https://ijorl.mums.ac.ir/ Iranian Journal of Otorhinolaryngology en daily 1 Sun, 01 Mar 2026 00:00:00 +0330 Sun, 01 Mar 2026 00:00:00 +0330 https://ijorl.mums.ac.ir/article_27349.html Introduction:Lemierre’s syndrome (LS) is a rare but potentially life-threatening condition characterized by septic thrombophlebitis of the internal jugular vein, typically following an oropharyngeal infection. First described in 1936, the syndrome was once considered a “forgotten disease” due to its rarity in the post-antibiotic era. However, recent decades have witnessed a modest resurgence in reported cases, attributed in part to increased clinical awareness, improved diagnostic techniques, and evolving microbial resistance patterns. Antibiotics and anticoagulation remain mainstay of treatment with a high rate of treatment response. However, there is a small subset of patients that fail standard treatment and instead clinically deteriorate necessitating prolonged antibiotic therapy. This cohort of patients typically has unexpected critical care unit admissions and prolonged hospital stays. Historically, these patients would undergo vessel ligation. Thrombectomy has been proposed as an alternative to surgical vessel ligation for treatment resistant LS.Materials and Methods: Using PubMed/MEDLINE and Scopus databases, we performed a comprehensive literature search on April 16, 2025, to identify studies relating to thrombectomy in Lemierre’s Syndrome. Results: Four articles were found that fit inclusion criteria.  Although limited by quantity, the studies found demonstrated that patients with treatment resistant disease usually had some clinical improvement after thrombectomy and on average had shorter intensive care unit and hospital stays. Conclusion:Thrombectomy use for treatment resistant LS is not well described in the literature. However, while not ideal or appropriate for every patient, there could exist a potential role for thrombectomy in patient with LS symptomology resistant to antibiotics and anticoagulation.  https://ijorl.mums.ac.ir/article_27367.html Introduction: Rhinitis is a common condition that is typically treated with medical therapies. However, 10–22% of patients are resistant to these treatments. In our study, the effectiveness of cryotherapy of the posterior nasal nerve (PNN) in treating rhinitis patients who have not responded to conventional medical treatments has been evaluated.Material and Methods: In this single-group interventional study (before/after), 40 patients with rhinitis referred to the ENT clinic of Baqiyatallah Hospital underwent PNN cryotherapy using a new device called Cryo Nose. To collect data, the Total Nasal Symptom Score (TNSS) questionnaire was administered before the intervention and at 1 week, 1 month, 3 months, and 6 months after the intervention.Results: After PNN cryotherapy, the TNSS 12-hour symptom score improved from 9.2 (±2.3) to 6.59 (±2.18) at 1 week later, 3.83 (±1.88) at 1 month later, 2.58 (±1.58) at 3 months later, and 1.98 (±1.47) at 6 months later (P < 0.05). Similar results were noted for the 2-week scores, which improved from 10.38 (±2.53) to 8.35 (±2.32) at 1 week later, 5.95 (±2.09) at 1 month later, 4.27 (±1.61) at 3 months later, and 3.38 (±1.49) at 6 months later (P < 0.05).Conclusions: PNN cryotherapy has been shown to be effective in treating rhinitis during a 6-month follow-up period, with no significant adverse events. The effect of PNN cryotherapy on the symptoms of these patients did not differ between the different types of rhinitis. https://ijorl.mums.ac.ir/article_27345.html Introduction:The etiology of Antrochoanal polyp (ACP) has been a subject of controversy. A deviated nasal septum may contribute to ACP formation by forcing a maxillary cyst through the accessory ostium. This study aims to evaluate the role of DNS in the formation of ACP.Materials and Methods: This retrospective case-control study included 40 diagnosed ACP cases (Group A) and 40 asymptomatic controls (Group B). The imaging scans of 80 patients were retrieved from the database and reviewed to correlate septal deviation with ACP using three septal deviation classifications- Mladina classification, classification based on the location of most prominent point of septal deviation and Baumann classification.Results: In Group A, septal deviation was present in 92.5% of patients, with 55% showing left-sided ACP with left DNS and 37.5% right-sided ACP with right DNS. In the control group, septal deviation was present in 90% of patients. On comparing septal deviation and ACP using Mladina classification (p value = 0.098) and Baumann classification (p value=0.805), no statistical significance was observed.  A statistically significant difference (p value <0.001) was observed between the cases and control groups based on the classification of the location of most prominent point of septal deviation.Conclusion: In the present study, we were unable to establish a definitive causality between deviated nasal septum and the occurrence of an Antrochoanal polyp. However, deviation of the nasal septum between the anterior and posterior ends of the middle turbinate may act as a contributory factor in the formation of ACP. https://ijorl.mums.ac.ir/article_27348.html Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is a peripheral labyrinth disease and is a prevalent cause of dizziness with a lifetime frequency of roughly 10%.  Otoconia found in the otolith organ contain calcium carbonate and protein. Derangement in calcium homeostasis due to vitamin D is implicated in both the onset and recurrence of BPPV, and supplementation could play a role in preventing or alleviating the condition.Materials and Methods: This prospective study enrolled a total of 60 patients with posterior semicircular canal BPPV. Subjects were divided into Group A with vitamin D<20ng/ml (45) and Group B with vitamin D>20ng/ml (15). Group A on day 1 received Canal Repositioning Manoeuvre (CRM) and vitamin D supplementation. Group B on day 1 received CRM only. Patients were followed up at 1,2,3, and 6 months and reassessed for vitamin D levels and relapse of BPPV.  Results: Out of 60 subjects, 14 showed relapse, 23.3%. Out of 45 subjects in Group A, 13 showed relapse (28.9%). Among 15 patients in Group B, only 1 patient showed relapse (6.7%). Vitamin D levels in the supplementation group normalized before 3 months of follow-up. After 3 months, no relapse was noted in either of the groups. Hence, vitamin D-deficient BPPV patients showed a significantly a higher rate of relapse (p value 0.039).Conclusion: This study demonstrates a high incidence of vitamin D deficiency among patients with BPPV. Also, patients with low vitamin D levels have higher rate of relapse of BPPV, and correction of vitamin D levels leads to a decrease in relapse frequency. https://ijorl.mums.ac.ir/article_27387.html Introduction: This study assessed the effect of supplementing Canalith Repositioning Maneuvers (CRM) with structured counselling on functional recovery in patients with Benign Paroxysmal Positional Vertigo (BPPV).Materials and Methods: In this prospective, controlled study, sixty patients with posterior or lateral canal BPPV underwent appropriate CRM. Patients were randomly allocated to receive either CRM alone or CRM combined with structured counselling. Functional recovery was assessed using the Dizziness Handicap Inventory (DHI) at baseline and one week after treatment. Handicap recovery was calculated as the change in DHI score (ΔDHI). Multivariate linear regression analysis was performed to determine whether counselling independently predicted handicap recovery after adjusting for age, sex, canal involvement, and baseline DHI severity.Results: Both groups showed significant DHI improvement after-CRM. However, the Intervention Group demonstrated a significantly greater mean ΔDHI (28.80 ± 3.13) compared to the Control Group (22.47 ± 4.66), with a mean difference of 6.33 point (p < 0.001). Furthermore, fewer patients in the Intervention Group (6.7% vs. 20%) returned to the clinic prematurely with concerns about persistent symptoms. After multivariate adjustment, structured counselling remained an independent predictor of greater handicap recovery (β = 5.07; 95% CI: 3.15–6.98; p < 0.001). Baseline DHI severity was also independently associated with recovery (p < 0.001), age, sex, and canal involvement were not significant predictors.Conclusion: Structured post-maneuver counselling independently enhances early functional recovery in patients with BPPV beyond the effect of CRM alone. Incorporating counselling into routine BPPV management may improve patient-perceived outcomes during the early recovery phase. https://ijorl.mums.ac.ir/article_27388.html Introduction: Laryngopharyngeal reflux is a common condition caused by exposure of the upper aerodigestive tract to gastroduodenal content, resulting in inflammation to the area. Despite the condition being well documented in the human population, the literature on animal models for laryngopharyngeal reflux is currently limited. The aim of this study is to create a non-invasive model of laryngopharyngeal reflux using rats to investigate changes in IL-6 expression in the laryngeal and laryngopharyngeal regions.Materials and Methods: Male Wistar rats, ranging from ages 10-14 weeks, were exposed to 0.5% bovine pepsin dissolved in artificial gastric juice three times daily for 5-15 days via a modified IV cannula in several volumes          (0 mL, 0.1 mL, 0.15 mL, and 0.2 mL) according to the treatment groups. Subsequently, laryngeal and laryngopharyngeal tissue IL-6 concentrations were measured through ELISA on allotted days of sacrifice.Results: Significant differences in laryngeal and laryngopharyngeal tissue IL-6 concentration were measured     (p = 0.005 and p = 0.020 respectively). Laryngeal expression of IL-6 was related to the volume administered (p = 0.007) but not to the duration of exposure (p = 0.338), with no significant interaction between duration of exposure and administered volume (p = 0.515). On the other hand, laryngopharyngeal expression of IL-6 was related to the duration of exposure (p< 0.001) but not to the volume administered (p = 0.521) with significant interaction between duration and volume (p < 0.001).Conclusion: The study established the feasibility of using a non-invasive rat model for studying laryngopharyngeal reflux. Additionally, the study demonstrated the differential responses of IL-6 to the addition of the acid-pepsin insult, with dose-dependent IL-6 responding more in laryngeal tissue and time-dependent IL-6 responding in laryngopharyngeal tissue. https://ijorl.mums.ac.ir/article_27346.html Introduction: Nasoethmoid schwannomas are rare benign tumors of the nasal cavity and paranasal sinuses that arise from local peripheral nerve sheaths. Up to 45% of all schwannomas develop in the head and neck region; however, fewer than 50 cases have been described in the nasoethmoid area in the medical literature. This case underscores the importance of including schwannoma in the differential diagnosis of nasoethmoidal masses with skull-base involvement. Case Report:A 60-year-old female presented with diminished sensitivity to smell for 12 months, swelling near left medial canthus and headache for the past 10 months. Nasal endoscopy revealed a smooth encapsulated mass in the anterior roof of nasal cavity between middle turbinate and septum bilaterally. CT and MRI revealed a smooth mass in the roof of nasal cavity having intracranial extra-axial extension. Biopsy displayed features of schwannoma. Patient underwent excision of tumor via combined approach of endoscopy and bifrontal craniotomy. Post-operative histopathology was consistent with features of schwannoma. Conclusion:Nasoethmoidal schwannoma is a benign neoplasm that infrequently exhibits intracranial extension. To date, there have been 17 documented cases in the literature, and this report presents the 18th reported case overall and 6th bilateral case. Because radiographic results are ambiguous, a histological investigation is required for a precise diagnosis. Bifrontal craniotomy combined with endoscopic transnasal excision is the preferred surgical treatment for tumors that extend into the anterior cranial fossa. Long-term clinical follow-up is critical for detecting future recurrences. https://ijorl.mums.ac.ir/article_27347.html Introduction: Solitary extramedullary plasmacytoma (EMP) of the nasopharynx is a rare plasma cell neoplasm, representing a small subset of head and neck malignancies. Its nonspecific symptoms often lead to diagnostic delays.Case Report: A 50-year-old female with non-specific progressive nasal obstruction and intermittent epistaxis, underwent complete endoscopic surgical excision using coblation. Post operative histopathology revealed Nasopharyngeal Extramedullary Plasmacytoma. The patient then received adjuvant radiotherapy (Volumetric Modulated Arc Therapy - VMAT), leading to a successful outcome with no recurrence at the one-year follow-up. Conclusion: This case underscores the importance of clinico-histopathological evaluation and a comprehensive, multimodal treatment approach, with nasopharyngeal extramedullary plasmacytoma (EMP) considered as a differential diagnosis in nasopharyngeal masses. Given the potential for progression to multiple myeloma, long-term surveillance is crucial. Increased awareness of this rare entity can facilitate early diagnosis, timely intervention, and improved patient outcomes.