Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725129120170101Experimental Visualization of Labyrinthine Structure with Optical Coherence Tomography59806210.22038/ijorl.2016.8062ENSaleh MohebbiBrain and Spinal cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran.0000-0003-4050-7714Marjan MirsalehiBrain and Spinal cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran.Lüder-Alexander KahrsInstitute of Mechatronic Systems, Leibniz University Hannover, Hannover, Germany.Tobias OrtmaierInstitute of Mechatronic Systems, Leibniz University Hannover, Hannover, Germany.Thomas LenarzDepartment of Otorhinolaryngology, Hannover Medical School, Hannover, Germany.Omid MajdaniDepartment of Otorhinolaryngology, Hannover Medical School, Hannover, Germany.Journal Article20160801<strong><em>Introduction:</em></strong><br />Visualization of inner ear structures is a valuable strategy for researchers and clinicians working on hearing pathologies. Optical coherence tomography (OCT) is a high-resolution imaging technology which may be used for the visualization of tissues. In this experimental study we aimed to evaluate inner ear anatomy in well-prepared human labyrinthine bones.<br /><strong><em>Materials and Methods:</em></strong><br />Three fresh human explanted temporal bones were trimmed, chemically decalcified with ethylenediaminetetraacetic acid (EDTA), and mechanically drilled under visual control using OCT in order to reveal the remaining bone shell. After confirming decalcification with a computed tomography (CT) scan, the samples were scanned with OCT in different views. The oval window, round window, and remnant part of internal auditory canal and cochlear turn were investigated.<br /><strong><em>Results:</em></strong><br />Preparation of the labyrinthine bone and visualization under OCT guidance was successfully performed to a remaining bony layer of 300µm thickness. OCT images of the specimen allowed a detailed view of the intra-cochlear anatomy.<br /><strong><em>Conclusion:</em></strong><br />OCT is applicable in the well-prepared human inner ear and allows visualization of soft tissue parts.Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725129120170101Meatoplasty in Canal wall down Surgery: Our Experience and Literature Review1117805010.22038/ijorl.2016.8050ENFaramarz MemariENT and Head & Neck Research Center, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.Mojtaba Maleki DelarestaghiDepartment of Otolaryngology and Head and Neck Surgery. Firoozgar Clinical Research Development center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.Parisa MirDepartment of Otolaryngology and Head and Neck Surgery. Firoozgar Clinical Research Development center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.Mohammad GolMohammadiDepartment of Internal Medicine. Shohada Medical Center, Shahid Beheshti University of Medical Sciences,Ehsan Shams KoushkiENT and Head & Neck Research Center, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.Journal Article20160131<strong><em>Introduction</em></strong><em>:</em><br /> Meatoplasty is the final and essential step in performing effective canal wall down surgery for chronic otitis media. In this article we review some previous techniques and discuss our preferred method.<br /> <strong><em>Materials and Methods:</em></strong><br /> In this observational case series study, we used this technique in 53 patients (28 male and 25 female) between January 2005 and January 2008. Our survey was completed in 31 patients.<br /> <strong><em>Results:</em></strong><br /> Twenty-six patients (83.9%) said their ear appeared normal after the procedure, but five patients (16.1%) complained of some minor change in the shape of their ear. Twenty-nine patients (93.5%) had a completely wide ear canal. The ear canal had some degree of stenosis in two patients (6.5%) post-operatively.<br /> <strong><em>Conclusion:</em></strong><br /> This technique offers good functional and cosmetic results with minimal manipulation and minimal anatomic disruption.Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725129120170101Opium Addiction and Risk of Laryngeal and Esophageal Carcinoma1922805510.22038/ijorl.2016.8055ENMehdi BakhshaeeSinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0001-9590-4798Hamid Reza RazieeCancer Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Reza AfshariAddiction Research Center, Mashhad University of Medical Sciences, Mashhad, IranAmin AmaliOccupational Sleep Research Center, Otorhinolaryngology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.0000-0001-5718-7150Mahmoud RoopooshGeneral Medical Practitioner, Mashhad University of Medical Sciences, Mashhad, IranAli LotfizadehVolunteer of the Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Journal Article20160525<strong><em>Introduction:</em></strong><br /> Cigarette smoking and alcohol consumption have a well-known effect on the development of upper aerodigestive tract carcinomas, but such a role for opium is questionable. This study was designed to assess the correlation between opium inhalation and cancer of the larynx and upper esophagus.<br /> <strong><em>Materials and Methods:</em></strong><br /> Fifty eight patients with laryngeal cancer, ninety eight patients with upper esophageal cancer and twenty seven healthy individuals with no evidence of head and neck or esophageal malignancies were selected from Otolaryngology and Radiation Oncology Department of Mashhad University of Medical Sciences. Duration and amount of cigarette smoking and opium consumption were recorded through comprehensive interviews.<br /> <strong><em>Results:</em></strong><br /> The crude odds ratio for laryngeal cancer was 5.58 (95% CI 2.05-15.15, P=0.000) in cigarette smokers relative to non-smokers and 9.09 (95% CI 3.21-25.64, P=0.000) in opium users relative to non-users. The crude odds ratio for esophageal cancer was 0.44 (95% CI 0.18-1.09, P=0.07) in cigarette smokers relative to non-smokers and 1.44 (95% CI 0.57-3.62, P=0.43) in opium users relative to non-users. After adjusting for smoking, the odds ratio for laryngeal cancer in opium users relative to non-users was 6.06 (95% CI 1.10-33.23, P=0.05). Laryngeal cancer was detected at a significantly lower age in opium users (54.54±10.93 vs 62.92±10.10 years, P=0.02) than in smokers. This effect was not observed in esophageal cancer. Although the duration (year 17.50±14.84 vs 21.91±14.03; P=0.34) and amount (pack/day 0.625 vs 0.978; P=0.06) of smoking were higher among those who were opium dependent, these differences were not statistically significant (P=0.34 and P=0.06, respectively).<br /> <strong><em>Conclusion:</em></strong><br /> Opium addiction by snuffing is an independent risk factor for the development laryngeal cancer but not esophageal cancer. Cigarette smoking increases this risk. Opium dependency increases the likelihood of developing laryngeal cancer at a younger age.Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725129120170101Comparison of Fluoroplastic Causse Loop Piston and Titanium Soft-Clip in Stapedotomy2328805610.22038/ijorl.2016.8056ENMohammad FaramarziOtolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.0000-0002-6903-3252Nafiseh GilanifarOtolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.Sareh RoostaOtolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.0000-0002-3927-0812Journal Article20160623<strong><em>Introduction:</em></strong><br />Different types of prosthesis are available for stapes replacement. Because there has been no published report on the efficacy of the titanium soft-clip vs the fluoroplastic Causse loop Teflon piston, we compared short-term hearing results of both types of prosthesis in patients who underwent stapedotomy due to otosclerosis.<br /><strong><em>Materials and Methods:</em></strong><br />A total of 57 ears were included in the soft-clip group and 63 ears were included in the Teflon-piston group. Pre-operative and post-operative air conduction, bone conduction, air-bone gaps, speech discrimination score, and speech reception thresholds were analyzed.<br /><strong><em>Results:</em></strong><br />Post-operative speech reception threshold gains did not differ significantly between the two groups (P=0.919). However, better post-operative air-bone gap improvement at low frequencies was observed in the Teflon-piston group over the short-term follow-up (at frequencies of 0.25 and 0.50 kHz; P=0.007 and P=0.001, respectively).<br /><strong><em>Conclusion:</em></strong><br />Similar post-operative hearing results were observed in the two groups in the short-term.Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725129120170101Vitamin D Levels in Children with Adenotonsillar Hypertrophy and Otitis Media with Effusion2933806610.22038/ijorl.2016.8066ENAlimohamad AsghariSkull Base Research Center, ENT and Head & Neck Research Center, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.https://orcid.org/00Zohreh BagheriENT and Head & Neck Research Center, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.Maryam JalessiENT and Head & Neck Research Center, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.Mohammad Mahdi SalemENT and Head & Neck Research Center, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.Elahe AminiENT and Head & Neck Research Center, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.Sahand GhalebaghiENT and Head & Neck Research Center, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.Sepideh BakhtiENT and Head & Neck Research Center, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.Journal Article20160809<strong><em>Introduction:</em></strong><br />Vitamin D has been suggested to play a considerable role in the function of the immune system in various infectious, inflammatory, and autoimmune conditions. Otitis media with effusion (OME), defined as the presence of non-purulent fluid within the middle ear without signs or symptoms of suppurative otitis media, has a number of inflammatory predisposing factors. This study was designed to explore the association between vitamin D deficiency and OME.<br /><strong><em>Materials and Methods:</em></strong><br />In this cross-sectional study, 74 children aged 2–7 years with an obstructive indication for adenotonsillectomy were included. Patients were divided into two groups based on the need for ventilation tube insertion for OME. Thirty-two children were enrolled in the OME group and 42 in the control group. The mean vitamin D level was compared between the two groups.<br /><strong><em>Results:</em></strong><br />Mean vitamin D concentration in all patients was 11.96±5.85 ng/ml (9.79±4.36 ng/ml in the OME group and 13.61±6.33 ng/ml in the control group; P=0.003). There was also a significant difference in levels of vitamin D in patients referred in winter (9.0±2.94 ng/ml) compared with the summer (19.85±4.21 ng/ml; P=0.001). Data analyzed based on the season in which the patients were referred showed no significant difference between the OME and the control group.<br /><strong><em>Conclusion:</em></strong><br />Although our results showed lower serum levels of vitamin D in OME patients, the difference was not significant when seasons were taken into consideration. Therefore, the season is an important confounding factor in any research related to vitamin D due to the effect of sun-induced vitamin D.Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725129120170101Central Myxoma / Myxofibroma of the Jaws: A Clinico-Epidemiologic Review3541804510.22038/ijorl.2016.8045ENRowland AgbaraDepartment of Oral and Maxillofacial Surgery, Jos University Teaching Hospital, Jos, Plateau state, Nigeria.0000-0003-3415-6479Benjamin FometeDepartment of Oral and Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna state, Nigeria.0000-0003-4690-0496Athanasius-Chukwudi ObiadazieDepartment of Oral and Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna state, Nigeria.0000-0001-9793-4835Uchenna-Kevin OmejeDepartment of Oral and Maxillofacial Surgery, Aminu Kano University Teaching Hospital, Kano, Nigeria.https://orcid.org/00Modupeola-Omotara SamailaDepartment of Pathology/Morbid Anatomy, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna state, Nigeria.Journal Article20160121<strong><em>Introduction:</em></strong><br /> Myxomas are a group of benign rare tumors of connective-tissue origin that occur in both hard (central) and soft tissues of the body. The aim of this study is to highlight our experience in the management of central myxoma of the jaw, with emphasis on its clinic-epidemiologic features as seen in our environment. <br /> <strong><em>Materials and Methods:</em></strong><br /> All patients who were managed for central myxoma of the jaw at the Oral and Maxillofacial Surgery department of a regional University Teaching Hospital between September 1997 and October 2015 were retrospectively studied. Details sourced included age, sex, site of tumor, duration, signs/symptoms, treatment given, and complications. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 16 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2007 (Microsoft, Redmond, WA, USA). Results from descriptive statistics were represented in the form of tables and charts, with a test for significance (<em>ρ)</em> using Pearson Chi-square (χ<sup>2</sup>) set at 0.05.<br /> <strong><em>Results:</em></strong><br /> A total of 16 patients were managed within the period reviewed, consisting of 10 (62.5%) females and six (37.5%) males, giving a male-to-female ratio of 1:1.7. The ages of patients ranged from 5 to 70 years, with a mean of 27.06±15.45 years. The mandible accounted for nine (56.3%) cases and the maxilla for six (37.5%) cases, while a combination of the maxilla and the zygoma were involved in one (6.3%) case. Bucco-lingual or bucco-palatal expansion were the most common presentation (six [46.2%] cases each). Histological assessment of tissue specimens showed that fibromyxoma accounted for seven (43.8%) cases, while the remaining nine (56.3%) cases were diagnosed as myxoma. All patients had jaw resections, and these consisted of mandibulectomies in nine (60.0%) patients and maxillectomies in six (40.0%) patients. The duration of hospital stay ranged from 5 to 29 days, with a mean of 17.86±7.68 days. Complications were noted in three patients, and all were surgical wound infections.<br /> <strong><em>Conclusion:</em></strong><br /> Most patients in our environment present late with large tumors and are usually not compliant with follow-up review. Thus, a radical approach is favored in most patients.Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725129120170101Two Techniques of Tonsillectomy Performed in Identical Twins: A Case Report4346804110.22038/ijorl.2016.8041ENAli BagherihaghDepartment of Otorhinolaryngology, Baqiyatallah University of Medical Sciences, Tehran, Iran.0000-0002-2079-6662Seyed Mousa Sadr HosseiniDepartment of Otorhinolaryngology, Tehran University of Medical Sciences, Tehran, Iran.Journal Article20150612<strong><em>Introduction:</em></strong><br />Cold dissection (CD) and bipolar cautery dissection (BCD) techniques are two common surgical tonsillectomy procedures used in the clinic. Obstruction has become more prevalent as the major surgical indication and is most prominently observed in younger children.<br /><strong><em>Case Report: </em></strong><br /> In this report, we aimed to explain the abovementioned surgical techniques in detail and compare the results in identical twins (monozygote twins). Using low energy electrocautery, irrigating the operation site continuously during cauterization, avoiding unnecessary sutures, and direct cautery to the tonsil bed are all effective measures that have diminished post-op pain in bipolar electrocautery dissection, compared to cold dissection tonsillectomy.<br /><strong><em>Conclusion: </em></strong><br />Bipolar cautery dissection with some modification is very good alternative for tonsillar surgery.Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725129120170101Childhood Laryngeal Dystonia Following Bilateral Globus Pallidus Abnormality: A Case Study and Review of Literature4751804210.22038/ijorl.2016.8042ENMohammad Javad Saeedi BorujeniDepartment of Anatomical Sciences and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.0000-0002-4075-5390Ebrahim EsfandiaryDepartment of Anatomical Sciences and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Mostafa Almasi- DooghaeeDepartment of Neurology, Iran University of Medical Sciences, Tehran, Iran.Journal Article20151011<strong><em>Introduction:</em></strong><br />Dystonia is a disorder of movement caused by various etiologies. Laryngeal dystonia is caused by the spasm of laryngeal muscles. It is a disorder caused by vocal fold movement in which excessive adduction or abduction of the vocal folds occurs during speech. The pathophysiology of this type of dystonia is not fully known. Some researchers have suggested that basal ganglia structures and their connections with cortical areas have been involved in the pathogenesis of dystonia.<br /> <strong><em>Case Report:</em></strong><br />In this paper a 7.5-year-old boy suffering from laryngeal dystonia with bilateral lesions in Globus Pallidus is presented. The patient also suffered from swallowing problems, monotone voice, vocal tremor, hypersensitivity of gag reflex, and stuttering. Drug treatment failed to cure him; therefore, he was referred to rehabilitation therapy. <br /><strong> </strong><strong><em>Conclusion:</em></strong><br />In conclusion, special attention should be brought upon laryngeal dystonia, especially in patients showing Extra-pyramidal symptoms and/or abnormalities of the basal ganglia. In children, laryngeal dystonia may be potentially fatal. Lack of consideration for this condition during rehabilitation therapy can lead to serious consequences for a child.<br /> <br /> Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725129120170101Abnormal Auditory Brainstem Response (ABR) Findings in a Near-Normal Hearing Child with Noonan Syndrome5357804310.22038/ijorl.2016.8043ENBahram JalaeiDepartment of Audiology, Faculty of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran.Mohd Normani ZakariaAudiology Program, School of Health Sciences, University Sains Malaysia, Kelantan, Malaysia.0000-0002-3694-3460Dinsuhaimi SidekDepartment of Otorhinolaryngology, School of Medical Sciences, University Sains Malaysia, Kelantan, Malaysia.Journal Article20151116<strong><em>Introduction: </em></strong><br />Noonan syndrome (NS) is a heterogeneous genetic disease that affects many parts of the body. It was named after Dr. Jacqueline Anne Noonan, a paediatric cardiologist.<br /><strong><em>Case Report: </em></strong><br />We report audiological tests and auditory brainstem response (ABR) findings in a 5-year old Malay boy with NS. Despite showing the marked signs of NS, the child could only produce a few meaningful words. Audiological tests found him to have bilateral mild conductive hearing loss at low frequencies. In ABR testing, despite having good waveform morphology, the results were atypical. Absolute latency of wave V was normal but interpeak latencies of wave’s I-V, I-II, II-III were prolonged. Interestingly, interpeak latency of waves III-V was abnormally shorter.<br /><strong><em>Conclusion:</em></strong><br />Abnormal ABR results are possibly due to abnormal anatomical condition of brainstem and might contribute to speech delay.Mashhad University of Medical Sciences (MUMS)Iranian Journal of Otorhinolaryngology2251-725129120170101Foreign Body Aspiration in Adults (Two Unusual Foreign Bodies; Knife and Tube Tracheostomy)5961805710.22038/ijorl.2016.8057ENSeyed Mozafar HashemiDepartment of Thoracic Surgeon, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.Mohsen KolahdouzanDepartment of Thoracic Surgeon, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.Shahab ShahabiDepartment of General Surgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.Hamid TalebzadehGeneral Surgeon, Resident of Thoracic Surgery, Isfahan University of Medical Sciences, Isfahan, IranMohammad Taghi RezaeiGeneral Surgeon, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, IranJournal Article20160629<strong><em>Introduction:</em></strong><br />Foreign body aspiration is usually a serious condition that is most common among the pediatric population, and rare in adults. In adults, aspiration may be tolerated for a long time.<br /><strong><em>Case Reports</em></strong><strong><em>:</em></strong><br />Our first case is a 38-year-old man who presented with a 2-day history of swallowing a foreign body. He was completely asymptomatic. Chest X-ray revealed the presence of 5-cm foreign object in the right main bronchus. Rigid bronchoscopy was performed and a knife was removed from the right main bronchus. Second, a 57-year old man with a known case of laryngeal cancer from 15 years previously was admitted for respiratory distress. He had previously undergone a permanent tracheostomy and had received radiotherapy for his cancer. At the first visit, the patient had prominent distress and was transferred to the operating room as an emergency. A tube was seen on chest X-ray. On bronchoscopy, we found the tracheostomy situated in the carina. The cleaved tracheostomy was removed using the grasper, by grasping the cuff line.<br /><strong><em>Conclusion:</em></strong><br />We conclude that foreign body aspiration might be completely asymptomatic, especially in an adult. A good history and imaging findings can help us to diagnose and treat the condition carefully.