Iranian Journal of Otorhinolaryngology最新文献

Introduction: Differentiated thyroid cancer (DTC) accounts for the most common types of thyroid cancer. The aim of the present study was to investigate the factors associated with recurrence and mortality after thyroidectomy in patients with diagnose of DTC in Hamadan, Iran.

Materials and methods: In this retrospective cohort study, 350 patients over 18 years old who underwent total thyroidectomy and ablation with radioactive iodine (RAI) and had DTC based on pathology and followed up for ten years were studied. The univariate and multivariate logistic regression was used for determining the risk factors of recurrence and mortality of DTC at a significance level of 0.05. SPSS software (Version 26) was applied to analyze the data.

Results: In the present study, 16.6% of the participants were male and 83.4% were female with a mean age of 40.7 ±14.7 years. Recurrence and mortality rates were obtained to be 26.9% and 4.9 %, respectively. Overall, the risk of recurrence and death was significantly higher in older age, men, smokers, tumors larger than 4 cm and regional lymph node (p<0.05). For each additional year of life, the risk of recurrence and death increased by 4% and 9%, respectively (P =0.001 and p<0.001). Recurrence in men were 5.111 times more likely than women (p<0.001). A 6.002-fold increase in the risk of death was associated with smoking (P=0.008).

Conclusion: Due to the high prevalence of DTC and on the other hand the good prognosis of this type of cancer, timely diagnosis and identification of risk factors of recurrence and death are very important.

Introduction: Sudden sensorineural hearing loss (SSNHL) is an otologic emergency that typically requires prompt treatment with corticosteroids, administered either systemically or intratympanically. The optimal route for initial therapy remains uncertain due to heterogeneity in efficacy and safety profiles.

Materials and methods: We conducted a systematic review of randomized controlled trials (RCTs) published between 2011 and 2025, comparing intratympanic and systemic corticosteroids as primary treatment for SSNHL in adults. Following PRISMA 2020 and Cochrane Handbook guidelines, we screened studies without language restrictions. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the RoB 2.0 tool. Outcomes were synthesized narratively, focusing on changes in pure-tone average (PTA), complete/functional recovery, speech discrimination, and safety. Trials with combination/salvage strategies, adjuncts, or formulation comparisons were synthesized separately.

Results: Seventeen RCTs were included. Efficacy results were heterogeneous; however, most studies indicated that intratympanic corticosteroids are at least as effective as systemic therapy. In severe hearing loss, intratympanic treatment achieved higher success rates (up to 70.6%) and greater PTA improvement compared to systemic administration. Adverse events differed by route: systemic corticosteroids were associated with metabolic disturbances, while intratympanic therapy caused localized, self-limiting events. Overall, 47.1% of studies had high risk of bias, and 52.9% showed some concerns.

Conclusion: Intratympanic corticosteroids appear to be a non-inferior alternative to systemic steroids for initial SSNHL treatment, with potential advantages in cases of severe hearing loss or systemic contraindications. Nonetheless, methodological limitations across studies warrant cautious interpretation. Future high-quality trials should address efficacy, functional recovery, and safety more rigorously.

Introduction: This study aimed to compare the mechanical properties of nasal cartilage preserved in ethanol at 4 °C versus normal saline at -18 °C, with the goal of assessing their suitability for reuse in subsequent nasal surgeries.

Materials and methods: Twenty nasal septal cartilage samples from patients who had undergone rhinoplasty were preserved for two months using two different methods. Ten cartilages were stored in alcohol at 4 °C, while the remaining ten were stored in normal saline at -18 °C. Additionally, a control group consisting of ten fresh cartilage samples was included for comparison. The mechanical properties (namely Young's modulus, fracture stress, yield stress, ductility, and tensile strength) were measured using a universal tensile testing machine STM-20 and analyzed to evaluate the effects of the preservation methods.

Results: Significant differences were observed between the groups in mean tensile strength, ductility, Young's modulus, and yield stress (P<0.05). However, no significant difference was found in mean fracture stress (P=0.318). The alcohol-preserved group exhibited significantly lower mechanical properties compared to the saline and fresh cartilage groups (P<0.05). No significant differences were detected between the frozen (saline) and fresh cartilage groups (P>0.05).

Conclusions: Cartilage stored in normal saline at -18 °C retained its mechanical properties better than cartilage preserved in alcohol at 4 °C. Freezing did not adversely affect the mechanical properties, and the slightly higher values observed in the frozen group suggest that lower temperature may enhance cartilage elasticity.

Introduction: Solitary extramedullary plasmacytoma (EMP) of the nasopharynx is a rare plasma cell neoplasm, representing a small subset of head and neck malignancies. Its nonspecific symptoms often lead to diagnostic delays.

Case report: A 50-year-old female with non-specific progressive nasal obstruction and intermittent epistaxis, underwent complete endoscopic surgical excision using coblation. Post operative histopathology revealed Nasopharyngeal Extramedullary Plasmacytoma. The patient then received adjuvant radiotherapy (Volumetric Modulated Arc Therapy - VMAT), leading to a successful outcome with no recurrence at the one-year follow-up.

Conclusion: This case underscores the importance of clinico-histopathological evaluation and a comprehensive, multimodal treatment approach, with nasopharyngeal extramedullary plasmacytoma (EMP) considered as a differential diagnosis in nasopharyngeal masses. Given the potential for progression to multiple myeloma, long-term surveillance is crucial. Increased awareness of this rare entity can facilitate early diagnosis, timely intervention, and improved patient outcomes.

Introduction: Blast wave exposure represents a primary cause of complex auditory and neurological injuries. The ear acts as a sensitive pressure transducer, making it exceptionally vulnerable to the intense mechanical forces of a blast. This review provides an overview of the multidimensional damage to the auditory system following blast events.

Materials and methods: We conducted a systematic literature search across PubMed, Scopus, Web of Science, and Google Scholar (January 2000-January 2025) using comprehensive search terms. After screening 462 unique records, 36 original research studies (27 animal, 8 human, 1 computational) met the inclusion criteria and underwent quality assessment.

Results: Evidence suggests that blast exposure causes widespread auditory impairment, ranging from cochlear synaptopathy to central neurodegeneration. Blast-related injuries involve distinct biomechanical forces that differ from conventional noise trauma. Furthermore, cumulative damage from repeated exposures leads to chronic functional impairments, including tinnitus and difficulty understanding speech in noisy environments.

Conclusion: Effective management of blast-induced hearing loss requires a multidisciplinary approach. Future research needs to focus on validating sensitive biomarkers for early diagnosis and developing targeted neuroprotective therapies.

Introduction: The ratio of neutrophils to peripheral lymphocytes is an inflammatory marker, and, based on previous studies, this ratio is associated with poor survival in several cancers. This study was conducted to compare the neutrophils-to-lymphocytes ratio (NLR) and platelets-to-lymphocytes ratio (PLR) in two groups of patients with benign and malignant salivary gland tumors.

Materials and methods: This study was cross-sectional, comparing two groups of patients with benign and malignant salivary gland masses. During the last 6 years (from 2018 to 2024), 380 Patients with a definite diagnosis of salivary gland tumors were included in the study, and NLR and PLR data were obtained from pre-operation laboratory exams.

Results: NLR and PLR were significantly higher on average than in benign masses (P<0.05). The best cut point was 2.24 for NLR (sensitivity: 78%, specificity: 80%) and 104.35 for PLR (sensitivity: 68%, specificity: 60%).

Conclusion: NLR and PLR are easy, practical methods that provide valuable information for diagnosing, assessing severity, and predicting prognosis of various diseases, such as salivary gland masses.

Introduction: Esophageal squamous cell carcinoma (ESCC) is the eighth most prevalent cancer worldwide. Head and neck squamous cell carcinoma (HNSCC) represents over 90% of all head and neck cancers, and nearly 40% of patients fail treatment. Therefore, discussion of cancer treatment is essential. In this in vitro study, we examined how conditioned medium from dental pulp stem cells (DPSC-CM) influences the ESCC cell line (KYSE-30).

Materials and methods: First, the middle pulp tissue of the wisdom tooth was extracted and, following sterilization, transferred to a cell culture flask containing MEM-α. After completing the culture procedures, conditioned medium (CM) was collected from the fourth passage culture after 72 hours in serum-free medium. The KYSE-30 cells were then treated with the CM for an additional 72 hours, and cell survival was assessed using the MTT assay. Statistical significance was evaluated using one-way ANOVA followed by Tukey's post-hoc test.

Results: The results demonstrated that treatment of esophageal cancer cells with conditioned medium (CM) significantly reduced the survival rate of cancer cells compared to control samples. The treatment of KYSE-30 cells with DPSC-CM led to a notable reduction in cell viability (CM group: 51.2 ± 4.1% vs. control group: 72.6 ± 3.3%; P = 0.004).

Conclusion: DPSC-CM demonstrates the ability to reduce the proliferation of cancer cells; therefore, this medium can be considered a potential drug (therapeutic) candidate for the treatment of esophageal cancer. However, further studies are required to confirm these results.

Introduction: Sinonasal undifferentiated carcinoma (SNUC) is a rare malignancy of the nasal cavity and paranasal sinuses, with highly aggressive behaviour. Although a multimodal strategy is considered the standard treatment approach, recurrence remains common both locally and at distant metastatic sites. Temporal bone metastases represent a rare entity, with patients primarily manifesting otologic symptoms. Breast, lung, and prostate cancers are the most common primary malignancies associated with temporal bone metastases, whereas no cases originating from the nasal cavity or paranasal sinuses have previously been reported. Herein, we report a unique case of metastatic SNUC to the temporal bone, presented with facial nerve paralysis. A brief descriptive review of all cases of distant metastases in SNUC is also reported.

Case report: We report the case of a patient with SNUC who developed temporal bone recurrence three years after trimodal treatment (induction chemotherapy, surgery and adjuvant radiotherapy) performed with good oncological outcome. Moreover, we retrospectively reviewed our case series of patients surgically treated for sinonasal undifferentiated carcinoma from 2006 to 2023 and we also performed a search of the literature from January 1, 1980, to December 31, 2024.

Conclusion: The incidence of recurrent metastasis from SNUC disease in patients treated surgically is variable. This case report represents the first case of SNUC metastasis on the temporal bone, highlighting the rare occurrence of a middle ear recurrence after multimodal treatment. Despite its rarity, temporal bone metastasis should be considered in oncological patients presenting with facial palsy or other persistent otologic symptoms.

Introduction: Lymphoma is the second most frequent type of malignancy in the head and neck region, following squamous cell carcinoma. However, the external auditory canal (EAC) is an extremely rare primary site, with only 13 cases reported worldwide.

Case report: We present a case of middle-aged woman presented with a four-month history of swelling at the right EAC, reduced hearing, and intermittent otalgia. Over the following two months, she developed swelling at the right preauricular and cervical regions. Radiological evaluation revealed an enhancing mass at the right EAC with extensive local extension. Histopathological and immunohistochemical analyses confirmed the diagnosis of lymphoma. Determining the primary site was challenging due to the extensive involvement of multiple adjacent structures. However, we believe EAC was the most probable primary site, given that EAC swelling was the initial presenting symptom, although this cannot be established with certainty.

Conclusion: The diagnosis of EAC lymphoma is challenging due to the rarity of the disease, nonspecific clinical presentation, and its frequent misdiagnosis as a benign lesion or infection at initial presentation. Additionally, obtaining an adequate biopsy sample for histopathological examination and immunohistochemical analysis can be difficult. Extensive involvement of surrounding structures at the time of presentation may further hinder accurate identification of the primary site. There is no well-established consensus on treatment guidelines, and prognosis is primarily determined by the lymphoma subtype, its clinical behaviour, the presence of B symptoms, and staging.

Introduction: Rhinitis is a common condition that is typically treated with medical therapies. However, 10-22% of patients are resistant to these treatments. In our study, the effectiveness of cryotherapy of the posterior nasal nerve (PNN) in treating rhinitis patients who have not responded to conventional medical treatments has been evaluated.

Materials and methods: In this single-group interventional study (before/after), 40 patients with rhinitis referred to the ENT clinic of Baqiyatallah Hospital underwent PNN cryotherapy using a new device called Cryo Nose. To collect data, the Total Nasal Symptom Score (TNSS) questionnaire was administered before the intervention and at 1 week, 1 month, 3 months, and 6 months after the intervention.

Results: After PNN cryotherapy, the TNSS 12-hour symptom score improved from 9.2 (±2.3) to 6.59 (±2.18) at 1 week later, 3.83 (±1.88) at 1 month later, 2.58 (±1.58) at 3 months later, and 1.98 (±1.47) at 6 months later (P < 0.05). Similar results were noted for the 2-week scores, which improved from 10.38 (±2.53) to 8.35 (±2.32) at 1 week later, 5.95 (±2.09) at 1 month later, 4.27 (±1.61) at 3 months later, and 3.38 (±1.49) at 6 months later (P < 0.05).

Conclusions: PNN cryotherapy has been shown to be effective in treating rhinitis during a 6-month follow-up period, with no significant adverse events. The effect of PNN cryotherapy on the symptoms of these patients did not differ between the different types of rhinitis.