who underwent tonsillectomy were randomly assigned to two groups, namely group C with a cold-served diet and group room temperaturewith a room-temperature-served diet postoperatively. Each patient’s post-operative pain was evaluated using the Face, Legs, Activity, Cry, Consolability (FLACC) scale prior to oral diet initiation after the operation, before thesecond acetaminophen dose, before the next day breakfast, and before discharge.<br /> <strong> </strong><br /> Results:<br /> Out of 103 children, 48 and 55 children were femaleand male, respectively. The average age of the children was 7 years and 2 months. There was no significant difference in gender and age between the two groups. There were no significant differences in the mean scores of FLACC scale between the two groups at different times, including before starting an oral diet (P>0.15), before the second dose of acetaminophen (P>0.22), before the next day breakfast (P>0.32), and before discharge (P>0.83). In terms of bleedingfrequency, as well as nausea and vomiting, no significant difference was observed between the two groups.<br /> <br /> Conclusion:<br /> The obtained results of this study indicated that using cold liquids and foods after tonsillectomy did not have a significant effect on post-tonsillectomy pain in children. According to the findings, it is not rational to advise the mother or the child about the temperature of fluids and foods consumed post-tonsillectomy.Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725131220190301Transoral Resection of Giant Parapharyngeal Space Tumors via a Combined Surgical Approach87961239010.22038/ijorl.2018.27837.1911ENKonstantinos MarkouDepartment of Otorhinolaryngology - Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi St, 54636 Thessaloniki, Greece.Sarantis BlioskasDepartment of Otorhinolaryngology - Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi St, 54636 Thessaloniki, Greece.0000-0001-6967-0633Argyrios KrommydasDepartment of Otorhinolaryngology - Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi St, 54636 Thessaloniki, Greece.George PsillasDepartment of Otorhinolaryngology - Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi St, 54636 Thessaloniki, Greece.orcid.org/0000-0003-3509-6519Petros KarkosDepartment of Otorhinolaryngology - Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi St, 54636 Thessaloniki, Greece.Journal Article20171130Introduction:
Parapharyngeal space (PPS) tumors account for 0.5% of the head and neck neoplasms. Based on the evidence, 80% of these tumors are of a benign nature. Surgical excision is the treatment of choice for this condition. The present study was conducted to propose transoral resection as an efficient way to excise the benign well-defined tumors of the PPS.
Materials and Methods:
This retrospective case series study was conducted on seven patients undergoing the transoral excision of the sizeable masses of the PPS via a combined approach. Computed tomography and magnetic resonance scans revealed giant masses in the PPS in all cases. These neoplasms were preoperatively diagnosed as well-delineated, non-vascular, and benign.
Results:
All patients underwent transoral tumor excision preceded by an auxiliary transcervical approach, which served as an assurance for the dissection and preservation of the cranial nerves and neurovascular bundle without any tumor spillage. Average hospital stay was limited to a maximum of 3 days, and all patients had an uneventful postoperative course. The follow-up examination did not indicate any recurrence.
Conclusion:
Based on the findings, transoral resection can be concluded as an efficient way to excise benign, well-defined tumors of the PPS. This procedure appears to be safe when a secondary transcervical approach is applied. Given the unnecessity of performing mandibulotomy in this procedure, it is expected to have lower morbidity and fewer complications.Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725131220190301Prevalence of Head and Neck Sarcoma in a Major Cancer Center in Iran- A 10-Year Study971021239410.22038/ijorl.2018.29949.1974ENSaede Atarbashi-MoghadamDepartment of Oral and Maxillofacial Pathology, Dental School of Shahid Beheshti University, Tehran, Iran.0000-0002-1731-2786Amir Nader Emami RazaviPhD Iran National Tumor Bank, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.Saman Salehi ZalaniResearch Committee, Dental School of Shahid Beheshti University of Medical Sciences, Tehran, Iran.Journal Article20180309Introduction:<br /> Sarcomas are rare malignancies with aggressive biological behavior. They are categorized into soft and hard tissue types. The main objective of this study was to analyze the prevalence of head and neck sarcomas (HNS) among the Iranian population.<br /> Materials and Methods:<br /> The pathology files derived from Iran National Tumor Bank of Cancer Institute in Imam Khomeini Hospital, affiliated to Tehran University of Medical Sciences, Tehran, Iran, served as the source of the materials for this study. All cases diagnosed with head and neck sarcoma were included in the study. The recorded data included the patient’s age, gender, tumor location, and rates of recurrence and metastasis.<br /> <br /> Results:<br /> Investigation of the pathology files of the patients referring to the center under study during a 10-year period resulted in the identification of 183 HNS cases, 96.17% of which were primary. Generally, the prevalence of this disease was at its highest level in patients within the age range of 30-60 years with a male to female ratio of 1.4. The recurrence and metastasis rates of HNS were 32.38% and 5%, respectively. Osteosarcoma was detected as the most common type of sarcoma. Soft tissue sarcomas constituted 69.3% of the lesions with a male predilection. The patients afflicted with this type of sarcoma had a mean age of 45.88 years. Furthermore, hard tissue sarcomas comprised 30.68% of the sarcoma cases with a mean age of 36.22 years and a female predilection. The commonest lesion was osteosarcoma, and the most typical location was the mandible.<br /> <br /> Conclusion:<br /> In the current study, head and neck sarcomas were most often observed in patients within the age range of 30-60 years with a male predilection. Osteosarcoma was identified as the most common type of sarcoma. Studies addressing rare lesions with a large sample size facilitate the recognition of the demographic data and histopathologic variation which may contribute to a correct diagnosis.Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725131220190301Evaluation of Bilateral Vestibular Dysfunction in Iranian Adults and Elderlies by Electronystagmography and Video Head Impulse Test1031071237610.22038/ijorl.2018.32238.2062ENSadegh JafarzadehDepartment of Audiology, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0001-8887-7509Mohammad Reza Golrokhian SaniDepartment of Otolaryngology, Sina Hospital, Mashhad, Iran.Nematollah Mokhtari AmirmajdiDepartment of Otolaryngology, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0002-7110-9666Masoud FirouziMarkazi Vestibular Assessment and Rehabilitation Center, Mashhad, Iran.Journal Article20180529Introduction:<br /> Vestibular abnormalities are common problems in the whole world, which can lead to bilateral vestibular dysfunction (BVD). That results in symptoms, such as vertigo, unsteadiness, falling, oscillopsia, and lower quality of life. The Objective of this study was to determine BVD in adults and elderlies with vertigo and unsteadiness.<br /> <br /> Materials and Methods:<br /> This study was conducted on 384 patients in two categories of adults (age range of 18-64 years) and elderlies (65 years old and above) through Electronystagmography (ENG), including caloric test and video head impulse test (vHIT). Patients called bilateral vestibular dysfunction when they have an abnormal bilateral weakness (summation of nystagmus response less than 20 for 4 stimulations and less than 12 for each ear) in caloric test and their vHIT has a gain lower than 0.6. The results of caloric tests were categorized into four groups, including normal, unilateral weakness, bilateral weakness, and central abnormalities.<br /> <br /> Results:<br /> The obtained results revealed that the frequency of BVD is higher than previously reported data in the medical literature. The frequency of BVD was 10.9% for the investigated patients (39.1% abnormal caloric, 12.5% abnormal vHIT, and 10.9% abnormal in both tests). The 38.5% of elderly patients had bilateral abnormal results in both tests.<br /> <br /> Conclusion:<br /> The results of this study showed BVD in some cases by caloric and vHIT tests.Elderlies showed more cases of BVD compared to adult patients.Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725131220190301Gap Junction Protein Beta 2 Gene Variants and Non-Syndromic Hearing Impairment among Couples Referred For Prenatal Diagnosis in the Northeast of Iran1091131239310.22038/ijorl.2018.31941.2056ENSamane VojdaniDepartment of Medical Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Reza Jafarzadeh EsfehaniMedical Genetic Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Vahid IranmaneshDepartment of Genetic, Academic Center for Education, Culture, and Research (ACECR)-Khorasan Razavi, Mashhad, Iran.Hafezeh DavariDepartment of Genetic, Academic Center for Education, Culture, and Research (ACECR)-Khorasan Razavi, Mashhad, Iran.Nasim AminiDepartment of Genetic, Academic Center for Education, Culture, and Research (ACECR)-Khorasan Razavi, Mashhad, Iran.Mohammad Ehsan JaripourDepartment of Genetic, Academic Center for Education, Culture, and Research (ACECR)-Khorasan Razavi, Mashhad, Iran.Peyman ZargariDepartment of Genetic, Academic Center for Education, Culture, and Research (ACECR)-Khorasan Razavi, Mashhad, Iran.Mahtab DastpakDepartment of Genetic, Academic Center for Education, Culture, and Research (ACECR)-Khorasan Razavi, Mashhad, Iran.Ariane SadrnabaviDepartment of Genetic, Academic Center for Education, Culture, and Research (ACECR)-Khorasan Razavi, Mashhad, Iran.Journal Article20180529Introduction:<br /> Hearing impairment is a complex medical disorder whichhas genetic and non-genetic causes. Gap Junction Protein Beta 2 (GJB2) gene variant is a well-known disease-causing gene among patients with hearing impairment. The frequencies of genetic variants in the GJB2 gene are different in each population. This study aimed to discuss the GJB2 gene status in an Iranian population with hearing impairment who referred for prenatal testing.<br /> <br /> Materials and Methods:<br /> This cross-sectional study was conducted in a genetic laboratory affiliated with Mashhad Jahad Daneshgahi, Mashhad, Iran. A total number of 21 bilateral hearing impaired patients were enrolled in this study. The exons for target GJB2 gene were amplified by polymerase chain reaction after the confirmation of the hearing impairment and the exclusion of the acquired causes of hearing loss.<br /> <br /> Results:<br /> The c.35delG and c.79G>A variants were the first and second most common variants in the study population, respectively. The mean age of the patients was 27.5 (8.7) years and 12 cases were male. There was no significant association between hearing impairment degree and age and heterozygosity status (P=0.376 and P=.074 respectively).<br /> <br /> Conclusion:<br /> The c.35delG and c.79G>A variants were determined as the first and second most common variants in the GJB2 gene, respectively. The mean age of 26 years in this study population indicates the late referral for the evaluation of the hearing difficulty. Furthermore, it highlights the further need to encourage families with a history of hearing impairment to engage in genetic counseling.Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725131220190301Ramsay Hunt Syndrome Associated with True Vocal Cord Palsy- A Case Report1151181238610.22038/ijorl.2019.35840.2188ENMohsen RajatiSinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.https://orcid.org/00Mohammad Ali ZarringhalamDepartments of Otorhinolaryngology, Mashhad University of Medical Sciences, Mashhad, Iran.https://orcid.org/00Journal Article20181121Introduction:<br /> Varicella-zoster virus may cause an infectious disease called Ramsay Hunt syndrome. The related symptoms include facial nerve palsy (FNP), otalgia, the vesicular eruptions of the auricle and external auditory canal, less common ocular movement disorder, facial hypoesthesia, myofascial pain, vestibular symptoms, hearing loss, dysphasia, vocal cord paralysis, as well as tongue paralysis due to cranial neuropathies.<br /> <br /> Case Report:<br /> Herein, we presented the case of a 55-year-old man with left peripheral facial nerve palsy, profound hearing loss, and true vocal cord paralysis. The FNP recovered after 2 weeks and synkinesis totally improved after 4 weeks.<br /> <br /> Conclusion:<br /> Ramsay Hunt syndrome may present as cranial polyneuropathy; therefore, accurate history taking and physical examinations are necessary in this regard. The recovery rate of the vagus nerve is probably fair without polyneuropathy; however, it seems to be poor in cases suffering from polyneuropathy.Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725131220190301Giant Congenital Sialolipoma of Parotid Gland with Parapharyngeal Extension1191221238710.22038/ijorl.2018.28376.1927ENTaner ErdağDepartment of Otorhinolaryngology, Dokuz Eylül University School of Medicine, Izmir, Turkey.Yüksel OlgunDepartment of Otorhinolaryngology, Dokuz Eylül University School of Medicine, Izmir, Turkey.Melih-Arif KözenDepartment of Otorhinolaryngology, Dokuz Eylül University School of Medicine, Izmir, Turkey.Handan GüleryüzDepartment of Radiology, Dokuz Eylül University School of Medicine, Izmir, Turkey.Erdener ÖzerDepartment of Pathology, Dokuz Eylül University School of Medicine, Izmir, Turkey.Journal Article20171213Introduction:<br /> Sialolipoma is an extremely rare salivary gland tumor characterized by a well circumscribed mass composed of glandular tissue and mature adipose elements. Herein our aim was to present the fifth case of congenital sialolipoma, which was firstly followed up as a parotid gland hemangioma, and underline the fact that sialolipomas should be kept in mind in the differential diagnosis of congenital parotid gland masses.<br /> <br /> Case Report:<br /> A 10-month old male presented with a left-sided huge neck mass which progressed after birth. Radiologic examination revealed a tumor originating from the parotid gland filling the parapharyngeal space. Histopathologic examination of an incisional biopsy was consistent with sialolipoma. A total parotidectomy with preservation of the facial nerve was performed at the age of 1 year. The postoperative recovery was uneventful with normal facial nerve function. There was no recurrence at the 24-month follow-up.<br /> <br /> Conclusion:<br /> Although it is a very rare benign tumor, congenital sialolipoma should be kept in mind in the differential diagnosis of congenital parotid mass.Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725131220190301Impacted Incus Foreign Body in the Eustachian Tube1231261240410.22038/ijorl.2018.29571.1963ENKartik ParelkarDepartment of Otorhinolaryngology, Grant Government Medical College and Sir J.J Hospitals, Mumbai, India.Devika ShereDepartment of Otorhinolaryngology, Durgabai Deshmukh Hospital, Hyderabad, India.Ankur WalliDepartment of Otorhinolaryngology, Grant Government Medical College and Sir J.J Hospitals, Mumbai, India.Varun DaveDepartment of Otorhinolaryngology, Sion Hospital, Mumbai, India.Karthik RaoDepartment of Otorhinolaryngology, Grant Government Medical College and Sir J.J Hospitals, Mumbai, India.0000-0002-1420-7366Journal Article20180208Introduction:<br /> Foreign bodies in the external auditory canal are fairly common, and tend to be seeds, toys, or insects. However, foreign bodies in the middle ear are rarer, and are generally accidental or iatrogenic. Although there are numerous reports regarding fascinating foreign bodies in the ear, the same cannot be said about foreign bodies in the Eustachian tube (ET).<br /> <strong> </strong><br /> Case Report:<br /> A 20-year-old male patient presented with right-sided active squamosal chronic otitis media (COM) persisting for 10 years. An incidental finding of a hyperintense foreign body (FB) located near the isthmus of the right ET was reported on high-resolution computed tomography (HRCT) of the temporal bones. The FB was bony (eroded incus), which was impacted near the isthmus of the ET and was extremely difficult to remove. A natural FB such as an eroded ossicle in the ET which aggravated the adhesive otitis and caused active squamosal COM has not been reported in the literature.<br /> <strong> </strong><br /> Conclusion:<br /> We have reported this case not only for its rarity but also to make readers aware of such incidental findings which can be found only by imaging, and to suggest how they can be tackled with current equipment and technology.Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725131220190301Tubercular Otitis Externa in an Elderly Male- A Case Report1271301238810.22038/ijorl.2018.29699.1966ENSantosh-Kumar SwainDepartment of Otorhinolaryngology, IMS and SUM Hospital, Siksha“O”Anusandhan(Deemed to be University), K8, Kalinganagar,Bhubaneswar-751003, Odisha, India.0000-0001-7933-4414Mahesh-Chandra SahuMedical Research Laboratory, IMS and SUM Hospital, Siksha “O” Anusandhan(Deemed to be University), K8, Kalinganagar,Bhubaneswar-751003, Odisha, India.Journal Article20180215Introduction:<br /> Tuberculosis is one of the most common diseases in developing countries, resulting in significant morbidity and mortality. Tuberculosis has varied clinical presentations, varying from common primary pulmonary tuberculosis to the extremely rare tubercular otitis externa, as in this case. Tubercular otitis externa has an extremely low clinical incidence.<br /> <br /> Case Report:<br /> We report the case of an immunocompetent elderly male with chronic otorrhea, otalgia, and pale granulation tissue at the ear canal with a positive biopsy report for tuberculosis, confirming the diagnosis. Subsequently, sputum culture positive for Mycobacterium tuberculosis indicated disseminated tuberculosis. The patient’s symptoms resolved after antitubercular therapy (ATT).<br /> <br /> Conclusion:<br /> Tuberculosis at a rare location such as the external auditory canal is possible in regions like India where tuberculosis has the highest burden in the world. In the case of chronic ear discharge resistant to routine antibiotic treatment, the clinician should not rule out suspicion of tuberculosis.<br /> Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725131220190301Infected Concha Bullosa with Fungus1311331238910.22038/ijorl.2018.26003.1852ENHasan-Emre KoçakDepartment of Otorhinolaryngology - Head and Neck Surgery, Bakırköy Dr.Sadi Konuk Training and Research Hospital, Istanbul, Turkey.Mehmet KeskinDepartment of Otorhinolaryngology - Head and Neck Surgery, Bakırköy Dr.Sadi Konuk Training and Research Hospital, Istanbul, Turkey.Mehmet-Nurettin KıralDepartment of Otorhinolaryngology - Head and Neck Surgery, Bakırköy Dr.Sadi Konuk Training and Research Hospital, Istanbul, Turkey.Hüseyin-Avni UlusoyDepartment of Otorhinolaryngology - Head and Neck Surgery, Bakırköy Dr.Sadi Konuk Training and Research Hospital, Istanbul, Turkey.Mehmet YiğitbayDepartment of Otorhinolaryngology - Head and Neck Surgery, Bakırköy Dr.Sadi Konuk Training and Research Hospital, Istanbul, Turkey.Kamil-Hakan KayaDepartment of Otorhinolaryngology - Head and Neck Surgery, Bakırköy Dr.Sadi Konuk Training and Research Hospital, Istanbul, Turkey.Journal Article20170903Introduction:<br /> Concha bullosa is the most common variation of the middle turbinate of the paranasal sinuses. When it causes nasal obstruction, osteomeatal unit dysfunction, or rarely chronic infection, surgery is required.<br /> <br /> Case Report:<br /> We present a fungal infection of concha bullosa, which is a rare indication for surgery of the concha bullosa. A 59-year-old female patient presented with hemifacial pain on the right side, which had lasted for 2 months. There were no pathological findings in her endoscopic nasal examination. Advanced examination by paranasal computed tomography (CT) revealed bilateral concha bullosa variation and soft tissue density in the right concha bullosa. As the biopsy taken from concha bullosa demonstrated fungal hyphae, endoscopic surgical treatment was performed.<br /> <br /> Conclusion:<br /> We stress the importance of the CT in hemifacial pain by this rare case report, in which endoscopic nasal examination was normal. Fungal infection in the concha bullosa is rare, and infected concha bullosa is a pathology to be considered in the differential diagnosis in patients with complaints of hemicranial headache.