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Background and Aim: Considering the effect of middle ear infection and dental caries on the children’s quality of life and ability to grow and thrive, high prevalence rates of these diseases in children, we conducted this study to evaluate the association between dental caries status and middle ear infection in preschool children in Rasht City. Materials and Methods: This study included 310 children between 3–6 years of age. Dental caries of the children were evaluated based on WHO decayed and filled primary teeth index. The children were divided into two groups; with and without caries and referred to Amiralmomenin Hospital in Rasht for clinical examination and audiometry test. Descriptive and analytical statistical tests were used for analysis at the significance level of 0.05. Results: 170 girls and 140 boys with mean age of 4.58±1.02 years participated in this study. Thirty children (9.67%) had middle ear effusion. Mean value of dft index was 2.07±2.35. Probability of middle ear infection with effusion in the children with dental caries was139% more (95%CI= 1.04- 5.50, OR = 2.39) than that in the children without dental caries which was statistically significant (P = 0.04). Other variables such as gender, age, education levels of fathers and mothers did not show any significant relationship with middle ear effusion (P >0.05). Conclusion: Middle ear effusion was significantly higher in the children with dental caries than in children without dental caries. Further prospective studies are recommended for evaluation of the effects of improved oral hygine on middle ear infection.

Background: Nasal tip correction is one of the most challenging parts of rhinoplasty. The objective of the study was to compare the prevalence of supra-alar crease deepening in lateral crura steal (LCS) and lateral crura overlay (LCO) techniques., Methods: In this prospective study, eligible patients referred to a university hospital for septorhinoplasty during 2022 were included., Results: The study was conducted on 200 patients in two groups (100 patients in each group), 162 were women and 38 men with a mean age of 31.12 ± 0.60 years. In the third month of follow-up, 36.5% of all studied patients had supra-alar crease deepening, of whom 13% were in the interrupt group and 23.5% were in the steal group (P = 0.002); however, only 4% in the LCO and 9% in the LCS group had aesthetic or breathing disorders (P = 0.25). Deepening of the alar crease was not significantly related to the skin thickness in the two techniques., Conclusion: According to the results, both LCO and LCS techniques are effective in achieving successful outcomes, although the problematic supra-alar crease deepening is less common in the LCO group; therefore, it seems to be a more suitable option in cases where there is a greater need to tip rotation, although this finding was not statistically significant., Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., Competing Interests: Declarations. Conflict of interest: Authors declare no conflict of interest. Ethical Approval and Consent to Participate: The study was approved by the Ethical Committee of GUMS (IR.GUMS.REC. 1401.029) and complied with the rules delineated in the Helsinki Declaration). Informed consent was obtained from each subject before participation. Consent for Publication: There is consent to publish., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Objective: Rhinosinusitis is one of the most common reasons for a visit to otolaryngology clinics. Some patients are candidates for sinus surgery. Infiltration of 1:100 000 adrenaline in the pterygopalatine fossa was studied, with the aim of evaluating the effect on bleeding in the surgical field., Methods: This double-blind clinical trial was conducted in 2021-2022 on 40 candidates for endoscopic sinus surgery. For each patient, one side of the pterygopalatine fossa was randomly selected to be infiltrated with a vasoconstrictor. Surgical field bleeding on each side was evaluated., Results: Blood loss was 35.8 ± 20.9 ml in the study group and 38.4 ± 23.7 ml for the control group, with no statistically significant difference between groups ( p = 0.49). In addition, there was no difference between the two groups in terms of the surgical field based on Boezaart scores., Conclusion: Although there are some recommendations on the usage of vasoconstrictors via the pterygopalatine foramen, debate remains.

Objective: To evaluate and compare choroidal thickness (CT) between patients with Meniere's disease (MD) and a control group., Methods: This case-control analytical study was conducted on 37 subjects with MD and 37 healthy subjects. Subfoveal CT (SCT), large choroidal vessel (LCV) layer thickness, and mean subfoveal LCV thickness/mean SCT ratio were measured using enhanced-depth imaging optical coherence tomography (EDI-OCT) in the eyes on the MD side (ipsilateral), the contralateral eyes, and the control group., Results: A statistically significant difference was observed in the mean SCT values between the ipsilateral and control groups after adjustment for age, sex, and migraine (p = 0.04). Moreover, there was a statistically significant difference between the mean subfoveal LCV thickness values and the mean subfoveal LCV thickness/mean SCT ratio between the ipsilateral and control groups (p = 0.006, and p < 0.001, respectively). Patients with a duration of disease over three years had a greater mean subfoveal LCV thickness/mean SCT ratio (67.35 ± 11.56 and 60.66 ± 11.27, respectively), which was statistically insignificant (p = 0.08)., Conclusion: We found a thicker choroid and Haller layer, and a greater subfoveal LCV thickness/SCT ratio on the MD side compared to the controls. Furthermore, patients with a greater duration of disease had a lower subfoveal LCV thickness/SCT ratio. These findings may reflect the role of the trigeminal vascular system (TVS) and neurovascular pathophysiology in MD patients. More extensive studies are required to reach more definitive conclusions about the association between CT and MD., Level of Evidence: 4 Laryngoscope, 134:1889-1893, 2024., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Introduction  Metabolic syndrome (MetS) and its associated components were reported as a possible cause of inner ear dysfunction. However, research about the influence of cardiovascular risk factors on hearing thresholds are conducted mainly in adult patients. Objective  The aim of the present study was to investigate auditory function in adolescents with MetS compared with healthy controls. Methods  One hundred adolescents with metabolic syndrome and 200 sex- and age-matched controls were recruited from a university pediatric endocrine clinic from May 2018 to July 2020. Hearing loss was defined as hearing level ≥ 15 dB at speech frequency (SFHL) or high frequency (HFHL) in one or both ears. A multivariable conditional logistic regression analysis examined the correlation between MetS components and several important demographic characteristics, and hearing loss. Results  A total of 165 (55.0%) boys and 135 (45.0%) girls participated in this study. The rates of SFHL and HFHL in adolescents with MetS were 32.0% and 51.0%, respectively. Those values for controls were 5.0% and 15.5%, respectively. The regression analysis showed high triglycerides as a significant predictor for SFHL (odds ratio 10.87; 95% confidence interval: 1.98, 59.74). Neither predictor of interest was significant for HFHL. Conclusion  Hypertriglyceridemia may be an important factor in the pathogenesis of SFHL. However, the strength of the association was not significant with a wide confidence interval. Also, we were unable to find an association between predictors and HFHL with the current sample size. Larger and prospective studies are recommended., Competing Interests: Conflict of interests The authors declare that they have no conflict of interests., (Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objectives: Rhinoplasty is one of the most common cosmetic surgeries in the world. Lack of adequate local homeostasis may lead to excessive bleeding during the operation, which increases the time of operation and recovery period, and the prevalence of complications. This study investigated the effects of nasal desmopressin on the quality of the surgical field and the volume of bleeding during rhinoplasty., Materials and Methods: This double-blind randomized clinical trial was performed on 120 patients aged 18-40 years who were candidates for rhinoplasty. Patients were randomly divided into three groups: low-dose desmopressin group and high-dose desmopressin group and placebo group. Hemodynamic changes and surgical field based on BOEZAART criteria, and the volume of bleeding were calculated., Results: In this study 115 women (95.8%) and 5 men (4.2%) participated. The mean age of patients was (27 ± 6.8). Bleeding volume in high dose desmopressin group was (21.7 cc ± 12.3), (27.7 cc ± 12.3) in low dose group, and (38.3 cc ± 12.3) in the placebo group, The difference in blood volume among the three groups was statistically significant with p < 0.005. Clean surgical field according to BOEZAART classification was marginally significant in both desmopressin groups. The differences in blood pressure, heart rate, blood and urine sodium, and hemoglobin before and after surgery between groups there not statistically significant., Conclusion: Based on the results of the present study topical nasal spray desmopressin can reduce surgical field bleeding during rhinoplasty. To generalize the results to other surgeries in the ENT field it is recommended to conduct studies., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Introduction: Cavernous hemangioma is a venous malformation and intramuscular hemangioma is a rare type of hemangioma. Most of these cases are reported in masseter and temporalis muscles, and the number of patients with hemangioma involving sternocleidomastoid (SCM) muscle is relatively less. The present study reported a case of intramuscular hemangioma and a literature review regarding hemangioma in the sternocleidomastoid muscle., Case Report: The present case was a 24-year-old woman with intramuscular hemangioma of the sternocleidomastoid muscle, manifesting a mass in the right supraclavicular region involving the sternocleidomastoid muscle. The woman was treated with surgery and achieved complete treatment. After surgery, the patient was kept under regular follow-up for the last six months without any evidence of recurrence., Conclusion: Intramuscular hemangioma of the sternocleidomastoid muscle is a rare entity that can present as a mass in the neck region. The treatment approach should be considered according to the diagnosis and site of vascular malformation.

Introduction: Tinnitus can be associated with many auditory and non-auditory factors, and its prevalence varies widely in the literature. There is no large sample of published data on tinnitus prevalence and its associated factors in Iran. Here, we analyzed the PERSIAN Guilan Cohort Study (PGCS) data and reported the prevalence of tinnitus and some of the risk factors related to tinnitus in the Iranian population., Materials and Methods: This cross-sectional study was conducted on 10520 men and women between 35 and 70 years old. The prevalence of tinnitus and associations between tinnitus and age, sex, habitat, marital status, employment status, socioeconomic status, educational level, lifestyle habits, and comorbid diseases were examined using simple and multiple logistic regression analyses., Results: The prevalence of tinnitus was 6.4% in this study. Based on the adjusted analysis, only older age (odds ratio: 2.60, 95% confidence interval: 1.88 - 3.60), residency in a rural area (odds ratio: 1.22, 95% confidence interval: 1.03 - 1.44), cigarette smoking (odds ratio:1.33, 95% confidence interval: 1.04 - 1.72), and having other comorbidities (odds ratio: 2.75, 95% confidence interval: 2.19 - 3.44) were related to tinnitus. In addition, the results of subgroup analyses by sex were mostly consistent with the overall analysis., Conclusions: Our results revealed that the prevalence of tinnitus in the north of Iran is comparable with other communities. Age and other comorbidities were among the most related factors to tinnitus.

Objective: To assess the correlation of serum prestin level and audiological findings in adults with idiopathic sudden sensorineural hearing loss., Methods: Audiometry and serum prestin measurements were performed at study entry (T0), at day 14 (end of treatment, T1) and at day 30 (T2)., Results: A total of 25 idiopathic sudden sensorineural hearing loss patients and 25 healthy adults were included. The geometric mean prestin level in the case and control groups at T0 was 227.7 pg/ml and 130.5 pg/ml, respectively. The geometric mean prestin level in the case group demonstrated a downward trend at T1 and T2 (214.0 pg/ml and 180.1 pg/ml, respectively; p < 0.001). Of 17 patients with high baseline prestin levels (over 150 pg/ml), prestin levels tended to decrease in 11 patients, and 5 of them (45.5 per cent) showed good recovery., Conclusion: The prestin concentrations increased in two-thirds of patients with idiopathic sudden sensorineural hearing loss. Future work is recommended to determine the location of injury.

The relationship between temporal bone pneumatization (TBP) pattern and sinus mucous thickness grading on computed tomography scans of paranasal sinuses was investigated. In this cross-sectional study, a total of 200 temporal bones and paranasal sinuses were evaluated in CT scans of 100 patients with chronic sinusitis (CRS). The mucosal thickness of paranasal sinuses was classified into two groups (0-6 and 7-12) according to the Lund-Mackay (LM) staging system. Also, pneumatization patterns of petrous apex and perilabyrinthine regions were classified according to Jadvah et al. method. Data were analyzed using Chi-square and Fisher's exact tests. The most common pneumatization pattern in the petrous apex was pattern A (49.5%) and in the perilabyrinthine region was pattern B (50%). In the petrous apex, the highest frequencies of pattern A (51.7%) and pattern C (24.6%), among other pneumatization patterns, were found in score range of 7-12 and 0-6, respectively, which was statistically significant ( P  = 0.017). Although in the perilabyrinthine region, the highest frequencies of pattern A (24.1%) and pattern C (32.7%) were in LM score ranges of 7-12 and 0-6, respectively, no significant difference was found ( P  = 0.589). The petrous apex pneumatization decreases with an increase in the severity of CRS, which can be in response to the eustachian tube dysfunction and common pathogens with CRS. A similar relationship was also found in the perilabyrinthine region, although it was not statistically significant. No significant relationship between TBP and severity of CRS was found in the age and sex groups., Competing Interests: Conflict of interestThere are no conflicts of interest., (© Association of Otolaryngologists of India 2021.)

Ethmoidal infundibulum (EI) is an important part of the osteomeatal complex, which provides the main pathway for the maxillary sinus drainage. This study aimed to compare the length, width, and angulation of EI in patients with/without maxillary sinusitis using computed tomography (CT). This cross-sectional study evaluated 818 spiral CT scans of patients with/without maxillary sinusitis (n = 409 maxillary sinuses in each group) classified according to the clinical symptoms and the Lund-Mackay score for mucosal thickening. The degree of mucosal thickening (on axial and coronal sections), anatomical variations namely concha bullosa (CB), ethmoidal bulla (EB), and Haller cells (HCs), the form of EI (on coronal sections), the length, width and angulation of EI, and degree of nasal septal deviation (on coronal sections) were all evaluated. Data were analyzed by parametric and non-parametric tests (alpha = 0.05). The frequency of EB ( P  < 0.001), EI form ( P  < 0.001) and HC ( P  = 0.011), and the length and width of EI ( P  < 0.001) were significantly different in patients with and without maxillary sinusitis. The length and width of EI were significantly correlated with the degree of mucosal thickening ( P  < 0.01). The frequency of CB ( P  = 0.002), EB ( P  < 0.001), and HC ( P  = 0.002), and the EI form ( P  < 0.001) were significantly different in groups with different degrees of mucosal thickening. EI was wider and shorter in patients with maxillary sinusitis. By an increase in mucosal thickness, the length of EI decreased while its width increased. Also, the frequency of EB and HC, and the EI form were significantly different in the two groups., Competing Interests: Conflict of interestThere is no conflict of intrest., (© Association of Otolaryngologists of India 2021.)

Objectives: Hemorrhagic events related to surgical field is a common disturbing complication which could worsen the outcomes of operation. This study aimed to evaluate how applying of topical tranexamic acid (TXA) could affect bleeding related to septorhinoplasty operation., Material and Methods: This double-blind controlled trial study finally evaluated 198 candidates for septorhinoplasty repair who were randomly allocated to two groups: TXA receivers (5 mg/kg) and control group (received 5 mg/kg of saline 0.9 %). Then cumulative volume of hemorrhage was calculated by adding total volume of suctioned blood and numbers of fully blood-filled surgical gauzes (15 mL in each). Additionally postoperative 24 h volume of hemorrhage was measured by counting number of bloody surgical gauzes., Results: Of all participants, 90 % were female. The mean age was 26 ± 7 years. Total cumulative volume of hemorrhage during surgery was significantly diminished when topical TXA was applied (p < 0.0001). Additionally drier field of operation was illustrated postoperatively in patients received topical TXA (2 % & 28 % in TXA and saline 0.9 % receivers, respectively) (p < 0.001)., Conclusion: Using topical TXA could decrease bleeding volume and make surgical field of septorhinoplasty drier either during surgery or postoperatively., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2022. Published by Elsevier Inc.)

Background: This study aimed to evaluate the effect of local nasal desmopressin premedication on blood loss and the quality of surgical field in Functional Endoscopic Sinus Surgery (FESS)., Material and Methods: In a randomized clinical trial, patients referred for FESS to treat their bilateral chronic rhinosinusitis were recruited. The participants were adults (≥18 years). They were randomly assigned (1:1:1) to receive low-dose (20 μg) or high-dose (40 μg) intranasal desmopressin (DDAVP) or placebo 60 min before the induction of general anesthesia. Standard FESS was performed by the same surgeon. The primary outcomes were volume of intraoperative bleeding and the quality of surgical field. Clean surgical field was defined as a score ≤2 on the Boezaart grading system., Results: A total of 120 patients were included on an intention-to-treat basis (mean age: 41.0 years; 40 women, 80 men). There were no significant differences in primary outcomes between low-dose DDAVP and placebo. As for the volume of blood loss, however, there was a significant difference between high-dose DDAVP and placebo (mean difference: 29.6 ml; adjusted Cohen's d: -1.02; p  < .001). Also, in the high-dose DDAVP, the probability of having a good surgical field over time was about two times higher than in the placebo group (RRs for first and second surgical sides: 1.89 and 2.18). The number needed to treat for the two time points was 1.6 and 1.3, respectively., Conclusion: The present study showed that the use of desmopressin at a dose of 40 μg 1 h before surgery can reduce bleeding and improve the quality of the surgical field. Further studies are recommended to be able to generalize these findings to other ENT surgeries., Level of Evidence: 1b., Competing Interests: The authors declare that no competing interests exist., (© 2022 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Purpose: One of the main side effects of chemotherapy with cisplatin is irreversible sensorineural hearing loss. This study was conducted to assess the correlation between the serum prestin concentration as a potential cochlear biomarker and audiologic findings in patients after cisplatin chemotherapy., Methods: A total of 52 patients aged 18-75 years were included in this prospective study. All the subjects were recruited from the radiotherapy and oncology center of a tertiary hospital in Rasht, Iran. Audiologic parameters evaluations and serum prestin concentrations were measured at baseline and after 1-3 weeks of chemotherapy. The inner ear function was evaluated by pure-tone audiometry (PTA) and distortion product of otoacoustic emission (DPOAE). A repeated-measure analysis of variance was performed to evaluate the relationship between the PTA, DPOAE, serum prestin concentration and cumulative cisplatin dose., Results: Fifty-two patients (36 females) participated in this study. The PTA results showed that ototoxicity was more frequent among the patients with a high cumulative dose of cisplatin (χ2 trend = 15.25; P < 0.001). DPOAE responses revealed that 38.5% of the patients had ototoxicity change after 40-80 mg of cisplatin administration. After receiving 40-80 mg of cisplatin, serum prestin concentration increased from 130 to 230 pg/ml. There is a significant positive correlation between prestin concentration after receiving more than 80 mg of cisplatin and the ototoxic changes in the DPOAE response., Conclusion: The present study showed correlations between prestin concentrations and ototoxicity diagnosis by DPOAE findings. An early rise in prestin concentration is particularly important and an early sign of hearing loss. Future studies are recommended to investigate the effect of varying doses of cisplatin on prestin concentration and any association between ototoxicity and clinicopathological features., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: One of the most common symptoms in COVID-19 patients is olfactory and taste dysfunction., Aims/objectives: This study aimed to evaluate the olfactory threshold, and identification using objective tests in the Iranian population., Material and Methods: The present study was a prospective cohort study conducted in 2020-2021 on clinically recovering COVID-19 patients. Olfactory function was evaluated at the baseline, 4-6 weeks, and 12 weeks later. Olfactory threshold assessment was performed using the Saba Sabalan kit. The Iranian version of the Pennsylvania Smell Identification Test (IR-SIT) was used for olfactory identification. The olfactory threshold was categorized as poor (<8) and good olfaction (≥8)., Results: In the present study, 111 patients were examined, including 55 men and 56 women (mean age 41.4 and 53.4 years, respectively). The mean olfactory threshold was better for men (7.2) than for women (6.6). Analysis showed age to have a negative relationship with good olfaction at baseline (OR = 0.93, p  = .05). Using IR-SIT, only 29.7% had normal olfactory function. Using linear regression, smoking was found to be significantly related to baseline IR-SIT score (adjusted Beta <0.001, p  = .03)., Conclusions and Significance: Objective tests are appropriate methods for assessing olfactory dysfunction in COVID-19 patients. Further studies are recommended.

Purpose: Microvascular involvement in patients with diabetes mellitus is one of the causes of retinopathy, nephropathy, and neuropathy. The same pathologic processes may occur in the inner ear structures. This case-control study aimed to evaluate the hearing thresholds in type 2 diabetic patients with different severity of diabetic retinopathy (DR) and to compare these findings with controls., Materials and Methods: We evaluated the hearing threshold in four groups of eligible subjects aged 20-70 years. These groups were controls, diabetic patients with no-DR, with mild-moderate non-proliferative DR (NPDR), and with severe NPDR/proliferative DR (PDR). Each group consisted of 105 subjects. Speech-frequency and high-frequency hearing levels (SFHL and HFHL, respectively) were measured and log-transformed. Analysis of covariance was used. The prevalence rate of moderate or more hearing loss in the groups was estimated., Results: In total, 194 men and 226 women participated. The ratio of means of SFHL and HFHL between PDR and controls was 0.18 and 0.20, respectively. Hearing loss was prevalent in severe NPDR/PDR (adjusted prevalence ratio 3.36 for SFHL and 1.51 for HFHL) compared to controls. Also, the prevalence of high-frequency hearing loss was more in mild-moderate NPDR (adjusted prevalence ratio 1.33)., Conclusions: The magnitude of the increase in hearing impairment prevalence between the severe NPDR/PDR patients and controls was about 24% for both SFHL and HFHL. We recommend hearing assessment in the screening of the DR patients., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: We aimed to simultaneously compare all available medical treatments for Bell's palsy using both direct and indirect data., Methods: The literature was searched from January 1, 1990, until March 1, 2020, with no language restrictions. Randomized clinical trials comparing pharmacological interventions were included in the current network meta-analysis. We estimated summary risk ratios (RRs), 95% credible interval (CrI), and the surface under the cumulative ranking curve (SUCRA) using network meta-analyses with random effects in a Bayesian framework. The primary outcomes were complete recovery in short-term (≤3 months) and intermediate/long-term (>3 months) after randomization. The secondary outcome was synkinesis., Results: In total, 21 trials comprising 2,839 participants were retrieved. In terms of good recovery, corticosteroids plus antivirals were the most effective treatment compared to placebo, with RRs ranging between 1.25 (95% CrI: 1.10, 1.43) for the short-term and 1.26 (95% CrI: 1.11, 1.45) for the intermediate/long-term recovery. For synkinesis, only corticosteroids plus antivirals (RR 0.35; 95% CrI: 0.19, 0.65) were associated with fewer synkinesis rates than placebo. The certainty of the evidence for good recovery and synkinesis was very low-low and moderate-high, respectively., Conclusions: This network meta-analysis showed that combined therapy remains the best regimen for a good recovery outcome and the only efficacious regimen for synkinesis. More research is needed to confirm these findings. Laryngoscope, 131:1615-1625, 2021., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: The most important aspect of hearing loss is its effect on the communication abilities of individuals. The aim of this study was to compare the prevalence of attention deficit hyperactivity disorder (ADHD) in hearing-impaired (HI) children with normal-hearing (NH) peers., Methods: A total of 130 children (65 children with severe-to-profound hearing loss and 65 NH peers) participated in this cross-sectional study from November 2013 to May 2014. ADHD Rating Scale IV questionnaires were given to children's parents to collect data. Descriptive and analytical analyses were used in order to achieve the objectives of the study., Results: The mean age of the HI children and NH peers was 14.1 and 13.3 years, respectively. In the case group, 52 children suffered from congenital hearing loss and 10 children had acquired hearing loss. In total, 19 cases (29.2%) and eight controls (12.3%) were diagnosed with ADHD. This difference was statistically significant (P=0.017). The prevalence of ADHD in children with hereditary or acquired hearing loss was 30.7% and 20.0%, respectively. However, this difference was not significant (P=0.71)., Conclusion: The prevalence of ADHD in school-aged children with hearing loss is higher than that in the general population of the same age. We could not find significant differences between the different subgroups due to the small sample size. Therefore, we recommend a further larger study to determine the interaction between hearing loss and ADHD., (Copyright © 2020 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: The performance in most smell identification tests is subjected to cultural variations. This study aimed to evaluate age, gender, and smoking-related effects on the test performance in the North of Iran., Materials and Methods: The olfactory function of 1470 eligible subjects was assessed in this study. Moreover, this study evaluated the influence of age, gender, and education on the test scores., Results: According to the results, females obtained higher mean test scores, compared to males (18.4 vs. 17.6). In general, the elderly obtained lower scores, and about 30% of the subjects who were ≥65 years of age had severe hyposmia or anosmia. Furthermore, the olfactory impairment frequency in smoker subjects was significantly more than non-smokers (P<0.001). Test scores were generally higher in subjects with higher education levels. Logistic regression analysis revealed that the total number of cigarette doses in smokers and age had a significant association with olfactory dysfunction (P value <0.001 and 0.004, respectively). Cronbach's α of Iran-SIT was obtained at 0.78 which was more than an acceptable value of 0.7., Conclusion: The findings of this study revealed that a low score in the Iran-SIT correlated with smoking, older age, low education level, and gender (male).

Objectives: To investigate predictors of fear of falling (FOF) among older people with or without hip fracture., Methods: The FOF was assessed by the Visual Analogue Scale (VAS-FOF), anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). The modified Berg Balance Scale (mBBS) to evaluate functional balance was used. All people were asked to complete the dizziness Handicap Inventory (DHI) and the 36-item Short Form Health Survey (SF-36) for evaluating quality of life., Results: Eighty-eight older adults (44 cases; 44 controls) took part in this study. The case group had received surgical intervention for femoral neck or trochanteric fracture resulting from a fall. The results showed significantly more intensity of FOF in hip fracture patients than controls ( p < .001). The FOF was significantly correlated with anxiety, DHI, mBBS, and SF-36. The results of the multiple linear regression showed that four predictors explained about 44% of the variance of the FOF. It was found that mBBS and DHI significantly predicted FOF ( p < .001 and < .001, respectively)., Conclusions: The hip fracture patients had a high degree of the fear of falling, low quality of life and low functional capacity. The mBBS and DHI were significant predictors of the FOF in older adults., Clinical Implications: It may be useful to employ an inter-disciplinary approach to addressing fear of falling to best understand physiological and psychological contributions.

Objectives: The aim of this study was to compare the effects of betahistine with dimenhydrinate on the resolution of residual dizziness (RD) of patients with benign paroxysmal positional vertigo (BPPV) after successful Epley maneuver., Methods: In this double-blind, randomized clinical trial, patients with posterior semicircular canal type of BPPV were included. After execution of the Epley maneuver, patients were assigned randomly to one group for 1 week: betahistine, dimenhydrinate or placebo. The primary outcomes were scores of the Dizziness Handicap Inventory (DHI) and the modified Berg balance scale (mBBS). All patients were asked to describe the characteristics of their subjective residual symptoms. Binary logistic regression analysis was performed to examine the predictors of improved RD. All analyses were conducted using SPSS 19.0., Results: In total, 117 patients (age range: 20-65 years) participated in this study. After the Epley maneuver, 88 participants had RD. After the intervention, 38 patients exhibited an improved RD. Less than 50% of participants in the three groups showed mild to moderate dizziness handicap. However, there was no significant difference between mBBS scores of groups before or after the intervention. Logistic regression was shown that patients with receiving betahistine were 3.18 times more likely to have no RD than the placebo group. Increasing age was associated with a decreased likelihood of improving RD ( P  = .05)., Conclusion: The analysis of data showed that the use of betahistine had more effect on improving RD symptoms. We recommended future studies using objective indicators of residual dizziness.

Purpose: Cardiovascular risk factors, including metabolic syndrome (MetS) components, were reported as possible risk factors of sudden sensorineural hearing loss (SSNHL). The objective of this study was to evaluate the relationship between MetS (and its components) and SSNHL., Methods: Eighty-one SSNHL patients and 243 sex-, aged-matched controls participated from January 2018 to July 2019. The participants included 176 (54.3%) men and 148 (45.7%) women. The correlation between Mets components, total cholesterol, low-density lipoprotein-cholesterol, and the onset of SSNHL was analyzed using used multivariate conditional logistic regression analysis., Results: A total 12 patients (14.8%) with SSNHL and 27 subjects (11.1%) in control group had MetS (p > 0.05). The rate of low levels of high-density lipoprotein-cholesterol (HDL-C), hypertriglyceridemia, and hypertension was significantly higher in the SSNHL group than those in the control group (p < 0.05). A trend of odds SSNHL was observed with increasing the number of MetS components (p < 0.001). The multivariable analysis revealed that the rate of hypertriglyceridemia and low HDL-C concentration was significantly higher in the SSNHL groups compared to the controls., Conclusions: Hypertriglyceridemia and low levels of HDL-C may be important factors in the pathogenesis of SSNHL, and should be assessed during the investigation of patients with this condition.

Introduction: The present study aimed to investigate the audiological profiles of elementary school-age children in Rasht, Iran, and estimate the prevalence of hearing impairments in this population ., Materials and Methods: In this cross-sectional descriptive-analytical study, the hearing threshold was screened using pure tone audiometry (PTA). Hearing impairment was defined as equal to or higher than 20 dB HL. Results of the hearing thresholds were separately reported in the left or right ears and better or worse ears. Logistic regression tests were used to investigate the association between hearing loss and possible risk factors. In this study, all the analyses were conducted using SPSS software (version 21)., Results: The present study was carried out on a total of 2019 children. Mean age of the participants was reported as 9.66±1.66 years. Based on low-frequency pure-tone average, the prevalence rates of hearing loss > 15 dB in the right and left ears were reported as 1.94% and 1.68%, respectively. The high-frequency hearing loss > 15 dB in the right and left ears was obtained at 1.14% and 1.04%, respectively. Prevalence rate of hearing loss (in all frequencies) in boys was higher than that in girls. There was a strong association between a history of otitis media and sensorineural or conductive hearing loss (adjusted odds ratio reported as 12.2 and 8.1, respectively)., Conclusion: In this study, the rate of hearing loss in the participants was approximately 2%. It was concluded that the screening of hearing loss in children is necessary for the identification and management of these children as early as possible. It is recommended to perform further trials to investigate the impact of different causes on childhood hearing impairment.

Introduction: The present study was designed to investigate the psychometric properties of the Persian version of the Dizziness Handicap Inventory (P-DHI). In addition, this research was targeted toward assessing the association of P-DHI with Medical Outcome Study 36-Item Short Form Health Survey (SF-36) and Hospital Anxiety and Depression Scale (HADS). The current study also involved a comparison of the scores of patients and healthy participants and implementation of a factor analysis., Materials and Methods: This cross-sectional study was conducted on 113 patients with dizziness and 30 healthy individuals referring to tertiary centers for otolaryngology and neurology, affiliated to Guilan University of Medical Sciences, Rasht, Iran. The mean age of the patients was 44.5±13.6 years. All patients re-completed the P-DHI after 2 weeks. Internal consistency and reproducibility of the inventory were evaluated using the Cronbach's alpha coefficient, Bland-Altman limits of agreement, and intraclass correlation coefficients. In addition, the relationships of the P-DHI with SF-36 and HADS were evaluated using the Spearman correlation coefficient. An exploratory factor analysis was also run to determine the factor structure of the questionnaire., Results: The Cronbach's alpha coefficient of P-DHI scale was obtained as 0.86. In addition, the functional, physical, and emotional subscales of this instrument had the Cronbach's alpha coefficients of 0.76, 0.52, and 0.80, respectively. The limits of agreement were 16 points for the total scale, and the range of intraclass correlation coefficients was 0.90-0.96. The P-DHI showed a fair correlation with vertigo severity which assesses functional disability subscale. This scale also demonstrated a moderate correlation with SF-36 and HADS. Factor analysis revealed a 2-factor solution which was different from the factor structure of the original DHI., Conclusion: As the findings indicated, the P-DHI had good psychometric properties; therefore, it could serve as a useful tool for measuring disability in patients with dizziness and unsteadiness.

Objectives: Current medications for allergic rhinitis (AR) may have undesirable side effects that could affect quality of life (QoL). Probiotics could be an alternative in these patients. The aim of this study was to assess the impact of add-on probiotics on symptoms and QoL of patients., Methods: In this randomized crossover clinical trial, patients with persistent AR were included. Each subject received budesonide with probiotic supplements (BP) or budesonide with placebo for 8 weeks (B), then vice versa for a further 8 weeks. There was an 8-week washout. The primary outcome was the change of the Short Form 36-Item Health Survey (SF-36) score. The secondary outcomes were assessed by the Sinonasal Outcome Test-22 (SNOT-22) and the Control of Allergic Rhinitis and Asthma Test (CARAT) questionnaires., Results: A total of 152 subjects (30.1 ± 7.6 years) completed the study. The SF-36 score in both groups showed improvement compared with baseline values. Treatment BP was more effective than that of B. The Cohen's d and the number needed to treat for Physical Component Scales of SF-36 were 0.40 and 10.77, respectively. These values for Mental Component Scales were 0.33 and 12.61, respectively. Also, treatment BP showed more reduction in the score of SNOT-22 and CARAT., Conclusion: This study showed that the addition of probiotics to budesonide significantly improved QoL in persistent AR patients. However, the clinical situation of these patients may be not very representative of AR patients in general population. Further studies are recommended., Level of Evidence: 1b Laryngoscope, 129:1744-1750, 2019., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)

Introduction: This study is aimed at investigating the olfactory function among different subtypes of Parkinson disease (PD) and the impact of sex on smell identification test., Methods: In this cross-sectional study, we used Iran-smell identification test (Iran-SIT). PD severity was determined using a Hoehn and Yahr (H&Y) scale. We used analysis of covariance (ANCOVA) to compare the olfactory function among different PD subtypes. All analyses were performed using SPSS software version 16.0., Results: In total, 66 males and 38 females participated in this study. The most common PD subtype was postural instability and gait difficulty (38.5%). Severe hyposmia and anosmia were found in 44.6 and 19.6% of participants, respectively. Women had a higher score in olfactory function than men (p = 0.44). The score of subjects with stage 1 in the H&Y scale was about 3 points higher than the score with stage 4. The ANCOVA showed a statistically significant effect of subtypes PD on Iran-SIT score after controlling for the effects of covariates (p = 0.03). There is a significant difference between tremor-dominant Parkinson disease (TDPD) and other subtypes of PD (p < 0.05). However, Iran-SIT scores failed to show a significant difference between men and women (p = 0.13)., Discussion/conclusion: Our results confirmed that PD is heterogeneous and there is significant variability in odor identification ability in these patients. We observed more olfactory impairment in TDPD, and subjects with higher H&Y stage. We recommended future studies with repeated measurements of different aspects of smell function to characterize the temporal relationship of olfactory dysfunction with PD., (© 2019 S. Karger AG, Basel.)

Objective: This study aimed to assess the effects of soy consumption on glucose metabolism in patients with type 2 diabetes., Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) principles. Literature published between 1990 and 2019 was searched. Primary outcomes were the effect of soy on fasting plasma glucose (FPG), insulin, and HbA1c. The data were pooled using random effects models. Heterogeneity was assessed using Cochran's Q and I 2 statistics. Also, the Cochrane Collaboration's tool for assessing risk of bias was used, and sensitivity analysis and meta-regression were conducted. Publication bias was evaluated using Egger and Begg tests., Results: Sixteen randomized clinical trials (RCTs) with a total of 471 participants were regarded as eligible and included in the study. Soy consumption had no significant effects on FPG, insulin, and HbA1c. After the "trim-and-fill" method was applied, soy revealed a significant effect size on FPG (adjusted Cohen's d: -0.18; p = 0.03). Also, subgroup analyses using studies with parallel design showed a significant improvement (moderate effect size) in FPG and insulin. Sensitivity analysis indicated the robustness of our findings. Among secondary outcomes, the results showed a significant effect of soy on HOMA-IR and total cholesterol levels., Conclusions: Although this systematic review and meta-analysis indicated no beneficial effects of soy consumption on FPG, insulin, and HbA1c in patients with type 2 diabetes, pooling of parallel studies showed different results from crossover studies. The quality of evidence revealed low levels of confidence for primary outcomes. Therefore, further research is recommended.

Objectives/hypothesis: This study sought to identify the predictors of outcome in patients with otosclerosis undergoing primary stapes surgery., Study Design: Retrospective analysis of medical records., Methods: A total of 995 patients with otosclerosis who underwent primary stapes surgery by a single surgeon between January 2006 and December 2016 were included. Logistic regression analysis was performed to examine factors affecting postoperative hearing thresholds at individual frequencies. A postoperative air-bone gap (ABG) closure ≤ 10 dB in the stapes surgery was considered as excellent outcome., Results: Stapedotomies and stapedectomies were conducted in 823 and 172 ears, respectively. The surgeries had an overall success rate of 93.6%. Univariate analysis showed a significantly higher success rate in patients with larger prostheses (diameter = 0.6 mm). According to the results of multivariate logistic regression analysis, preoperative ABG (B coefficient = -0.10), bilaterality (odds ratio [OR] = 2.09), right ear involvement (OR = 2.00), female gender (OR = 1.81), and nonobliterative footplate (OR = 3.69) were significant prognostic factors predicting excellent outcome., Conclusions: Our findings indicated that the functional results were generally good. Based on logistic regression analysis, preoperative ABG and nonobliterative footplate were the most important predictors of hearing outcome after stapes surgery for otosclerosis. The success of the surgery did not depend on the procedure types (stapedotomy vs. stapedectomy) or the diameter of the prosthesis (0.4 mm vs. 0.6 mm)., Level of Evidence: 4. Laryngoscope, 128:2403-2407, 2018., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)

Methylphenidate (MPH) is the most commonly used treatment for attention-deficit hyperactivity disorder (ADHD) in children. However, the response to MPH is not similar in all patients. This meta-analysis investigated the potential role of SLC6A3 polymorphisms in response to MPH in children with ADHD. Clinical trials or naturalistic studies were selected from electronic databases. A meta-analysis was conducted using a random-effects model. Cohen's d effect size and 95% confidence intervals (CIs) were determined. Sensitivity analysis and meta-regression were performed. Q-statistic and Egger's tests were conducted to evaluate heterogeneity and publication bias, respectively. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence. Sixteen studies with follow-up periods of 1-28 weeks were eligible. The mean treatment acceptability of MPH was 97.2%. In contrast to clinical trials, the meta-analysis of naturalistic studies indicated that children without 10/10 repeat carriers had better response to MPH (Cohen's d: -0.09 and 0.44, respectively). The 9/9 repeat polymorphism had no effect on the response rate (Cohen's d: -0.43). In the meta-regression, a significant association was observed between baseline severity of ADHD, MPH dosage, and combined type of ADHD in some genetic models. Sensitivity analysis indicated the robustness of our findings. No publication bias was observed in our meta-analysis. The GRADE evaluations revealed very low levels of confidence for each outcome of response to MPH. The results of clinical trials and naturalistic studies regarding the effect size between different polymorphisms of SLC6A3 were contradictory. Therefore, further research is recommended., (© 2017 Wiley Periodicals, Inc.)

Introduction: There remains controversy about the optimal kind of graft to repair tympanic membrane. The purpose of this study was to evaluate the anatomical and auditory outcomes of type I tympanoplasty using fascia with or without cartilage reinforcement., Materials and Methods: This retrospective cohort study was conducted from 2005 to 2015. All cases were surgically treated by a single surgeon. We excluded cases in which the etiology of chronic otitis media was cholesteatoma. According to the use of cartilage reinforcement in the posterosuperior part of the graft, patients were divided into two groups, and the results of anatomical and auditory evaluation were compared between the two groups. The anatomical outcome was grafting success and the auditory outcome was improvement of air bone gap (ABG)., Results: A total of 320 patients were classified in Group A (tympanoplasty with fascia temporalis only) and 346 were in Group B (tympanoplasty with cartilage reinforcement). All patients were followed for at least 2 years. The overall success rate in the two groups was 91.6% and 93.4%, respectively (P=0.3). The most common cause of failure in the two groups was re-perforation (5.6% and 3.8%, respectively). The improvement of ABG in two groups was 18.5 dB and 3.2 dB, respectively. The difference between two groups was statistically significant (P<0.001)., Conclusion: In patients with dry perforation of the tympanic membrane, the anatomical success with tympanoplasty with fascia only or with cartilage reinforcement was similar. However, hearing improvement in the fascia only group was greater than in the group undergoing cartilage reinforcement.

Objective: To systematically review the results of type 1 tympanoplasty with temporalis fascia (TF) versus cartilage in patients with chronic otitis media (COM) for graft integration and hearing improvement., Data Sources: The English language literature (until June 1, 2016) was searched, using Medline (via PubMed), Scopus, ProQuest, Ovid, Cochrane database, and Google Scholar., Review Methods: A comprehensive review of the literature was performed. Prospective and retrospective studies enrolling patients with COM were included. Relevance and validity of selected articles were evaluated. Heterogeneity was assessed using I 2 statistics. For dichotomous variables, absolute rate differences, and number needed to treat (NNT) were calculated. For continuous variables, standard mean differences were calculated., Results: A total of 11 prospective and 26 retrospective studies involving 3,606 patients were included. In general, the overall graft integration rates of cartilage and fascia tympanoplasty were 92% and 82%, respectively (NNT = 11.1, P < 0.001). Although there was no significant difference in the air-bone gap (ABG) closure of < 10 dB between the two groups, the subanalysis of prospective studies showed that patients in the TF group had less mean postoperative ABG (P = 0.02). Subgroup analysis of palisade grafts compared with that of TF graft revealed a significant difference in the graft integration rate favoring cartilage tympanoplasty (P = 0.01)., Conclusion: Cartilage grafting seemed to show a higher graft integration rate compared with TF grafting. Both cartilage and fascia tympanoplasty provided similar improvements in the hearing outcome postoperatively. Large prospective trials are necessary to collect high-quality data., Level of Evidence: NA. Laryngoscope, 127:2139-2148, 2017., (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)

Intimate partner violence (IPV) is a neglected public health issue in Iran. This study was conducted among married women residing in urban Rasht (northern Iran), to estimate the prevalence and frequency of different forms of IPV from husband and their associations with socio-demographic factors. We carried out a population-based cross-sectional survey with cluster sampling design from February to October 2015. The samples consisted of married women aged ≥ 18 years with total household in Rasht city (north Iran) as the sample frame. We administered the Revised Conflict Tactics Scale (CTS-2) to estimate prevalence of past-year IPV. Of 2091 women, 57.1% had suffered psychological aggression, 27.6% physical abuse, 26.6% sexual abuse, and 6.9% injury. A significant association with IPV was found for women with, age ≤ 40 years, unemployed, low education, husband's addiction and rented-householders. Women who experienced physical abuse, had less age at marriage than women without violence. Also women with sexual coercion had less length of marriage than other non-abused women. On logistic regression, the strongest predictor of psychological, physical and sexual abuse was unemployment of spouse, whereas for injury it was low educational level (<12 years) of women. Our findings suggest that risk of IPV is high in our population. There is an obvious need of preventive and treatment activities. Our findings point at that various forms of abuse are different from each other in terms of differing characteristics of the perpetrators and it might be that also different strategies are needed to reduce and prevent these violence. Confirmation by further research is needed.

Background: Children with attention deficit hyperactivity disorder/developmental coordination disorder (ADHD/DCD) suffer from problems associated with gross and fine motor skills. There is no effective pharmacological therapy for such patients. We aimed to assess the impact of methylphenidate (MPH) on motor performance of children with ADHD/DCD., Methods: In this double-blind placebo-controlled, 17 children (12 boys) with ADHD/DCD with a mean age of 7 years 6 months were recruited in Shafa Hospital, Rasht, Iran. The response was defined as ≥25% reduction in the total score of ADHD rating scale-IV from the baseline. Sixteen boys entered phase 2 of the study in which the impact of MPH on motor function was determined through a crossover randomized clinical trial. Eligible individuals were scheduled for baseline and two assessment visits after a one-week period of intervention. We used the short form of Bruininks-Oseretsky test (BOT-2) to identify the disability of motor function. Children were randomly assigned to receive MPH or inert ingredients (placebo). In the second period, medication (MPH/placebo) was crossed over. The effects of MPH were analyzed using χ 2 test for related samples to compare the performance during baseline, placebo, and MPH trials. The results were analyzed using the SPSS software version 16.0., Results: The mean minimal effective dose of MPH per day was 17.3 mg (0.85 mg/kg). Children with higher ADHD rating scale had a significantly lower standard score in BOT-2 (P=0.03). Following MPH intake, 26.6% of the children showed clinically significant improvement in motor function. However, the improvement was not statistically different between the MPH and placebo., Conclusion: Although MPH improved ADHD symptoms, problems with motor performance still remained. Further work is required to determine the probable effects of MPH in a higher dosage or in different subtypes of ADHD., Trial Registration Number: IRCT201107071483N2.

In this study, we conducted a systematic literature review and meta-analysis on the effect of repetitive transcranial magnetic stimulation (rTMS) compared with sham in chronic tinnitus patients. We searched databases, from their onset up to August 2014, for randomized controlled trials (RCT) in English that assessed the effectiveness of rTMS for chronic tinnitus. RCTs were selected according to inclusion/exclusion criteria before data were extracted. For the meta-analysis weighted mean differences (and standard deviations) of Tinnitus Questionnaire (TQ) and Tinnitus Handicap Inventory (THI) scores were determined. Therapeutic success was defined as difference of at least 7 points in the THI score between baseline and the follow-up assessment after treatment. The odds ratio (OR) for this variable was assessed. Results from 15 RCTs were analyzed. The mean difference for TQ score at 1 week after intervention was 3.42. For THI, the data of mean difference score in two groups, 1 and 6 month after intervention, was 6.71 and 12.89, respectively. The all comparisons indicated a significant medium to large effect size in follow-up which is in favor of the rTMS. The pooled OR of therapeutic success of the studies which used THI at 1 month after intervention was 15.75. These data underscore the clinical effect of rTMS in the treatment of tinnitus. However, there is high variability of studies design and reported outcomes. Replication of data in multicenter trials with a large number of patients and long-term follow-up is needed before further conclusions can be drawn.

Cephalic resection of the lateral crura of the alar cartilages, lateral osteotomies, and removal of the nasal hump during rhinoplasty may cause collapse of the internal nasal valve angle. This study was performed to compare preventive effects of two techniques (spreader grafts and flaring sutures) on rhinoplasty by rhinomanometry. Two hundred and forty-eight patients participated in this semi-experimental study. The patients were assigned into two groups. 28 of them were not available for follow-up. All patients had a straight nose in the midline and no severe septal deviations. 87 of 220 patients underwent the spreader grafts technique and the flaring sutures technique was performed in 133 patients. The nasal airway resistance was calculated by active anterior rhinomanometry on admission to hospital and again between 3 and 6 months following surgery. The mean of follow-up was 20.9 ± 2.9 weeks. After rhinoplasty, nasal airway resistance decreased in 46 patients (52.9 percent) of spreader grafts group and in 84 patients (63.2 percent) of flaring sutures group. The median nasal airway resistance difference (before-after surgery) of spreader grafts and flaring sutures groups was 0.027 Pa/ml/s (range -110 to 130) and 0.017 Pa/ml/s (range -0.690 to 0.790), respectively. The difference of nasal airway resistance between before and after rhinoplasty in two groups was insignificance (Mann-Whitney U test, P = 0.5). The spreader grafts and flaring sutures move the dorsal border of the upper lateral cartilage in a lateral direction and had similar preventive effect on nasal airway resistance after rhinoplasty.

Background and Aims: A normal consequence of aging is a general deterioration in a number of musculoskeletal and sensory systems that affect postural control and balance. The aim of this study was to evaluate history of falls among active older individuals in Iran, and estimate the risk factors for falls among this population., Methods: A total of 448 active older subjects from rural region of Rasht city, Iran, were included. They were divided into three groups depending on their age: young-old (n = 266); middle-old (n = 154) and oldest-old (n = 28). We assessed balance performance by One-Leg Balance (OLB), Functional Reach (FR), Timed Up and Go (TUG) and Romberg tests., Results: The fall rate (>2 in the last year) was 27.0 %. The cut-off point 13.75 s for TUG test showed 84.7 % sensitivity and 56 % specificity. Also the best cut-off point for OLB test was 12.7 s (63 % sensitivity and 83.5 % specificity). Logistic regression analysis revealed that age, BMI, diabetes, and failure in OLB, FR, and Romberg tests predicted fall risk. The decision tree classification of older individuals showed three categorical variables, which in their order of importance included diabetes, Romberg test, and OLB test., Conclusions: This study revealed the value of history taking about diabetes as a predictor for existing falling. Decision tree technique showed that Romberg and OLB tests help in identifying older adults with balance problems. Given the incidence and consequences of falls among older adults, large-scale prospective studies on older individuals to identify those prone to falls are warranted.

Introduction: Tinnitus can have a significant effect on an individual's quality of life, and is very difficult quantify. One of the most popular questionnaires used in this area is the Tinnitus Handicap Inventory (THI). The aim of this study was to determine the reliability and validity of a Persian translation of the Tinnitus Handicap Inventory (THI-P)., Materials and Methods: This prospective clinical study was performed in the Otolaryngology Department of Guilan University of Medical Sciences, Iran. A total of 102 patients aged 23-80 years with tinnitus completed the (THI-P). The patients were instructed to complete the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Audiometry was performed. Eight-five patients were asked to complete the THI-P for a second time 7-10 days after the initial interview. We assessed test-retest reliability and internal reliability of the THI-P. Validity was assessed by analyzing the THI-P of patients according to their age, tinnitus duration and psychological distress (BDI and STAI). A factor analysis was computed to verify if three subscales (functional, emotional, and catastrophic) represented three distinct variables., Results: Test-retest correlation coefficient scores were highly significant. The THI-P and its subscales showed good internal consistency reliability (α = 0.80 to 0.96). High-to-moderate correlations were observed between THI-P and psychological distress and tinnitus symptom ratings. A confirmatory factor analysis failed to validate the three subscales of THI, and high inter-correlations found between the subscales question whether they represent three distinct factors., Conclusion: The results suggest that the THI-P is a reliable and valid tool which can be used in a clinical setting to quantify the impact of tinnitus on the quality of life of Iranian patients.

Introduction: Radiotherapy is a common treatment modality for patients with head and neck malignancies. As the nose lies within the field of radiotherapy of the head and neck, the olfactory fibers and olfactory receptors may be affected by radiation. The aim of this study was to evaluate changes in olfactory threshold in patients with head and neck malignancies who have received radiation to the head and neck., Materials and Methods: The olfactory threshold of patients with head and neck malignancies was assessed prospectively before radiation therapy and serially for up to 6 months after radiotherapy using sniff bottles. In vivo dosimetry was performed using 82 LiF (MCP) chips and a thermoluminescent dosimeter (TLD) system., Results: Sixty-one patients were recruited before radiotherapy was commenced. Seven patients did not return for evaluation after radiation. Fifty-four patients were available for follow-up assessment (28 women, 26 men; age, 22-86 years; median, 49 years). Total radiation dose was 50.1 Gy (range, 30-66 Gy). Mean olfactory threshold scores were found to deteriorate significantly at various timepoints after radiotherapy (11.7 before radiotherapy versus 4.0 at Month 6, general linear model, P<0.0001). With in vivo dosimetry, we found that the median measured dose to the olfactory area was 334 µC. We also identified a cutoff point according to the dose to the olfactory epithelium. Olfactory threshold was significantly decreased 2-6 weeks after initiation of therapy, with cumulative local radiation >135 µC (Mann-Whitney U test, P=0.01)., Conclusion: Deterioration in olfactory threshold scores was found at 6 months after initiation of radiation therapy. Provided that these results are reproducible, an evaluation of olfactory functioning in patients with head and neck malignancies using in vivo dosimetry may be useful for determining the optimal dose for patients treated with conformal radiotherapy techniques while avoiding the side effects of radiation.

Objectives: To investigate the prognostic implications of p53 expression in the surgical margins of laryngeal squamous cell carcinomas., Methods: Thirty one patients with T3-4N0M0 cancers with pathologically negative margins were analyzed by immunohistochemistry (IHC) to detect expression of p53., Results: The p53 positive rates by IHC in the surgical margin were 16.1% (5/31). In the p53 positive margin group, the recurrent rate was higher than those without (80% vs 19.2%, P = 0.006). Also, the median free of disease period in the p53 positive margin group was shorter than other group (22.2 vs 47.8 months, P < 0.0001)., Conclusions: We found that the overexpression of p53 can serve a prognostic role for both recurrence and disease-specific mortality in head and neck squamous cell carcinoma. p53 expression could stratify patients, in an easy and inexpensive way, according to their risk of local or regional recurrence.

Background: Drooling is a common problem in children and adults with neuromuscular disorders. This problem is best dealt with using a multidisciplinary team approach. The objective of this paper is to assess the results following surgery at the Drooling Clinic of Amiralmomenin Hospital., Methods: The results of the surgical protocol used between 1994 and 2007 at the Drooling Clinic of Amiralmomenin Hospital in Rasht, Iran, reported thirty-two patients underwent submandibular duct relocation and sublingual resection. The preoperative and postoperative levels of drooling were measured. The parents of the patients were contacted by telephone at least one year after operation., Results: Of all the patients, eighteen were male and fourteen were female and were aged 6 years to 26 years. Of 30 patients with complete patients' chart, the mean drooling score fell from 7.59 to 2.71 after surgery (p < 0.0001). In 30 patients, results of operation were ascertained by telephone at average of 5.6 years after operation. In 78.1% of patients, long-term result was successful and none were considered worse after the procedure. There were few complications, none of which had any long-term adverse effects. Swelling of submandibular glands was frequently observed in the immediate post-operative period. Only one ranula was seen as delayed complication., Conclusions: Submandibular duct relocation with simultaneous sublingual gland excision is a safe and consistently efficient procedure for the treatment of chronic sialorrhea. It is believed that this operation is more physiological procedure than others.

Background: Tinnitus remains a phenomenon with an unknown pathophysiology and for which few therapeutic measures are available. To date there has been insufficient evidence to support the use of alprazolam in the treatment of tinnitus. We sought to evaluate the efficacy of alprazolam for relief of tinnitus., Material/methods: Thirty-six tinnitus sufferers participated in this cross-over, randomized, triple-blind, placebo-controlled trial. Inclusion criteria included patients between ages 21 and 65, with a complaint of non-pulsatile tinnitus of more than 1 year duration. Patients with depressive or anxiety disorders were excluded, as were those using hearing aids. Participants received alprazolam 1.5 mg daily versus placebo in each period. Primary outcome variables included the Tinnitus Handicap Inventory (THI), a Visual Analog Scale (VAS), and tinnitus loudness., Results: Thirty patients completed the study. The average age of patients was 47.58+/-7.65 years. Alprazolam in comparison with placebo did not result in statistically significantly greater relief in THI score and tinnitus loudness. There was a significant improvement in VAS score in the alprazolam group compared with the placebo group (p<0.001)., Conclusions: These results suggest that although alprazolam did not improve the THI score or sensation level of loudness significantly, it has a desirable effect on VAS. Further work is needed to determine the beneficial effects of alprazolam in distressed or depressed patients.

Background: Thyroglossal duct cysts are the most common congenital abnormality of thyroid development. They represent the most common midline neck masses in childhood, however, can be found in adults. Less than 1% of these cases are malignant. Our patient was a 28-yr-old man and his chief complaint was a progressively enlarged paramedian neck mass for a duration of 6 months., Results: We describe the imaging and pathologic characteristics of papillary carcinoma of thyroglossal duct cyst in a 28 years old man and subsequent treatment recommendations. The pathologic examination revealed papillary carcinoma of thyroglossal duct cyst followed by a total thyroidectomy. An axial CT scan of the neck showed a left Paramedian cyst,measuring 15 x 18 mm in the submental region. Neck dissection was done followed by 131I ablation., Conclusions: Base upon our past and current experience,we recommend that thyroglossal duct cyst with a microscopic focus of papillary carcinoma without cyst wall invasion be managed with Sistrunk procedure along with effective suppressant dose of thyroxine.

In computed tomographic (CT) scans, a wooden foreign body can appear as a lucency with nearly the same density as air or fat, and it can be indistinguishable from orbital adipose tissue. Magnetic resonance imaging (MRI) can localize these wooden foreign bodies in the orbit. We studied a case in which a wooden golf tee lodged in the right optic canal of a nine-year-old boy. The head portion lodged in the orbital apex and the tip entered the interpeduncular fossa. Clinical examination revealed a right paranasal laceration; the right eye had no light perception and a peripapillary hemorrhage, but was otherwise normal. Surgical exploration and evaluation by CT failed to locate the foreign body. However, the golf tee was demonstrated by MRI as a low intensity image. Although it was removed by craniotomy with good neurological results, bacterial panophthalmitis led to enucleation of the eye. This case emphasizes the diagnostic value of MRI and the hazards of retained wooden foreign bodies.