Case Report

Unexpected Complication During Stent Placement for Esophageal Cancer

Asmae Sair, Samir Mrabti, Ahlame Benhamdane, Tarik Addajou, Sara Sentissi, Fedoua Rouibaa, Ahmed Benkirane, Hassan Seddik

Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 9 No. 1 (2023), 2 Shahrivar 2023, Page 1-4

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.


A Young Case with Endolymphatic Sac Tumors Presented with Right-sided Hearing Loss and Facial Hemi-paralysis

Farzin Davoodi, Mahtab Mashayekhi, Mahdi Khajavi, Farhad Mokhtarinejad, Shahrokh Khoshsirat, Zahra Rahmani, Narges Bazgir, Reza Naseri

Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 9 No. 1 (2023), 2 Shahrivar 2023, Page 1-5

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.

Acute mastoiditis in a child with a history of cochlear implantation : a case report

Hasan Pourmoshtagh, Ali Eftekharian

Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 9 No. 1 (2023), 2 Shahrivar 2023, Page 1-4

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.

Tonsillar Lymphangiomatous Polyps: A Rare Case Report

Aslan Ahmadi, Hosna Zobairy, Ayda Sanaei, Soraya Dadkhah , Mohammad Mahdi Salem, Farzin Davoodi, Haideh Mosleh, Reza Naseri

Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 9 No. 1 (2023), 2 Shahrivar 2023, Page 1-9

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.

Original Article

Propofol Pretreatment Protects Hippocampal CA1 Neurons from Ischemia-reperfusion Injury in Rat

Delaram Farhangi, Shabnam Movassaghi, Mohammad Mahdi Nazarnejad , Zahra Nadia Sharifi

Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 9 No. 1 (2023), 2 Shahrivar 2023, Page 1-9

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.

The Protective Role of Zinc Sulfate in Temporary Noise-induced Threshold Shift: a Randomized Clinical Trial Study

Behrouz Barati, Mahboobe Asadi, Ali Goljanian Tabrizi, Reza Karimi

Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 9 No. 1 (2023), 2 Shahrivar 2023, Page 1-8

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.

Sinonasal Findings on Paranasal Computed Tomography in Patients Presenting with Facial Pain

Nasim Raad, Jahangir Ghorbani, Mahboobeh Karimi-Galougahi, Javad Yarmohammadi

Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 9 No. 1 (2023), 2 Shahrivar 2023, Page 1-7

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.

Evaluation of the Concordance of Cytological Findings Based on the Milan System with Histopathological Findings in Salivary Gland Tumors

Noushin Afsharmoghadam, Abdolreza Javadi, Golfam Mehrparvar, Mohsen Firoozi Parizi, Aida Saki

Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 9 No. 1 (2023), 2 Shahrivar 2023, Page 1-5

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.

The Geographical Distribution of Laryngeal Cancer in Iran from 2004 to 2014

Ali Safavi Naeini, Nasim Raad, Abdolaziz Eslami, Habib Emami, Alireza Moradi, Enayatollah Noori

Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 9 No. 1 (2023), 2 Shahrivar 2023, Page 1-6

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.

Investigating the Correlation of Serum Acyl-carnitine Level with Acromegaly Following Pituitary Adenoma

Haideh Mosleh , Mahdi Khajavi , Shahrokh Khoshsirat , Farhad Mokhtarinejad, Guive Sharifi, Sharooz Sabeti , Nader Akbari Dailamaghani

Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 9 No. 1 (2023), 2 Shahrivar 2023, Page 1-10

Background: Acromegaly is a chronic disease caused by excessive GH secretion, primarily due to a pituitary adenoma. It leads to an overgrowth of tissues and organs, resulting in various clinical manifestations. The diagnosis of acromegaly is often delayed due to its slow progression and non-specific symptoms. Therefore, identifying reliable biomarkers for early disease detection and monitoring is crucial. Serum acyl-carnitines are metabolic intermediates involved in fatty acid oxidation and energy production. Alterations in their levels have been associated with various metabolic disorders. Recent studies have suggested that changes in serum acylcarnitine profiles may be linked to the pathophysiology of acromegaly.

Aim: This study aims to explore novel biomarkers for its diagnosis or monitoring of acromegaly.

Methods: This study will employ a case-control design involving patients diagnosed with acromegaly following pituitary adenoma (cases) and age- and sex-matched healthy controls. A total of 40 cases and 40 controls will be recruited from our endocrinology clinic. Baseline demographic data, medical history, and clinical characteristics will be collected for all participants. Fasting blood samples will be obtained from each participant to measure serum levels of GH, insulin-like growth factor 1 (IGF-1), and various acylcarnitines using validated laboratory assays. Descriptive statistics will be used to summarize the demographic characteristics of the study population. Depending on their distribution, continuous variables will be presented as means ± standard deviations or medians (interquartile ranges). The primary analysis will involve comparing serum acylcarnitine levels between cases and controls using independent t-tests, or Mann-Whitney U tests as appropriate. Multiple regression analysis will also be performed to assess the association between serum acyl-carnitines and clinical parameters such as GH levels, IGF-1 levels, tumor size, duration of disease, etc. 

 Results: The results obtained from this study will provide insights into the potential correlation between serum acylcarnitine levels and acromegaly following pituitary adenoma. If significant differences are observed between cases and controls, it could suggest that alterations in fatty acid metabolism play a role in the pathogenesis or progression of acromegaly.

 Conclusion: This research aims to investigate the correlation between serum acylcarnitine levels and acromegaly following pituitary adenoma. By exploring potential alterations in fatty acid metabolism associated with this endocrine disorder, we hope to contribute valuable insights into its pathophysiology while potentially identifying novel biomarkers for early detection or monitoring purposes.

Case Series

Histopathologic Findings of Olfactory Mucosa in COVID-19 Patients

Jahangir Ghorbani, Mahin Pourabdollah, Nasim Raad, Mahboobeh Karimi Galougahi, Atefeh Abedini, Behrooz Farzanegan, Seyed Mohammadreza Hashemian, Seyed Alireza Nadji, Amirali Safavi Naini, Ali Safavi Naini

Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 9 No. 1 (2023), 2 Shahrivar 2023, Page 1-5

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.