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Objectives The aim of the present study was to describe and evaluate the results of a new technique in endolymphatic sac decompression surgery. Methods Forty-three patients with intractable unilateral Meniere's disease were selected. Endolymphatic sac was identified after simple mastoidectomy, and its lateral layer was incised, using a sickle knife. Outer layer of the sac was turned around and placed under the anterior bony border. Results Mean duration of the follow-up was 24 months. Mean tinnitus handicap index, pure tone average (PTA) on thresholds at 500, 1000, 2000, and 4000 Hz, mean speech reception threshold, mean speech discrimination score, hearing stage, and mean vertigo score before and after surgery were evaluated. Conclusion The new marsupialization technique with anterior bony border is a safe and effective way to improve tinnitus, vertigo, and ear fullness among these patients. According to PTA and hearing stage, this surgery can control progressive hearing loss. Level of evidence 3.

The purpose of the study is to evaluate the efficacy of double skin paddle anterolateral thigh flap (ALT) to reconstruction of through and through oral cavity defect due to cancer surgery.A prospective review was performed of patients referred to Firoozgar and Erfan hospitals with oral cavity defects with two or more oral cavity subunits and skin simultaneously involvement and immediate reconstruction using double-skin paddle ALT flap at the same time of tumor ablation from January 2019 to November 2020.A total number of 6 patients was evaluated. The mean area of skin paddle was 110.4 cm2 and 92.8 cm2 in distal and proximal paddle respectively. Except one patient was complicated and expired in hospital admission, the remaining 5 patients got fully oral intake and completely survived flaps with primarily closed donor site. Tumor recurrence was not found in the mean follow-up time of 12 months.The double skin paddle anterolateral thigh flap serves as an efficient reconstruction technique in complex and perforating oral cavity defects with the same functional outcome and the same flap related complications as conventional ALT flap.

To evaluate the auditory performance and speech production outcome in children with auditory neuropathy spectrum disorder (ANSD). The effect of age on the outcomes of the surgery at the time of implantation was also evaluated.Cochlear implantation was performed in 136 children with bilateral severe-to- profound hearing loss due to ANSD, at four tertiary academic centers. The patients were divided into two groups based on the age at the time of implantation; Group I: Children ≤24 months, and Group II: subjects24 months. The categories of auditory performance (CAP) and speech intelligibility rating (SIR) scores were evaluated after the first and second years of implantation. The differences between the CAP and SIR scores in the two groups were assessed.The median CAP scores improved significantly after the cochlear implantation in all the patients (p value 0.001). The improvement in the CAP scores during the first year in Group II was greater than Group I (p value: 0.007), but the improvement in CAP scores tended to be significantly higher in patients who were implanted at ≤24 months (p value 0.001). There was no significant difference between two groups in SIR scores at first-year and second-year follow-ups. The evaluation of the SIR improvement revealed significantly higher values for Group I during the second-year follow-up (p value: 0.003).The auditory performance and speech production skills of the children with ANSD improved significantly after cochlear implantation, and this improvement was affected by age at the time of implantation.

This multicenter study evaluated the auditory performance and speech production outcomes of cochlear implantation in children with inner ear anomaly and compared the outcomes of patients with different kinds of malformation.Cochlear implantation was performed in 107 children with inner ear malformation at four tertiary academic centers. The categories of auditory performance (CAP) and speech intelligibility rating (SIR) scores were evaluated preoperatively and one year and two years postoperatively.Types of inner ear malformation and their frequencies were: incomplete partition type-I, 19 (17.8%) patients; incomplete partition type-II, 31 (29%), common cavity, 17 (15.9%), cochlear hypoplasia, 17 (15.9%), and isolated enlarged vestibular aqueduct (isolated EVA), 23 (21.5%) patients. EVA was the coexisting anomaly in 27(25.2%) subjects. The median CAP and SIR scores improved significantly during the first two years after cochlear implantation in all groups (p-values0.001 and 0.001, respectively). No significant difference was seen in CAP and SIR scores of children with different inner ear malformations (p-value = 0.147 and 0.570, respectively) or in patients with isolated EVA compared to coexisting EVA (p-value = 0.538 and 0.075, respectively).The median CAP and SIR scores two years after surgery were 5 (Understanding of common phrases without lip-reading) IQR: 4-6, and 3 (Connected speech is intelligible to a listener who concentrates and lip-reads within a known context) IQR: 3-4, respectively. Auditory performance and speech production were significantly improved in all inner ear malformation patient groups, and no significant difference was observed between the scores of patients with different types of anomaly.

Background: Rhinosinusitis is an inflammatory disease of the nasal and paranasal sinus mucosa, and it becomes chronic when it lasts longer than 3 months without symptom improvement. The aim of this study was to determine the effect of PRP on improvement of endoscopic sinus surgery. Methods: This was a randomized clinical trial (RCT) designed and implemented on 21 patients with chronic rhinosinusitis in Rasool Akram hospital in Tehran during 2016-2017. In this study, one side of the nose was randomly selected as the control and the other side as the case, and at the end of the surgery, PRP was sprayed onto the surface where the polyp was removed in the side that was intended as the case. The nasal endoscopy findings were graded according to Meltzer’s criteria before and after surgery and CT findings were classified according to the Lund-Mackay scoring system. Then, all patients were followed for 6 months. The SNOT-22 questionnaire, charts of Meltzer’s criteria, and Lund-Mackay were used for data collection. Kolmogorov–Smirnov test, Wilcoxon Signed Rank test, and Mann-Whitney U test were used to analyze data in SPSS-22 software. P value

Background: Ménière’s disease (MD) is a common inner ear disorder which is characterized by recurrent attacks of vertigo, fluctuating sensorineural hearing loss (SNHL), tinnitus, and a sense of fullness in the affected ear. MD is a complex disorder; although six genes have been linked to familial autosomal dominant form of the disease, in many cases, the exact genetic etiology remains elusive. Methods: To elucidate the genetic causes of MD in an Iranian family, we performed exome sequencing on all members of the family: consanguineous parents and four children (two affected and two unaffected). Variant filtering was completed using a customized workflow keeping variants based on segregation with MD in autosomal recessive (AR) inheritance pattern, minor allele frequency (MAF), and in-silico prediction of pathogenicity. Results: Analysis revealed that in this family, 970 variants co-segregated with MD in AR pattern, out of which eight variants (one intergenic, four intronic, and three exonic) were extremely rare. The exonic variants included a synonymous substitution in USP3 gene, an in-frame deletion in ZBED2 gene, and a rare, highly conserved deleterious missense alteration in LSAMP gene. Conclusion: The phenotype observed in the proband described here, i.e. vertigo, poor sense of smell, tinnitus, and borderline hearing ability, may originate from aberrant changes in the cerebellum and limbic system due to a deleterious mutation in the LSAMP gene; hence, LSAMP mutation is a possible candidate for the etiology of MD in this family.

This study was conducted to evaluate the effect of the round window membrane accessibility on the residual hearing after cochlear implantation surgery in adults. Moreover, the effects of the other demographics and intra-operative factors on the residual hearing loss have been evaluated. The hearing preservation cochlear implantation surgery was performed on 64 adults with residual hearing thresholds ≤80 dB at 250 and 500 Hz, who had referred to our tertiary academic center. All the patients underwent a standardized surgical approach with the same straight electrode inserted through the round window membrane. The hearing thresholds at 250, 500, and 1000 Hz were compared in pre-operative and 1 month postoperative pure-tone audiograms. The average hearing threshold shifts at these frequencies was used to evaluate the hearing preservation. The effects of the round window accessibility and other factors (including gender, age, side of the surgery, necessity of anterior-inferior drilling of the round window margin and average insertion speed) on hearing threshold shifts were analyzed. The mean low-frequency hearing threshold shift was found to be 17.5 dB for all the patients. The hearing preservation goal (threshold shifts ≤30 dB) was achieved in 58 patients. Among the evaluated parameters, only accessibility of the round window membrane could change the hearing threshold shifts significantly (p = 0.026), and was a predictor for the hearing loss (B coefficient = 7.5, p = 0.006). Incomplete accessibility of the round window membrane may be a predictor for increased hearing threshold shifts in short-term evaluations after cochlear implantation.

The aim of the study was to evaluate insertion forces during manual insertion of a straight atraumatic electrode in human temporal bones, and post-implantation histologic evaluation of the samples to determine whether violation of intracochlear structures is related to insertion forces. In order to minimize intracochlear trauma and preserve residual hearing during cochlear implantation, knowledge of the insertion forces is necessary. Ten fresh frozen human temporal bones were prepared with canal wall down mastoidectomy. All samples were mounted on a one-axis force sensor. Insertion of a 16-mm straight atraumatic electrode was performed from different angles to induce “traumatic” insertion. Histologic evaluation was performed in order to evaluate intracochlear trauma. In 4 of 10 samples, dislocation of the electrode into scala vestibuli was observed. The mean insertion force for all 10 procedures was 0.003 ± 0.005 N. Insertion forces measured around the site of dislocation to scala vestibuli in 3 of 4 samples were significantly higher than insertion forces at the same location of the cochleae measured in samples without trauma (p

Trauma is the fourth major cause of mortality in the Western countries, of which approximately one half involve maxillofacial injury. Statistics reported by emergency room officials show motor vehicles cause many of the injuries and deaths that occur in Iran. Having completed a retrospective descriptive study of 200 patients who experienced maxillofacial trauma, the authors report its occurrence with respect to age, sex, trauma type, and site of injury so as to evaluate the operational functionality of the Department of Otolaryngology and Head & Neck Surgery of Hazrat-e Rasoul Akram Hospital from 2000 to 2004. Mandibular fractures (36.2%) occurred in the subsequently listed sites and at the specified frequencies: mandibular angle (9.7%), mandible body (6.9%), parasymphysis, ramus and subcondyle at 5.6% each, and symphysis at 2.8%. No condylar fractures were reported. Frontal bone fracture was observed in 9.7% of the patients with eye globe injury occurring simultaneously in 8.3% of corresponding cases. Orbital fracture (63.9%) also occurred in various cases as follows: orbital floor 39%, lateral rim 24%, inferior rim 22%, medial wall 11%, and the superior rim and orbital roof at 2% each. Motor vehicle accidents were the most common causes of trauma (42%). The most common fracture was in the zygoma (43%) with 8.3% of them being orbital injury. Fractures of mandibular bones (36.2%) and the maxilla (33%) were the most commonly seen in trauma occurring to the maxillomandibular region.

Objectives Tonsillectomy is one of the most common operations performed in pediatric population. One of the most prevalent tonsillectomy complications is early or delayed post-operative hemorrhage. Other important morbidity is post-operative pain. Historically, honey has been used for wound control, reducing the inflammation, and healing acceleration. The aim of this study is to investigate the effect of honey on reducing pain after tonsillectomy in children 5–15 years old. Methods After tonsillectomy, 80 patients were randomly divided in two equal groups. Patients in the first group were treated with antibiotic and acetaminophen, while those in the second group were treated with antibiotic, acetaminophen and honey. Data was gathered via a questionnaire and observation of tonsillar bed healing. Data was analyzed by SPSS17 software and related tests. Results Pain comparison between two groups showed that the average time required for pain relief in patients who received honey was less than the control. The pain intensity was higher during the first 9 days post-operatively in control group. Results also showed that acetaminophen consumption in patients who received honey is lower. In the case group, the average time to resume regular diet and the frequency of awakening at night is significantly less than the control group. Conclusion Honey administration after tonsillectomy has valuable effect in pain relief and it can be used as an adjunctive regimen after surgery for better pain control.