Journal of Otorhinolaryngology and Facial Plastic Surgery

Background: Parapharyngeal space abscess is a rare and life-threatening condition that is more prevalent in preschool children. Patients mostly are febrile with sore throat and torticoli. The diagnostic method of choice is a neck CT scan with contrast. Patients should be admitted and receive intravenous antibiotics with coverage of aerobic and anaerobic organism. Also, otolaryngology consultation for early surgery and drainage should be done. In this report, we presented a three and a half years old boy with fever, sore throat, and torticoli.

Case presentation: A three and a half years old boy was referred to our hospital due to fever, sore throat, torticollis, neck lymphadenopathy, and poor feeding except receiving antibiotics, his symptoms didn’t change. Ultrasonography was done with multiple bilateral lymphadenopathies in submental, submandibular, and jugular proximities with the maximum sizes if 9 mm in the left side and 7 mm in the right side with no collections or abscess. In the CT scan there were a left parapharyngeal space abscess with spread to retropharyngeal and pressure effect on hypopharynx and another abscess in the same site. Surgical drainage of both abscesses was done and postoperative ICU admission with blood transfusion and intravenous antibiotics including meropenem, vancomycin, and metronidazole administered. Finally, the patient was discharged with a good condition and there was no complaint or problem in follow-ups.

Discussion: Although this disease is life-threatening but, with early diagnosis and proper treatment, prognosis will be good. Delay in the diagnosis and treatment increases complication rate and can increase mortality rate to 40%.

Conclusion: Retropharyngeal or parapharyngeal abscess is rare and life-threatening condition that physician should be aware about it.

Background: Mucoceles most commonly occur in the frontal sinuses and can expand the sinus cavity, invade surrounding tissues, and cause health problems like brain abscesses and vision loss. The common causes of mucoceles include previous sinus surgery, trauma, and chronic inflammatory diseases like acute and chronic rhinosinusitis.

Case presentation: A 38-year-old man with forehead and medial cantus swelling was admitted to Loghman Hakim Hospital.  He reported no history of chronic inflammatory disease, trauma or surgery. patient had a satisfactory postoperative period and was discharged two days later with good cosmetic results.

Discussion: Mucoceles form when a sinus opening is blocked, causing a buildup of mucus. They are most commonly found in the forehead region and can cause symptoms such as headaches, eye swelling, visual disturbances, and difficulty breathing. CT scans are essential for diagnosis, but MRI is superior for distinguishing mucoceles from other masses. Endoscopic surgery is the preferred treatment with low risk of recurrence.

Conclusion: A middle-aged male patient was diagnosed with a large frontoethmoidal mucocele spontaneously with no prior surgery, trauma or chronic inflammatory disease history.

Background: Inflammatory pseudotumor (IP) is a collection of histocytes, and inflammatory cells including plasma cells, lymphocytes, eosinophils, and fibroblasts. The IP in the nasopharyngeal space is exceedingly rare. If left untreated it may cause permanent and serious complications.

Case presentation: A 46-year-old man with left nasal congestion, and a hearing decrement in his left ear was admitted to Loghman-hakim Hospital. In audiometric evaluations, there was a 20 decibels gap in the hearing threshold between two ears. In nasopharyngoscopy, there was a large gray-to-white mass with intact epithelia in the nasopharynx. In a computed tomography scan, a large soft mass in the left nasopharynx, with no evidence of bone destruction. Magnetic resonance imaging (MRI) homogenous isointense and hypointense mass in T1-weighted and T2-weighted images, respectively. Based on all the investigations, the risk of malignancy was considered low. As a result, the final diagnosis of IP was considered for him.

Discussion: IP can occur anywhere in the body and encompasses a diverse range of masses, including inflammatory myofibroblastic tumors, IPTs of lymph nodes, orbit, and spleen, genitourinary pseudosarcomatous, and post-infectious or reparative disorders. The tumors usually affect children and young adults, and the precise incidence and prevalence of IPs are difficult to estimate. The main treatment is surgical resection, corticosteroids, or both, with alternative treatments including small molecule inhibitors, immunoglobulin, and radiotherapy.

Conclusion: Sinonasal IPs are exceedingly rare. In this article, we reported a mid-aged man with an IP in his left nasopharynx space.

Background: Tracheotomy is a common procedure, which can induce late and serious complications, such as tracheoarterial fistulae and tracheal stenosis. The tracheal narrowing may occur due to the wrong technique at the time of tracheotomy. In this case report, we aimed to present a rare post-tracheotomy tracheal narrowing during total laryngectomy.

Case presentation: The patient was a 62-year-old man with a history of smoking and 6-month hoarseness. At the time of the first surgery, direct laryngoscopy had revealed a large exophytic ulcerative mass of epiglottis and pre-epiglottic space with an extra-laryngeal extension. During laryngectomy and after the removal of the larynx, an abnormal coronal thick membrane was found in the caudal part of the specimen with significant tracheal narrowing.

Discussion: There are different types of incisions that can be made for tracheotomy tube insertion, such as horizontal, vertical, T-shaped, and H-shaped incisions, as well as resection of a small section of the tracheal ring to create a window. Each type has its own advantages and disadvantages.

Conclusion: Although it seems that the tracheal narrowing was due to the inverted portion of the tracheal flap during the previous tracheotomy, which was an accidental finding, however, it necessitates a proper evaluation of the tracheal incision types for tracheotomy.

Background: Nasal chondromesenchymal hamartoma (NCMH) is a very rare benign tumor of sinonasal tract with mixed components of predominantly mesenchymal and cartilaginous tissues which is mostly seen in infants and young children.

Case presentation: We present the case of an infant with a nasal chondromesenchymal hamartoma which was confused with a malignancy. This clinicopathologic entity is notable because of its rarity and also it may present a diagnostic dilemma with major implications in management.

Discussion: Nasal chondromesenchymal hamartomas (NCMHs) are rare, mostly benign lesions found in the nasal cavity and paranasal sinuses. They can be locally destructive and may be mistaken for malignant tumors due to their aggressive appearance. NCMHs consist of various lobulated mesenchymal components, with areas of fibro-osseous proliferation. They can cause nasal mass, obstruction, respiratory distress, maxillary bulge, or proptosis, and may extend to the adjacent paranasal sinuses. Radiological imaging is essential for differential diagnosis and evaluating surrounding tissues. Complete surgical excision is sufficient therapy for NCMHs.

Conclusion: We present a rare case of NCMH, which can be difficult to distinguish from malignant tumors. Although NCMH are benign lesions, there is a chance of recurrence following incomplete resection. Recurrence may mimic malignancy, and their differentiation is important for choosing appropriate treatment.

Background: Due to the delay in esophageal cancer until the late stages, its mortality rate is relatively high. One of the most common presentations of advanced esophageal cancer is dysphagia. Esophageal stenting is a palliative treatment modality to resolve dysphagia and restore oral intake. Despite this advantage, stenting has various complications.

Aim: We reported a case of active bleeding after esophageal stenting.

Case presentation: A case of a complication caused by an esophageal stent placement for carcinoma is presented. The placement of the stent was difficult under fluoroscopic control, which led to some pushing, resulting in a wound in the pharynx with active bleeding without perforation. The bleeding was successfully controlled by the surgeon. Therefore, the patient was postponed a few days later and we preferred this time to put a stent through the scope without complications.

Conclusion: Active bleeding is one of the esophageal stenting complications. In this article, we reported a middle-aged woman with advanced esophageal cancer who underwent esophageal stenting. Afterward, she developed active bleeding, which was successfully managed.

Background: Endolymphatic sac tumors (ELSTs) are uncommon low-grade, locally invasive epithelial tumor that originates from the endolymphatic sac of the inner ear and temporal bone. It is a rare event with less than 300 cases worldwide. In this article, we present a case of ELTS who presented with facial asymmetry and hearing loss. In this article, we present a case of ELTS who presented with facial asymmetry and hearing loss.                   

Case presentation: A 15-year-old female was admitted to our hospital with right-sided facial hemiplegia and hearing loss in her right ear which was started and progressed within two years. Except for facial hemiparalysis, other physical examinations were normal. In her audiological investigations, severe hearing loss of her right ear was evident. Imaging studies were indicative of ELSTs. This diagnosis was confirmed by histopathological investigations.

Discussion: ELST is an aggressive papillary tumor that arises from the endolymphatic sac. In most cases, this tumor presents as a solitary growth. It usually presents with hearing loss but can be associated with other symptoms like tinnitus, vertigo and nerve VII paralysis. Imaging studies play a crucial role in the diagnosis of ELST, as it can reveal a characteristic soft-tissue mass involving the temporal bone, with bony erosion and extension into adjacent structures. Surgery is considered as the main form of treatment for ELSTs.

Conclusion: ELSTs are exceedingly rare events. Here we presented a case of ESLT with right facial hemiplegia and right ear deafness.

Background: Acute mastoiditis is one of the complications of acute otitis media in children. Patients with acute mastoiditis commonly have manifestations of acute otitis media and inflammation of the mastoid bone. Computed tomography is the most frequent diagnostic method for diagnosing acute mastoiditis. In this report, we presented a 6-year-old boy with a history of cochlear implantation three years ago, who was referred for acute swelling and pain in the mastoid bone one day ago. 

Case presentation: A 6-year-old boy with fever, pain, redness, and swelling of the posterior side of his right ear from one day ago was referred to the clinic. Physical examination showed tenderness, redness, warmness, and swelling on the right auricle and mastoid bone. Implantation in the right ear about three years ago was mentioned. Last week, involvement with coryza, nasal congestion, and low-grade fever without ear pain was mentioned. Acute mastoiditis was confirmed with CT scanning, and he was cured with antibiotic therapy.

Discussion: Acute mastoiditis is not common. It may occur after a few times of cochlear implantation, but it occurs rarely after a long time. The main cause is bacterial infection. After confirmation of the diagnosis with CT scanning, treatment with antibiotics should be started intravenously, and then it can be changed to oral antibiotics.    

Conclusion: Acute mastoiditis should be considered as a differential diagnosis in pediatrics with acute swelling, pain, and any manifestation of inflammation on mastoid bone, even though there is no history of acute otitis media.

Background: Tonsillar Lymphangiomatous Polyp (TLP) is a rare hamartomatous lesion composed of lymphangiectasia fibro-lipomatous elements. Its stromal framework includes adipose tissue with dilated lymphatic ducts and lymphoid tissue. Despite its rarity, TLP can be challenging to classify due to its unique clinical and pathological characteristics. In this context, we present a comprehensive examination of a TLP patient and documented TLP cases.

Case presentation: A 27-year-old man was referred to the Kurdistan Otolaryngology Clinic due to persistent snoring, difficulty swallowing, and a foreign body sensation in his throat. A pedunculated mass was found on the superior pole of the right tonsil. He underwent a bilateral tonsillectomy, and the pathological examination revealed lymphangiomatous polyps. The patient had no postoperative bleeding and showed no recurrence after a year.

Discussion: The head and neck region is the most common area for lymphatic lesions, particularly lymphangiomas. While tonsillar lymphangiomatous tumors are rare, identifying them in this area can be challenging. Tonsillar lymphangiomatous polyps are benign tumors that can sometimes be misdiagnosed as malignant neoplasms. Common clinical presentations of lymphangiomatous polyps included dysphagia, dyspnea, and a sensation of having a foreign body in the throat. Surgical removal through tonsillectomy is the established treatment approach, with no documented instances of post-surgery recurrence.

Conclusion: We studied a Tonsillar Lymphangiomatous Polyp (TLP) case and provided a comprehensive understanding of its clinical, histopathological, and immunohistochemical attributes. Accurate diagnosis requires histological evaluation, and the recommended treatment involves complete removal of the tonsils.

Background: Iranian researchers' scientific output in otorhinolaryngology needs to be evaluated from a bibliometric perspective.

Aim: This survey aimed at studying Iranian researchers' global contribution to the field during the recent decade (2011-2020).

Methods: Data were extracted by conducting a formulated search strategy in Scopus and analyzed by applying some bibliometric approaches and depicting scientific visualizing maps in VOSviewer software package.

Results: Iranian researchers published 2488 documents on otorhinolaryngology during 2011-2020. The mean h-index of the documents was 42, with mean citations per document=6.60. The majority of documents were original research (87.78%) and in English (.96.70%). The annual growth of Iranian researchers' documents on otorhinolaryngology was increasing in the studied years (R²=0.91), especially in 2019 and 2020. Nader Saki from Ahvaz Jundishapur University of Medical Sciences with 65 documents (citations per document=18.42 and h-index=11) ranked first among top authors. Iranian Journal of Otorhinolaryngology was the first-ranked journal with publishing 327 documents. Among research institutes, Tehran University of Medical Sciences ranked first with 631 documents. The first-ranked collaborating country was the USA collaborating with Iran in authoring 125 documents. Broad-ranged keywords covering almost all aspects of the field were used in the published documents that were included in four topic clusters.

Conclusions: The global research on otorhinolaryngology made by Iranians has found its way. This study recognized important authors, journals, institutions, and countries as well as highly frequent co-occurred keywords and main subject clusters included in otorhinolaryngology documents published by Iranian researchers in the field.

Background: Tinnitus is the perception of sound within the ear without external sound. It's common in patients with otosclerosis and can compromise surgical results. Stapedectomy or stapedotomy can relieve tinnitus, with the latter being preferred due to fewer complications. In a retrospective study, we aim to gather tinnitus data using a validated instrument over time.

Aim: This study aimed to gather data on tinnitus by using a validated tinnitus severity instrument over a while after Stapedectomy or stapedotomy.

Methods: We conducted a retrospective study on patients with otosclerosis who underwent stapedectomy or stapedotomy and suffered from tinnitus. Diagnosis was done through physical examination and pure tone audiometry. The surgical procedure involved a partial stapedectomy, stapedotomy, and Teflon piston prosthesis insertion under general anesthesia. We used the tinnitus handicap inventory to evaluate tinnitus severity before and after surgery. We analyzed the data using SPSS version 22 and found statistically significant improvements in tinnitus severity post-surgery.

Results: In this study, 30 patients were included, with a mean age of 35 ±10.62. Each question showed a significant difference pre- and post-operatively. A paired t-test was conducted to assess the effect of stapedotomy on each subcategory of THI, which found a significant difference in tinnitus severity for each subscale. The total THI score was also significantly different (p-value=0.000).

Conclusion: Stapedectomy or stapedotomy in otosclerotic patients who suffer from tinnitus significantly decreases tinnitus severity. 

Background: Epistaxis affects about 10% of those seeking medical treatment, with posterior epistaxis from the sphenopalatine artery (SPA) posing management challenges. The sphenopalatine foramen (SPF) is crucial for interventions, and CT imaging aids preoperative planning by detailing the SPF and adjacent structures.

Aim: Performing a morphometric analysis of the sphenopalatine foramen using CT imaging to identify and quantify anatomical landmarks that help surgeons locate the sphenopalatine artery.

Methods: A retrospective observational study analyzed Sinus CT scans from 200 adult patients to measure the sphenopalatine foramen's anteroposterior and craniocaudal dimensions. Distances from the SPF to key anatomical landmarks, such as the maxillary line and anterior head of the middle turbinate, were also measured. Statistical analysis was performed to assess variations based on sex and side of the nasal cavity, with a significance level set at p < 0.05.

Results: The average size of the SPF was 5.01 mm ± 1.37 in the anteroposterior dimension and 5.58 mm ± 1.71 in the craniocaudal dimension. The mean distances to anatomical landmarks were as follows: maxillary line 35.73 mm ± 2.47, anterior head of the middle turbinate 33.76 mm ± 4.52, basal lamella 9.71 mm ± 1.84, choanal arch 8.78 mm ± 1.62, posterior fontanelle of the maxillary sinus ostium 14.49 mm ± 1.32, and the bony attachment of the inferior turbinate 13.89 mm ± 2.01. The height above the nasal floor was 25.69 mm ± 2.43. Males exhibited longer distances to key landmarks compared to females, with no significant differences noted between the right and left nasal cavity sides.

Conclusion: Preoperative CT imaging effectively identifies key bony landmarks for accurately locating the sphenopalatine foramen, enhancing the safety and efficiency of endoscopic approaches to the sphenopalatine artery, especially in managing posterior epistaxis.

Background: Occasionally, chronic sinusitis has a dental origin. This Entity is usually resistant to common treatments and high clinical suspicion is necessary for its diagnosis. The symptoms of odontogenic sinusitis are similar to the symptoms caused by other causes of sinusitis, and so far no special symptoms have been introduced for it. In this study, we decided to measure the frequency of this disease and its symptoms.

Aim: The aim of this study was to examine people with dental sinusitis in CT scan (with or without clear signs of sinusitis) and also to examine the prevalence of sinonasal symptoms in all patients as well as the group with odontogenic sinusitis.

Methods: All candidates for septorhinoplasty in 2018 who came to the otorhinolaryngology clinic of Firoozgar Hospital, Tehran, Iran were included in the study. The coronal CT scan of the maxillary sinus of these people were checked for odontogenic sinusitis and at the same time the SNOT-22 sinonasal symptoms questionnaire was completed by the patients. Finally, the prevalence of odontogenic sinusitis and sinonasal symptoms among these patients have been examined.

Results: Twenty-eight of 100 patients had evidence of chronic sinusitis. The prevalence of odontogenic sinusitis in the studied population was 17%. The average score of SNOT-22 was 34.23 ± 8.87 in patients with chronic sinusitis and 38.0 ± 10.45 in patients with odontogenic sinusitis.

Conclusion: Sinonasal symptoms in patients with odontogenic sinusitis had a low prevalence and no special symptom can be considered to differentiate this disease from other causes of sinusitis.

Background: Carotid body tumors are the most prevalent type of paragangliomas in head and neck region, which present as painless mass in carotid triangle with slowing growth. A palpable mass in the neck is the most common symptom of these tumors and other less common symptoms including hoarseness and dysphagia. The current standards of care for carotid body tumor patients are surgical resection. These tumors don’t response to radiation therapy and chemotherapy.

Aim: In this study we evaluated surgical treatment without embolization as a safe treatment modality for carotid body tumours.

Methods: In this study, 46 patients with a total of 50 carotid body tumors were investigated in order to recording their demographic data, clinical presentation, diagnostic modality and treatment strategy.

Results: The results demonstrated that almost 78% of patients were female and patients were 21 to 78 years of age, with the average of 49.1. Bilateral carotid body tumors were observed in 8.7% of patients who had familial history.

Conclusion: Carotid body tumors can be removed surgically with minimal morbidity and mortality risks. Understanding the vascular anatomy of this region is critical for the surgeon. However, there is a major surgical challenge due to the nature of the tumor and its vital neighbourhood.

Background: There is an association between osteitis and symptoms in chronic rhinosinusitis (CRS), but the exact clinical significance of osteitis is unclear. Most histological studies on osteitis of paranasal sinuses are limited to the ethmoid bone.

Aim: The current study examined the histologic changes of mucosa and bone in the middle turbinate and sphenoid sinus for comparison.

Methods: The current observational, cross-sectional study was conducted in a tertiary referral university hospital, from September 2017 to September 2021. Consecutive adult patients with chronic rhinosinusitis symptoms who underwent endoscopic sinus surgery were enrolled in the study. Histopathological evaluations for the existence and level of inflammation were performed by a blinded pathologist regarding the history and imaging results. SPSS (version 26) was used to analyze the data and other analyses.

Results: Inflammatory changes of mucosa in the middle and inferior turbinates and sphenoid sinuses were more severe than inflammatory changes of bone in these areas (p values 0.006, 0.003, and 0.046, respectively).

There was no significant difference in the prevalence of bone and mucosal inflammation between the patients with polyps and the ones without polyps. We did not observe a significant difference in the prevalence of osteitis between the primary and revision surgery nor between patients with asthma and without asthma. There was an association between the severity of inflammatory changes of mucosa with bone in the middle and inferior turbinates and sphenoid sinus (p values 0.007, 0.002, and 0.037, respectively). 

Conclusion: The present study indicates that chronic rhinosinusitis is not a disease that only involves mucosa. It is thus necessary to expand the boundaries of treatment beyond mere mucosa.

Background: Body dysmorphic disorder significantly reduces self-esteem and may be prevalent among individuals seeking cosmetic surgery.

Aim: Investigating the mediating role of self-concept in the relationship between body dysmorphic disorder and emotion regulation in individuals seeking cosmetic surgery in Ahvaz.

Methods: This descriptive-correlational study employed structural equation modeling. From individuals with body dysmorphic disorder who visited beauty clinics in Ahvaz in 2022, 180 participants were selected using a convenience sampling method. Data were collected using the Body Dysmorphic Metacognitive Questionnaire, Emotion Regulation Questionnaire, and Self-Concept Questionnaire. Pearson correlation coefficient and structural equation modeling using AMOS and SPSS version 23 were employed for data analysis.

Results: The results indicated that the model fit indices were within the acceptable range. There was a significant negative correlation between body dysmorphia and positive emotion regulation (reappraisal) (r=-0.37), a significant positive correlation between body dysmorphia and negative emotion regulation (suppression) (r=0.42), and a significant positive correlation between body dysmorphia and self-concept (r=0.22). Furthermore, the relationship between suppression and reappraisal with body dysmorphia was significantly mediated by self-concept.

Conclusion: Self-concept plays a significant role in the relationship between body dysmorphic disorder and emotion regulation. Individuals with higher levels of body dysmorphia may exhibit poorer emotional regulation strategies and lower self-confidence. These results highlight the importance of addressing self-concept in the treatment of body dysmorphic disorder.

Background: Apoplexy is known as a critical issue all over the world and certain parts of the brain are more sensitive to Ischemia/cerebral reperfusion such as the hippocampus. Coenzyme Q10 is a powerful anti-oxidant, which helps in cells membrane durability.

Aim: This study attempts to find the effect of coenzyme Q10 on the change of hippocampal area texture after cerebral reperfusion/Ischemia.                                                                                                                               

Methods: Twenty-four male Wistar rats were organized into 4 groups of six including control, Ischemia, vehicle and experimental groups, with 100 mg /Kg of coenzyme Q10. Coenzyme Q10 was given to the rats 5 days before and 3 days after Ischemia/reperfusion induction. Ischemia was done for 20 minutes by reciprocal blocking of carotid arteries. The rat’s brains were removed and stained by applying the chrysalis fast violet method. The number of viable cells of the hippocampal regions of all 4 groups was counted by Imaging-Pro-Plus software. Statistical analysis of the data was then accomplished by one-way ANOVA and Tukey's test.

Results: Findings revealed that the number of viable cells in CA2 and CA3 area reduced following ischemia induction. Whereas, there was no notable change between the control and experimental groups in terms of cells numbers. Besides, there was no remarkable change between the control, experimental and ischemia groups in terms of the number of cells within CA4 area.

Conclusion: The results support the use of coenzyme Q10 as a neurotrophic substance and as an adjunctive therapy in patients at risk for ischemic stroke.

Background: Rhinoplasty outcomes evaluation (ROE) is a type of quality-of-life questionnaire. The ROE questionnaire, originally developed in English, has been translated into several languages.

Aim: This study focuses on assessing the reliability and validity of the Persian version of the questionnaire.

Methods: The study utilized a cross-sectional descriptive-analytical method to validate the Persian version of the rhinoplasty outcomes evaluation (ROE) questionnaire. The translation process involved two independent translators. The Persian version was then translated back into English and sent to the original designers of the questionnaire for permission. The content validity of the questionnaire was assessed by a group of experts, and the content validity ratio (CVR) and content validity index (CVI) were calculated. To assess reliability, test-retest, and Cronbach's alpha coefficient were used.

Results: The questionnaire demonstrated good reliability, with a Cronbach's alpha coefficient of 0.76, indicating internal consistency. The inter-item correlation (IIC) of the current questionnaire was equal to 0.727. The CVR of all questions was higher than the standard CVR for 10 experts, that is 0.62, except for question number two, which had a CVR of 0.564.

Conclusion: The research effectively confirmed the reliability and validity of the ROE questionnaire version in evaluating contentment after rhinoplasty procedures. This questionnaire now serves as an accurate tool specifically designed for assessing satisfaction, among individuals, in Iran.

Background: An operation called functional endoscopic sinus surgery (FESS) can improve symptoms with success rates ranging from 67% to 98%. However, post-FESS management is still uncertain, and this expert opinion provides guidelines for managing patients after the surgery.

Aim: This study aimed to evaluate postoperative care in functional endoscopic sinus surgery.

Methods: In the current descriptive cross-sectional study, a questionnaire consisting of 25 questions about pre- and post-FESS considerations in terms of medications, imaging and the follow-up period was designed and 40 expert rhinologists in this field responded to the questions.

Results: Post-operative antibiotics, pre-and post-operative corticosteroids especially in the form of nasal spray, corticosteroid-soaked Gelfoam, saline irrigation in large volumes, and nasal debridement after surgery were recommended by the majority of the surveyed experts. Post-operative imaging was suggested if any adverse event is suspected. Furthermore, oral corticosteroids are suggested for exacerbations. Most of the experts recommend long-term follow-ups.

Conclusion: Based on the findings of the current survey, the experts' practice not only is remarkably variable over each other but also differs from the current guidelines. Further investigations and practical workshops are strongly recommended to improve the experts’ performance in FESS.

Background: Endoscopic endonasal transsphenoidal surgery is commonly used to remove pituitary adenomas. However, it can lead to cerebrospinal fluid (CSF) leakage, with an incidence of around 5% in sphenoid transnasal procedures and up to 20% in extended endonasal approaches. A retrospective study was conducted on 160 pituitary adenoma patients admitted to Loghman Hakim Hospital from 2016 to 2020 to evaluate the factors influencing CSF leak.

Aim: The aim of this study was evaluating the occurrence of cerebrospinal fluid leakage and analyzing the factors involved.

Methods: This is a retrospective analysis of patients diagnosed with pituitary adenoma at Loghman-Hakim hospital over a four-year period. Demographic information, tumor characteristics, surgical procedures, and complications were collected. All patients gave their consent, and the study was approved by the ethics committee. Surgical procedures were conducted using a direct endonasal trans-sphenoidal approach under general anesthesia, and antibiotics were given. Statistical analysis was conducted using SPSS to evaluate the relation between measured variables and the occurrence of CSF leak.

Results: The study found that 19.4% of the patients developed CSF leak during their hospital stay. Age and body mass index (BMI) of patients with CSF leak significantly differed from those without. The size of the tumor did not differ significantly between patients with and without CSF leak. The only variable associated with CSF leak was sphenoid sinus anatomy.

Conclusion: The study concluded that older patients with a lower BMI and a larger defect size are more prone to CSF leak, but no significant difference was found in tumor size between the groups with and without CSF leak. Sphenoid sinus anatomy correlated with CSF leak, while other factors did not show any correlation with the incidence of CSF leak.

Background: Rhinoplasty is a common cosmetic procedure in which the nasal shape is changed and reconstructed. It can be done for both reconstructive and cosmetic purposes. Evaluating the success of the procedure involves traditional measures as well as the patient's perspective, both of which are important for their psychological well-being.

Aim: This research was conducted to evaluate the mental health changes after rhinoplasty in different populations. Understanding the level of anxiety and depression in rhinoplasty patients before and after the operation is important for achieving positive outcomes.

Methods: In this study, 200 patients over 18 years of age who underwent rhinoplasty surgery were selected. Anxiety levels were checked using Hamilton questionnaire prior to the operation and the depression level via Beck questionnaire. Then, after six months, the anxiety and depression levels were examined again. The differences before and six months after the operation were evaluated by paired t-test. A P-value less than 0.05 was considered statistically significant.

Results: 200 patients underwent rhinoplasty for a study. The average patient age was 28.14 ± 10.21, and 83.5% were women. Most patients did not have a history of depression. The Beck questionnaire showed a significant reduction in depression scores post-surgery (p=0.032). Anxiety levels showed no significant difference before and after rhinoplasty (p=0.862). 

Conclusion: The level of depression in patients after rhinoplasty decreased significantly. Rhinoplasty did not affect the anxiety level of the patients.

Background: Knowing the long-term consequences or side effects induced by various types of strut and septal extension grafts following rhinoplasty are essential and aid in estimating and predicting difficulties later. The purpose of this study is to look at how the projection of the nose tip changes following rhinoplasty with the L-shape strut, a new type of septal extension.

Aim: We aimed to determine the changes in nasal projection in patients who received an L-shaped strut at 6 and 12 months’ post-operation.

Methods: Following inclusion and exclusion criteria, an L-shape strut was prepared from the patient's septal cartilage and used in the surgery. We objectively assess the results of the L-shape strut with standard images. These standard images were taken before surgery and on the day of the nasal splint off, six- and twelve-months after surgery. Then the nasal projection was calculated using Goode's ratio.

Results: Thirty patients were included. The mean Goode's ratio was 0.573 ± 0.014 shortly after surgery, all participants had a ratio between 0.55 and 0.60. After 6 and 12 months of follow-up, the measured Goode ratio of the participants was 0.556 ± 0.024 and 0.550± 0.027, respectively. Thus, the observed ratio declined by 2% during the first six months, and 1 % during the second six months. This decreasing pattern was statistically significant. After twelve months of follow-ups, Goode's ratio of all included cases was in the optimal range of 0.55 to 0.6. 

Conclusion: The findings of this study demonstrate that the L-shape strut, a new type of septal extension, can help to keep the optimal Goode’s ratio after a year follow-up. 

Background: The number of brain strokes induced by ischemia has increased significantly in recent years as a result of brain vascular disorders. Some of these patients will require brain vascular surgery. Brain ischemia, large-scale bleeding, and hypoxia are all severe risks that must be avoided when using an anesthetic medicine that has the best protective benefits for the patient's brain and vascular system during the surgical process. One of the most critical pathogenic events in ischemia-reperfusion is apoptosis, and the CA1 region of the hippocampus is one of the most vulnerable parts of the brain to ischemia. Propofol is a neuroprotective intravenous anesthetic for cerebral ischemia-reperfusion (I/R) injury. Few studies have been conducted on the neuroprotective and neurobehavioral effects of propofol, and the underlying mechanism remains unclear. However, few studies have looked into the dose and injection timing of the drug to achieve neuroprotective effects.

Aim: The purpose of this study was to see if propofol could protect male Wistar rat hippocampal CA1pyramidal cells from ischemia and brief overall reperfusion damage.

Methods: The 18 male Wistar rats were placed into three groups: control, ischemia, and experimental. 1 hour before ischemia, 40 mg/kg propofol was given intraperitoneally. Ischemia was induced by blocking the common carotid arteries on both sides for 20 minutes. For histomorphologic alterations, the Hematoxylin-Eosin, Nissl, and TUNEL techniques were used.

Results: The researchers discovered that 40mg/kg propofol has protective effects on hippocampus pyramidal neurons in ischemia/reperfusion-induced lab rats.

Conclusion: Propofol can drastically reduce neuron death while also protecting them from ischemia damage.

Background: Exposure to excessive sound leads to hearing loss. Temporary threshold shifts are defined as threshold shifts that return to baseline levels in the hours to weeks after excessive sound exposure.

Aim: This study aimed to examine the zinc sulfate protective effect following noise exposure.

Methods: Fifty-two participants with normal audiograms at baseline were randomly assigned to control and intervention groups. First, a distortion product otoacoustic emission test (DPOAEs) was carried out as the baseline assessment, then the intervention group received zinc sulfate supplement capsules for one month and placebo capsules were given to controls. To induce a transient hearing shift, an ABR test was performed. The ABR test was done with 90 dB of sound stimuli for each ear. This input stimulus was a noise exposure that induces a temporary reduction in hearing, in fact, a transient hearing shift has occurred. Then, both groups had a DPOAE test and a follow-up assessment. Signal/noise ratio and DP (distortion product) levels were measured to evaluate the effect of zinc supplement use on transient hearing shift.

Results: Comparing the results of the distortion product otoacoustic emission test before and after the auditory brainstem response testing showed significant differences between intervention and control groups (p <0.05). Moreover, the differences in signal/noise ratio between the intervention group before and after ABR testing and also in the control group were significant (p <0.05).

Conclusion: Daily zinc sulfate supplement might protect against the transient hearing shift.

Background: Facial pain is one of the common complaints in otolaryngology. Patients often self-diagnose facial pain as "sinusitis". The sinonasal source of facial pain and headache could be one of the possible etiologies, which needs to be confirmed by nasal endoscopy or CT scan.

Aim: This study aimed to detect the frequency of variations and pathological findings in the sinonasal region of patients presenting with facial pain and sinonasal symptoms by PNS CT imaging.

Methods: This descriptive study was conducted in a tertiary referral hospital where consecutive patients presenting to the otorhinolaryngology clinic with facial pain and at least one of the sinonasal symptoms, including nasal obstruction, nasal congestion, rhinorrhea, reduction or loss of smell, and postnasal discharge, were included. For evaluation of facial pain, a paranasal sinus CT scan in coronal view was performed and analyzed by an otolaryngologist.

Results: A total of 64 patients including 27 males (42%) and 37 females (57.8%) were included. The average age was 35.5±10.5. Most patients experienced bilateral facial pain (78.1%.). The most common location of pain was the forehead (76.6%). Fifteen patients (23.4%) had acute pain (<12 weeks) while 49 (76.6%) experienced chronic pain (>12 weeks). Cold weather was the most common triggering factor in 29 patients (45.3%). The most common sinonasal symptom was posterior nasal discharge (in 42 patients, 65.6%). A minority of patients, 8 (12.5%), had evidence of rhinosinusitis (acute or chronic). Ethmoid sinus was the most frequently involved sinus (9.3%), and sphenoid and frontal sinuses were the least commonly involved. 2 patients (3.1%) had unilateral complete opacification of the maxillary sinus.

Conclusion: Sinusitis was not the most common cause of facial pain in the present study, even in the presence of sinonasal symptoms. The definitive diagnosis of facial pain warrants confirmation by complementary imaging before starting therapy.

Background: The goal of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is to standardize the reporting of salivary gland cytology and guide treatment decisions. Considering the newness of this system and the need for more studies in this regard, the aim of this study was to evaluate the concordance of cytological findings based on the Milan system with histological findings in salivary gland masses.

Aim: evaluating salivary gland tumors’ cytological findings of Milan system with histopathological findings.

Methods: This diagnostic study was conducted on 94 patients with salivary gland masses were referred to the pathology department of Imam Hossein hospital in 2022. FNA was performed for all patients and cytological classification was done based on the latest classification of the Milan system. Cytological findings were compared with histological findings.

Results: In this study 10.6% were diagnosed as non-neoplastic, 18.1% with AUS, 37.2% benign neoplasm, 20.2% with SUMP, 5.3% suspicious for malignancy, and 8.5% were diagnosed as malignant. In the pathology results, 18.1% of patients were non-neoplastic, 56.4% had benign neoplasm, and 25.5% had malignant mass. The agreement coefficient between the two methods based on the Kappa coefficient was 40%, which indicates a relatively good agreement. The correlation coefficient between the two methods was 0.70.

Conclusion: It is concluded that there is a relatively good agreement between the Milan system in the cytology of salivary gland neoplasms with pathology findings.

Background: Laryngeal cancer accounts for about 1 to 2 % of all cancers; this incidence rate depends on the geographical region and ethnicity. Due to the lack of a comprehensive epidemiological study on laryngeal cancer in recent years, we designed this study to investigate the incidence and geographical distribution of laryngeal cancer.

Aim: This study aimed to investigate the incidence and geographical distribution of laryngeal cancer in Iran from 2004 to 2014.

Methods: The data collected from the Iranian National Cancer Data System registry, all the cases of laryngeal cancer (with topography code 32 and histology of laryngeal cancer) have been retrieved and analyzed from a comprehensive cancer database during the 11 years' period. Then statistical data were analyzed by SPSS, version 16.

Results: During the 11-year study, 13,241 new cases of laryngeal cancer were recorded, of which 11454 were men (86%) and 1788 were women (14%). According to this assessment, North Khorasan, Sistan and Baluchestan, and East Azerbaijan provinces had the highest growth rate, and North Khorasan, Gilan, and Kerman provinces with the highest incidence rates of 4.44, 3.29, and 2.23 per 100,000 respectively, between 2004 and 2014.

Conclusion: According to the results of this study, the incidence rate of laryngeal cancer, especially in women, is increasing in Iran. Further studies are needed to investigate the causes of increased incidence.

Background: Pure-tone audiometry (PTA) is the most common audiological test to determine hearing thresholds. However, accurate assessment of hearing in difficult-to-test populations has always remained an audiological challenge as it gives inconsistent responses in PTA.

Aim: The aim of this study was to evaluate the reliability of the Auditory Steady State Response (ASSR) and Auditory Brainstem Response (ABR) in determining the frequency specific hearing thresholds by establishing a correlation between the thresholds determined by subjective test- PTA and objective test - ASSR and ABR at 500 Hz, 1 kHz, 2 kHz and 4 kHz.

Methods: In this prospective study we have included 40 adult subjects (n = 80 ears) of both genders. All subjects underwent ASSR, tone burst ABR and PTA to record frequency specific hearing thresholds at 500 Hz, 1 kHz, 2 kHz and 4 kHz. Data were recorded and analyzed with SPSS IBM software version 22.

Results: Mean difference between PTA - ASSR was 14.2 dB and between PTA - ABR was 18.8 dB in the study population. We found a strong correlation between PTA-ASSR and PTA-ABR across all frequencies. We also confirmed that correlation was better in the sensorineural hearing loss and conductive hearing loss group in comparison with the normal hearing group. The overall reliability was better in high frequency for both ASSR and ABR.

Conclusion: Results of this study concluded that both ABR and ASSR can be used to predict frequency specific hearing thresholds. ASSR was more reliable than ABR for accurate prediction of frequency specific hearing threshold as the mean difference between ASSR and PTA was smaller than the mean difference between ABR and PTA.

Background: The rise of social media has significantly impacted how individuals perceive themselves and present themselves to the world. This is particularly concerning for women, who are often bombarded with idealized images of beauty standards that can lead to body dissatisfaction and a desire for cosmetic surgery.

Aim: This study aimed to investigate cosmetic surgery tendencies in women in Ahvaz City (Iran) based on social media addiction and emotion regulation through the mediating role of body image.

Methods: The research sample included 200 women who underwent cosmetic surgery in 2022-2023 and were selected using a convenience sampling method. The data collection tools included the Body Image Questionnaire, the Emotion Regulation Questionnaire, the Social Media Addiction Questionnaire, and the Cosmetic Surgery Tendencies Questionnaire. SPSS version 22 and Amos version 20 software were used for data analysis.

Results: The results indicated robust positive associations between social media addiction and both cosmetic surgery desire and body image among women (P<0.001). Conversely, significant negative correlations were found between emotion regulation and both body image and cosmetic surgery desire (P<0.001). Mediation analyses revealed that body image significantly mediated the relationships between social media addiction and cosmetic surgery desire, as well as emotion regulation and cosmetic surgery desire (P<0.001). The proposed model demonstrated a satisfactory fit to the data, as evidenced by acceptable fit indices (RMSEA= 0.073, IFI= 0.90, CFI= 0.90, GFI= 0.90). 

Conclusion: This study provides valuable insights into the complex interplay between social media addiction, emotion regulation, body image, and cosmetic surgery tendencies in women. The findings underscore the mediating role of body image in these relationships and emphasize the need for interventions that promote healthy body image and emotional regulation skills among women.

Background: Brain stem cavernomas (BSCs) are rare vascular malformations, accounting for 8-22% of intracranial cavernoma lesions. These lesions can cause severe neurological deficits and life-threatening hemorrhages, making their management challenging.

Aimes: This study retrospectively evaluates the clinical presentation, surgical management, and outcomes of patients with BSCs to improve clinical strategies and patient care.

Methods: This retrospective study analyzed 20 patients with BSCs treated at Loghman Hakim Hospital, Tehran, Iran, from 2014 to 2023. Clinical data were collected from medical records, including demographic information, clinical presentations, imaging findings, and surgical intervention details. Lesion characteristics were documented and classified. Surgical approaches were based on lesion location and proximity to critical structures. Outcomes were assessed using the Modified Rankin Scale (MRS), resolution of cranial nerve (CN) palsies, incidence of rebleeding, and postoperative complications. Descriptive statistics was used to summarize patient characteristics and outcomes.

Results: The study included 20 patients (mean age 34.25 years; 55% male) with a mean follow-up of 37.1 months. The most common presentation was headache (30%), followed by hemiparesis (15%) and cerebellar symptoms (70%). Prior hemorrhage occurred in 75% of cases. Lesions were predominantly deep-seated (60%) and averaged 30 mm in diameter. Postoperative outcomes showed improvement in MRS scores in 75% of cases, with CN palsies resolving in 20%. Rebleeding occurred in 20% of patients, and other complications included ataxia and gait disturbances. Surgical management, primarily through suboccipital telovelar and retrosigmoid approaches, significantly improved neurological function and quality of life.

Conclusion: Surgical intervention for symptomatic BSCs, particularly through suboccipital telovelar and retrosigmoid approaches, leads to favorable clinical outcomes. Accurate patient selection, preoperative planning, and meticulous microsurgical techniques are crucial for optimizing results. Future research should focus on refining surgical approaches and exploring genetic and molecular aspects of BSCs to enhance management strategies and patient outcomes.

Tramadol is widely used in the management of moderate to moderately severe pain due to its unique dual mechanism of action as a weak μ-opioid receptor agonist and as an inhibitor of serotonin and norepinephrine reuptake. However, it seems that this medication may possess neurotoxicity, especially in misuse, overdose, or chronic use. This review highlights current knowledge on the neurotoxic effects of tramadol, outlining the mechanisms of both its acute and chronic effects on seizure induction, serotonin syndrome, oxidative stress, neuroinflammation, and neurotransmitter dysregulation. Patients susceptible to the adverse effects from such neurotoxicity-geriatric, pediatric, or with previous neurological disorders-also come into focus, with personalized clinical approaches being recommended. It also touches on the possible connections of chronic tramadol use with neurodegenerative disorders such as Alzheimer's and Parkinson's diseases and gives the implications for public health and clinical practice. The future directions of research are outlined: large-scale epidemiological studies, biomarker development, alternative pain management strategies, and enhanced regulatory frameworks. This review therefore addresses these gaps to guide safer use of tramadol and improving our understanding of its long-term consequences on brain health.

Background: Olfactory manifestations are common findings during the course of COVID-19, while exact physiopathology is not known

Aim: We review histological changes of the nasal olfactory mucosa in COVID-19 non-survivors who died in the ICU.

Methods: Sampling was done within 1 hour of death under direct vision. Specimens were taken medial to the middle turbinate in the cribriform area and embedded in paraffin blocks and stained by haematoxylin and eosin.

Results: The most frequent histologic finding was the infiltration of inflammatory cells mostly comprised of lymphocytes. Inflammatory infiltration of mucosa was seen in all 11 patients with ulceration in 9 cases and neuritis in 3 cases. 

Conclusion: Inflammatory infiltration of olfactory mucosa may be associated with smell manifestations. Further histological studies will clarify the role of the nasal mucosa in the physiopathology of COVID-19 especially olfactory involvement.