Letter To The Editor

Original Article

Ossiculoplasty with Sculpted Incus: Hearing Results and Risk Factors

Farhad Mokhtarinejad, Masoud Motasaddi Zarandy, Farzaneh Barzegar, Mehdi Poorqasemiyan

Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 2 No. 1 (2016), 5 March 2016, Page pp. 1-6

Background: Incus is the most common damaged ossicle in the ear trauma and chronic infection (COM). Sculpted incus is one of the methods have been used for ossicular reconstruction and transition of sound from tympanic membrane to stapes.

Purpose: To evaluate the success rate and risk factors of ossiculoplasty with sculpted incus.

Methods: A before- after clinical trial study of 25 patients with normal and mobile stapes who underwent  ossiculoplasty using autologous or homologous sculpted incus was performed .Pre and post intervention audiometric results were compared. The utility of the middle ear risk index (MERI) in predicting hearing outcome in these cases were evaluated, also outcomes in patients with primary versus staged ossiculoplasty and incus interposition versus incus transposition were compared. P value <0.05 was considered significant.

Results: The mean preoperative air-bone gap (ABG) was 33.9 dB and mean postoperative ABG was 19.4dB, with significant improvement (P value =0.001). The best results achieved in 2000 Hz with 13 dB improvement in mean ABG and worst results in 4000 Hz with 8.8dB improvement. Seventy six percent of patients had postoperative mean ABG less than 20dB and 88% less than 25dB. Hearing results were not significantly different in primary osiculoplasty when compared with staged procedure and in incus interposition osiculoplasty compared with incus transposition. There was no correlation between postoperative ABG and preoperative ABG or the middle ear risk index (MERI)

Conclusion: Osiculoplasty with sculpted incus has a good hearing outcome and recommended in the first stage tympanoplasty. This is independent of middle ear risk factors, if the stapes is normal and mobile.


Adult Onset Otitis Media with effusion: Prevalence and Etiology

Navid Ahmady Roozbahany, Niloofar Majdinasab, Mahbobeh Oroei, Saeedeh Nateghinia

Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 2 No. 1 (2016), 5 March 2016, Page pp. 7-9


Background: Otitis media with effusion (OME) is a subtype of chronic otitis media. It is a common disease in children but may occur in adults due to various reasons.

purpose: To determine the prevalence of pathological findings related to OME in adults.

Methods: This descriptive study was carried out in Otolaryngology department of Loghman Hakim hospital, Tehran, Iran, from March to August 2015. Thirty-one patients between 18-65 years old with symptomatic OME were selected. The underlying cause of OME was investigated using examination, audiometry test, endoscopy and biopsy.

Results: Thirteen patients (41.9%) had allergy, 35.4%patients had gastro esophageal reflux.  Fourteen cases (45.2%) had nasopharyngeal mass which almost 9% of patients were found neoplasm.

Conclusion: Adult onset OME can be an indicator of nasopharyngeal cancer and should be noticed as well as systematic approach in diagnostic procedure. However it is a clue for further studies to find out causal association in future.

Reasons of Delay in the Referral for Cochlear Implantation of Pre-lingual Sensory-Neural Deaf Children

Masoud Motasaddi Zarandi, Iran Malekzadeh, Mohammad Jafar Mahmoudi, Sevil Nasirmohtaram

Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 2 No. 1 (2016), 5 March 2016, Page pp. 10-15

Introduction: Deafness is the most common congenital sensory disorder. Clearly, deafness has a lot of negative influence on a child’s growth, learning, and social communications. More than 90% of deafness cases are sensory-neural, which can be cured with cochlear implantation. One of the most important factors which can change the results of cochlear implantation is the child’s age at the time of implantation. In this work, the reason of delay in referring sensory-neural deaf children for cochlear implantation is studied. Methods: A questionnaire was designed to investigate the reasons of delay in regards to deaf children referred of age 3 or more. 54 children, 28 (51.9%) boys and 26 (48.1%) girls were studied. Variables such as age, sex, reason of delay, parents’ level of education, etc. were considered. Results: 36 (66.7%) cases were due to the unfortunate referrals by the Ear, Nose and Throat specialists, among which 19 (35.2%) of them were reported this to be the only reason. 20 (37%) cases reported improper services at the cochlear implantation centers as their reason. 3 (5.6%) cases were due to the unfortunate referral by the pediatricians. 21 cases reported the delay due to combined factors. In an additional study, 49 cases of children with deafness which referred for a cochlear implantation before the age of 3 were questioned of how they were informed of this treatment. 27 (56.3%) cases reported that they were referred by a physician. Conclusion: Many reasons can be concluded as to the main reasons for the delay in referring children with deafness for cochlear implantation. The most important factor can be inappropriate referral by the treatment-health system and the second reason can be considered improper services at cochlear implantation centers.

Evaluation of Auriculocephalic Angle following Canal Wall Up and Canal Wall Down Mastoidectomy Procedures

Farhad Mokhtarinejad, Hosein Esmaeil Talai, Seiedreza Seiedmohammaddoulabi, Mahbobeh Oroei

Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 2 No. 1 (2016), 5 March 2016, Page pp. 16-18

Background: Mastoidectomy is a common procedure in otolaryngology. It has numerous complications. Aesthetic issues following this surgery are not widely discussed.

Purpose: To evaluate auriculocephalic angle and helix to mastoid distance between patients who underwent canal wall up and canal wall down mastoidectomy procedures.

Methods: In this cross sectional study, sixty patients who underwent canal wall down or canal wall up mastoidectomy, observed for auriculocephalic angle and helix to mastoid distance of both ears before and after surgery. We analyzed data with paired t-test and independent t-test. All tests were conducted at the 0.05 level of significance.

Results: Patients, who underwent canal wall down mastoidectomy, had a significant reduction in auriculocephalic angle and helix to mastoid distance. In canal wall up group, these parameters increased, although the observed differences were not statistically significant.

Conclusion: Mastoidectomy can alter the aesthetical parameters of the auricle and may also lead to functional disorders due to these changes.

Comparison of Impact Factors of Journals and H Index of Faculty Members of Different Medical Specialties in Loghman Hakim General Hospital

Navid Ahmady Roozbahany, Omid Shafagh

Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 2 No. 1 (2016), 5 March 2016, Page pp. 19-24

Background: With the advancement of knowledge, increasing science production and competition, evaluation of scientific products becomes one of the challenging and undeniable necessary subjects. In Iran, Deputy of Research for Ministry of Health uses H index as one of the scientometrics index for evaluation of research activities of the board members. In journals rating system Impact Factor index, is used.

Purpose: This study aims to compare H index of the board members and impact factor in top journals of each medical specialty.

Methods: In this descriptive study, data for H index of the board members gathered via Google Scholar citation database and impact factor of top journals, from SClmago database, supported by Scopus. 10 top journals with the highest impact factor in medical specialties, until the end of 2015, were studied. Study population of Loghman Hakim Medical Center was selected as a sample of Shahid Beheshti University of Medical Science. In the present study, 10 medical specialties were studied and information for each field including analyzed and compared.

Results: From 10 medical fields, infectious diseases had the highest and otolaryngology had the lowest mean of the impact factor. Toxicology had the highest and radiology had the lowest mean H index. Comparing means of H index and impact factor between the medical specialties, showed that the mentioned indexes in various fields have significant difference statistically.

Conclusion: Applying equal criteria for evaluation of medical specialties will lead to a bias. Comparing research activities of a researcher in otolaryngology field with other fields, relying on the current criteria, will leads to completely wrong interpretation.