Medical Journal of The Islamic Republic of Iran (MJIRI)

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Pendred's syndrome is defined as a triad of congenital perceptive hearing loss, goiter, and abnormal perchlorate test. Three brothers with Pendred's syndrome [P.S.] are reported. The oldest brother has hearing loss (he has been deaf and mute since childhood) and has a large goiter. A thyroid scan revealed euthyroid multinodular goiter and a perchlorate test was performed, and reported abnormal. His brother had the same manifestations but with less severity and after subtotal thyroidectomy, the pathology report revealed follicular carcinoma. The youngest brother had hearing loss since childhood but a normal sized thyroid. We report three patients and compare the frequency of their symptoms with that reported in the literature.

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The occurrence of mast cells is studied in the normal facial nerve and in the facial nerve post mortem exam of patients with chronic suppurative otitis media without associated facial paralysis. A small number of mast cells were found in the normal facial nerve. These cells were usually located in close proximity to the endoneural and epineural blood vessels. The number of mast cells was increased in some areas of the facial nerve in the majority of examined cases with chronic otitis media. In these cases, although the facial nerve showed some signs of neuropathy, its function was normal.

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The authors present a case of embryonal rhabdomyosarcoma of the middle ear in an adult patient. Computerized tomography indicated a malignant tumor and the diagnosis was confirmed by pathological analysis.

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Although inflammatory processes involving facial sinuses rarely develop during childhood, these antrums due to their anatomic situations are exposed to a variety of biologic and nonbiologic agents after birth. Many types of bacteria are able to initiate inflammatory responses in these antrums. Since effective management of these patients rests upon demonstration of a specific pathogen and testing the organism(s) for sensitivity to a variety of antimicrobial agents and due to the fact that there are distinct epidemiological features in certain regions with respect to the etiologies, we have randomly selected 264 patients with sinusitis from several Tehran hospitals in order to estimate the frequency with which various organisms may cause the condition and to evaluate antibiotic potency and efficacy in eradicating the condition. . In 62.12 percent of cases the causative organisms could be cultured, in 32.3% of which more than one genus of bactria were isolated. The most common bacterium in this setting was Staphylococcus aureus followed in order by pneumococcus, enterobacteriaceae, haemophilus, pseudomonas and branhamella. The sensitivity of these organisms to various antibiotics (suitable in each case) were studied as well.

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The authors presented a proposal for surgical classification of chronic suppurative otitis media which may be used' for evaluating the surgical outcome of the disease.

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The author presents an unusual extension of the cerebrospinal fluid space into the proximal tympanic part of the facial nerve, and points out the clinical and surgical significance of this anatomical variation.

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The report of two cases of chest and kidney infections reminds of the possibility of distant infections caused by thrombophlebitic complications of cholesteatoma. Deep neck infection, mediastinitis, pleural empyema, pulmonary abscesses and hematogenic microabscesses of kidney have been proved by clinical, radiologic and laboratory examinations in two cholesteatoma patients. The clinical course of distant infections could be terminated by effective surgical elimination of contaminated thrombi from sigmoid sinus during a mastoid surgery.

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The author studied anatomical variations of the origin of the chorda tympani nerve from the mastoid portion of the facial nerve. The studies were performed on 200 specimens of human temporal bone. It was found that the chorda tympani may arise from the facial nerve in three levels: most commonly from the mid third of its mastoid segment (70%), less commonly from the proximal third (20%), and very rerly from the distal third (10%). Knowledge of these variations has a certain value in surgical intervention of the middle ear.

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Loss of hearing is a known problem in patients with chronic renal failure, occurring in 40-XO% of cases and being most often of the high frequency sensorineural type. We performed a study on 50 patients with this disease, including 20 who had undergone a successful kidney transplantation. Our results show an 80% incidence of hearing loss in these patients and a chance of improvement in at least 60% of cases after transplantation.

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Echinococcosis is a tissue infection of the human caused by the larval stage of Echinococcus granulosus or E. multilocularis. Hydatid cyst of the head and neck region is uncommon and involvement of the salivary glands, especially the submandibular gland, is very rare. In this article, a case of submandibular gland hydatid cyst is reported in a patient who presented with swelling of this area of 5 months' duration. Examination revealed a soft, nontender, mobile mass measuring 7x5 cm. Chest x-ray and abdominal ultrasonography were normal. Excision of the mass was performed and pathologic examination revealed a hydatid cyst of the submandibular gland.

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Thyroglossal duct cyst is a well-known congenital entity, and its embryonic development and clinical presentation are well understood. Very little can be added to the classic material found in the world literature. Rare cases of unusual clinical presentation have also been reported. Our case of endolaryngeal thyroglossal duct cyst is reported because of its unique endolaryngeal presentation, having no characteristic external cystic mass. This case is reported along with its cr and FVL studies and pathological slides.

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35 patients with unilateral sensorineural impairment and hearing levels within the normal range in the opposite ears were investigated by bilateral transtympanic electrocochleography (TIECoG). Only 19 patients (54%) satisfied the criteria for Meniere's disease and 16 patients (46%) showed sensorineural impairment due to other etiologies. Clinical studies have focused exclusively on the a mplitude ratio of the summating potential (SP) and the action potential (AP) derived from alternating polarity click responses (Le., SP/AP). In only clinically defined ears with Meniere's disease have abnormally large SPs been found. Neither normal ears nor sensorineural impaired ears of other etiologies exhibited abnormal SPs, hence we used normal ears as a control in this study.

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Teratomas are bulky lesions that rarely occur in the head and neck regions.They are composed of tissues from all germ layers with varying degrees of differentiation. They arise from pluripotential stem cells and ectopic embryonic non-germ cells. The most common sites of occurrence in the head and neck are the cervical region and the nasopharynx. Three cases of these tumors are reported here that were found in the nasopharynx, cervical region and the base of the tongue.

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This study evaluated the histopathologic changes in the round window niche. , and membrane in cases of chronic suppurative otitis media. The pathologic process was found in all subjects. Fibrocystic or fibrous tissue was most commonly seen, while active granulation was less developed. The round window membrane was thicker and inflamed throughout its layers. Inflammatory invasion of the inner ear through the membrane: is very rare, because the thickened membrane has a protective role for spreading of infection.

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This study investigated the presence of mast cells in inflammatory aural polyps using light microscopy. The number of mast cells was increased in all examined cases and varied from 2.33 to 41.54 per mm2• The cells were located most commonly around small blood vessels. Occurrence of mast cells was not different in various types of polyps, but their density was severely increased in active inflamed polypous tissue. These findings suggest that mast cells may be a contributory factor in the pathogenesis of middle ear inflammatory processes.

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In an attempt to determine the diagnostic value of FNA biopsy of head and neck masses, we reviewed FNAs performed on target lesions of the head and neck in1 59 patients who subsequently underwent surgery in Khalili hospital dur-. ing a 55 month period. Results ofFNAs were compared with postsurgical histologic diagnoses. These 159 cases were broken down into four categories: thyroid masses 34 , lymph nodes 3 6, salivary gland masses 58 , and masses not classified in the first three categories 31 . Values of specificity, sensitivity, positive predictive vlaue (in diagnosing malignancy) and negative predictive value (in diagnosis of benign disease) were calculated for each category and for all masses. Overall, we obtained a sensitivity of 77%, specificity of 94%, positive predictive value of 84% and negative predictive value of90% that was comparable with several other studies performed elsewhere, except that our elevated numbers of false negative in the salivary gland category lowered the sensitivity of FNA in this category to 57% and the overall sensitivity to 77%. The other disparity between our results and those of other studies I is our slightly elevated false negative rate (6.9%), overall sensitivity.

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The objective of this study was to describe the role of electrical stimulation in controlling peripheral vertigo. In a prospective study on 13 healthy volunteers, nystagmus was induced with caloric stimulation and the interval of nystagmus disappearance was recorded. This time indicates the basal response of vestibular end-organ. After caloric irrigation, pulsed signal was applied for each person through retroauricu1ar transcutaneous electrodes and the interval of nystagmus disappearance was measured, secondarily. In second examination on three new volunteers, simultaneous caloric warm water irrigation in one ear and electrical induction in the other ear were done for a long period. There was a significant decrease in the duration of nystagmus with electrical stimulation in the first stage (p