Shahin Bastaninejad - Academia.edu (original) (raw)

Papers by Shahin Bastaninejad

Research paper thumbnail of Publication bias in otorhinolaryngology meta-analyses in 2021

Systematic Reviews, 2024

Introduction One concern in meta-analyses is the presence of publication bias (PB) which leads to... more Introduction One concern in meta-analyses is the presence of publication bias (PB) which leads to the dissemination of inflated results. In this study, we assessed how much the meta-analyses in the field of otorhinolaryngology in 2021 evaluated the presence of PB. Methods Six of the most influential journals in the field were selected. A search was conducted, and data were extracted from the included studies. In cases where PB was not assessed by the authors, we evaluated the risk of its presence by designing funnel plots and performing statistical tests. Results Seventy-five systematic reviews were included. Fifty-one percent of them used at least one method for assessing the risk of PB, with the visual inspection of a funnel plot being the most frequent method used. Twentynine percent of the studies reported a high risk of PB presence. We replicated the results of 11 meta-analyses that did not assess the risk of PB and found that 63.6% were at high risk. We also found that a considerable proportion of the systematic reviews that found a high risk of PB did not take it into consideration when making conclusions and discussing their results.

Research paper thumbnail of Comparison of different approaches to the reduction of anterior temporomandibular joint dislocation: a randomized clinical trial

International Journal of Oral and Maxillofacial Surgery, 2016

This randomized clinical trial was designed to compare three different reduction methods for ante... more This randomized clinical trial was designed to compare three different reduction methods for anterior temporomandibular joint (TMJ) dislocation. The three methods evaluated were the conventional method, wrist pivot method, and extraoral method. The study sample comprised 90 consecutive patients suffering from anterior dislocation of the TMJ, who were allocated randomly to one of the three groups. This study found success rates of 86.7% for the conventional method, 96.7% for the wrist pivot method, and 66.7% for the extraoral method. The extraoral method was more difficult for the physician and the patient than the other two methods. For the patients, the wrist pivot method was easier than the other methods. For the doctors, the extraoral method was significantly more difficult than the other methods. In conclusion, due to the absence of a biting risk with the extraoral method and the lack of a significant difference in success between this method and the conventional method, the extraoral method could be considered the appropriate first-line treatment where there is a risk of the patient biting the surgeon's hand. Given the overall benefits of the wrist pivot method, this method could be considered the first-line and gold standard treatment modality in other cases.

Research paper thumbnail of Publication bias in otorhinolaryngology meta-analyses in 2021

IntroductionOne concern in meta-analyses is the presence of publication bias (PB) which leads to ... more IntroductionOne concern in meta-analyses is the presence of publication bias (PB) which leads to the dissemination of inflated results. In this study, we assessed how much the meta-analyses in the field of otorhinolaryngology in 2021 evaluated the presence of PB.MethodsSix of the most influential journals in the field were selected. A search was conducted, and data were extracted from the included studies. In cases where PB was not assessed by the authors, we evaluated the risk of its presence by designing funnel plots and performing statistical tests.Results75 systematic reviews were included. 51% of them used at least one method for assessing the risk of PB, with the visual inspection of a funnel plot being the most frequent method used. 29% of the studies reported a high risk of PB presence. We replicated the results of 11 meta-analyses that did not assess the risk of PB and found that 63.6% were at high risk.DiscussionOur results indicate that systematic reviews published in som...

Research paper thumbnail of Hearing status in patients with vitiligo

DOAJ (DOAJ: Directory of Open Access Journals), Jun 1, 2019

Background: Vitiligo is an acquired disorder characterized by depigmented macules and patches tha... more Background: Vitiligo is an acquired disorder characterized by depigmented macules and patches that result from a progressive loss of functional melanocytes. During embryogenesis, precursor cells of melanocytes (melanoblasts) migrate not only to the epidermis and hair follicles but also to the leptomeninges, uveal tract of the eye, and inner ear. Thus, it has been proposed that these organs may be involved in vitiligo, as well. Objective: This study was designed to evaluate the frequency and characteristics of hearing loss by means of audiometry and distortion product otoaucostic emission (DPOAE) in patients with vitiligo. Methods: Fifty-three patients with vitiligo and 52 age-and sex-matched healthy subjects were enrolled in this case-control study. After a complete otological examination, comprehensive audiological evaluations including pure tone audiometry (PTA) and DPOAE were performed for all participants and the results were compared between the two groups. Results: Neither PTA nor DPOAE showed significant difference between the two groups in any of the evaluated frequencies (0.75-8 KHz). Furthermore, in patient group, there was no association between PTA/DPOAE and age, gender, duration of the disease, presence of halo nevus, type of vitiligo, extent of involvement, and positive family history of vitiligo. Conclusion: Vitiligo patients have normal hearing status.

Research paper thumbnail of Distinguishing Characteristics of COVID-19-Associated Mucormycosis; a Case Series

Archives of academic emergency medicine, 2022

Research paper thumbnail of ORIGINAL REPORT The Efficacy of Clarithromycin in Patients with Severe Nasal Polyposis

Although several treatments have been suggested for nasal polyposis, from medical to surgical, th... more Although several treatments have been suggested for nasal polyposis, from medical to surgical, there is no standard guideline for the management of this disease. During recent years increasing attention has been directed toward the effects of macrolide antibiotics on chronic sinusitis and nasal polyposis. In this study, the efficacy of clarithromycin on severe nasal polyposis were examined. In a Prospective, before-after study, forty patients with severe nasal polyposis received clarithromycin 500 mg twice a day for 8 weeks. At the beginning and end of treatment, the severity of patients' symptoms (using subjective analogue scale), computed tomography (CT) scan and endoscopic findings were recorded. After treatment, the severity of nasal obstruction, smelling problems, Post Nasal Discharge and rhinorrhea decreased significantly (P<0.05). Furthermore, the degree of sinus opacification in CT scan and endoscopic findings showed significant improvement. Most patients completed th...

Research paper thumbnail of Inaccuracy of Standard 2D Photography for the Diagnosis of Cephalic Malposition of Lateral Crural Cartilages

Facial Plastic Surgery, 2021

Lateral crural cephalic malposition (LCCM) is a well-known deformity of the nasal tip which contr... more Lateral crural cephalic malposition (LCCM) is a well-known deformity of the nasal tip which contributes to functional disturbances of the external nasal valve. Accurate diagnosis of this deformity helps surgeons plan for better outcomes. A total of 176 candidate patients for primary rhinoplasty underwent standard 2D medical photography of the face. Senior authors analyzed photography results and differentiated the patients with LCCM. In addition, we measured the angle between the dorsal septum and lateral end of the long axis of the alar cartilage in the operation room. Ninety-five patients were diagnosed with LCCM on photography. As much as 31.3% (55) of all the patients had LCCM in intraoperative measurements. The sensitivity and specificity of 2D photography for diagnosing LCCM were 0.7924 and 0.5391, respectively. The main surgical techniques for correction of LCCM were alar repositioning (34.3% in total, 56% in LCCM patients) and lateral crural strut graft (43.8% in total, 69% ...

Research paper thumbnail of Integrated Internal Stabilization for Saddle Nose Surgery

Iranian Journal of Otorhinolaryngology, 2016

Introduction: Correction of Saddle nose deformity is one of the most challenging issues in facial... more Introduction: Correction of Saddle nose deformity is one of the most challenging issues in facial plastic surgery. Materials and Methods: In this study, a single structure in the form of L-strut was attempted to be created by using one 0.035" Kirschner wire and an autologous costal graft out of the 10th and 11th ribs. This study involved 13 cases, most of whom were traumatic. The corrective surgical techniques used in this study will be described in detail. Results: There was no warping, no rejection, and no infection in the created L-strut and patients’ satisfaction was very good during the follow up period. Conclusion: Surgical correction of a saddle-shaped nose using the described technique seems to be an acceptable and uncomplicated technique, and the cosmetic result is totally acceptable.

Research paper thumbnail of A Comparison between Cold Dissection Tonsillectomy and Harmonic Scalpel Tonsillectomy

Iranian Journal of Otorhinolaryngology, 2017

Introduction: This study aimed to compare operation time, intraoperative bleeding and postoperati... more Introduction: This study aimed to compare operation time, intraoperative bleeding and postoperative pain between cold dissection tonsillectomy and harmonic scalpel tonsillectomy. Materials and Methods: In this single-blinded clinical trial, 32 patients aged 14–48 were enrolled. Each patient randomly underwent tonsillectomy using the harmonic scalpel on one side and cold dissection on the other side. Operation time and bleeding volume were measured during surgery. The pain intensity level on each side was recorded on the first and seventh postoperative days. Results: The mean volume of intraoperative bleeding was 9.59 ml on the harmonic side and 74.38 ml on the cold dissection side; which represents a significantly lower amount on the harmonic side (P<0.001). The mean time of tonsillectomy was 427.63±196.32 s for the harmonic side and 711 271.88 s for the cold dissection side (P<0.001). The mean pain intensity level on the first postoperative day was 3.88 on the harmonic side...

Research paper thumbnail of Endoscopic pericranial flap design for the restoration of nasal mid-vault lining defects

International Journal of Oral and Maxillofacial Surgery, 2018

Despite progress made in nasal reconstruction, the restoration of a large defect, including the w... more Despite progress made in nasal reconstruction, the restoration of a large defect, including the whole septum and mid-nasal vault structures, remains a challenge. The pericranial flap (PCF) is used widely for the reconstruction of anterior cranial fossa defects. This article presents a surgical technique for nasal lining restoration with an endoscopic PCF design. This technique was used in patients with huge intranasal tumours. Two patients with nasal eosinophilic angiocentric fibrosis were treated. The structural involvement was similar in each case. The tumour was resected completely by combined endoscopic and external methods through an open rhinoplasty approach. The resulting defect included the whole nasal septum, bilateral upper lateral cartilage, and the entire mid-nasal vault mucosal lining. Reconstruction was achieved by endoscopic PCF design for internal lining reconstruction and rib cartilage for framework repair. The first patient was followed up for 18 months and the second for 8 months. No infection occurred in the postoperative period. Framework stability and texture were good, and both nasal shapes were acceptable. In conclusion, this endoscopic PCF approach for restoring the internal nasal lining appears to be a good choice in selected cases.

Research paper thumbnail of Hearing status in patients with vitiligo

Clinical, Cosmetic and Investigational Dermatology, 2019

Background: Vitiligo is an acquired disorder characterized by depigmented macules and patches tha... more Background: Vitiligo is an acquired disorder characterized by depigmented macules and patches that result from a progressive loss of functional melanocytes. During embryogenesis, precursor cells of melanocytes (melanoblasts) migrate not only to the epidermis and hair follicles but also to the leptomeninges, uveal tract of the eye, and inner ear. Thus, it has been proposed that these organs may be involved in vitiligo, as well. Objective: This study was designed to evaluate the frequency and characteristics of hearing loss by means of audiometry and distortion product otoaucostic emission (DPOAE) in patients with vitiligo. Methods: Fifty-three patients with vitiligo and 52 age-and sex-matched healthy subjects were enrolled in this case-control study. After a complete otological examination, comprehensive audiological evaluations including pure tone audiometry (PTA) and DPOAE were performed for all participants and the results were compared between the two groups. Results: Neither PTA nor DPOAE showed significant difference between the two groups in any of the evaluated frequencies (0.75-8 KHz). Furthermore, in patient group, there was no association between PTA/DPOAE and age, gender, duration of the disease, presence of halo nevus, type of vitiligo, extent of involvement, and positive family history of vitiligo. Conclusion: Vitiligo patients have normal hearing status.

Research paper thumbnail of Efficacy of systemic and intratympanic corticosteroid combination therapy versus intratympanic or systemic therapy in patients with idiopathic sudden sensorineural hearing loss: a randomized controlled trial

European Archives of Oto-Rhino-Laryngology, 2017

Objective The present study was conducted to compare the rates of recovery from idiopathic sudden... more Objective The present study was conducted to compare the rates of recovery from idiopathic sudden deafness after the treatment with oral and intratympanic corticosteroids in both mono and combination therapies. Study design Triple-blind randomized clinical trial. Settings Tertiary referral hospital. Subjects and methods A total of 112 patients who were admitted to the ENT emergency department randomly divided into three groups: an oral corticosteroid plus intratympanic placebo (systemic corticosteroid monotherapy group); an intratympanic corticosteroid plus oral placebo group (IT monotherapy group); and a combination therapy group (IT plus systemic combination group). All patients were treated additionally with antiviral and proton pomp inhibitor. An audiometry was performed once before beginning the therapies and again at the end of the therapy. Results Of the total of 112 patients, 32 received intratympanic (IT) corticosteroids, 45 were receiving systemic corticosteroids, and 35 were receiving a combination of the two. A total of 74 patients (66.1%) responded positively [response to treatment was calculated as gain of at least 10 dB in 10 dB in average threshold or with the minimum improvement of 15% in speech discrimination scores (SDS)] to corticosteroid therapy. No significant differences were observed between the three groups (IT, systemic group, and combination therapy group) in their overall response to treatment (p = 0.5). Patients who suffered from concomitant tinnitus and dizziness responded less positively to the treatment (p < 0.002). Positive family history of SSNHL seems to be negative prognostic factors in the response to treatment (p < 0.001). The response to treatment was not related to the pattern (p = 0.04) and initial severity of hearing loss (p = 0.9). Conclusion This study did not find any difference in the rate of hearing improvement between systemic, intratympanic, and combined corticosteroid therapy for sudden hearing loss. Level of evidence 1b.

Research paper thumbnail of Determining effectiveness of EBM education in otolaryngology residents using modified fresno test

The Laryngoscope, 2019

Objective: To determine the effectiveness of education in evidence-based medicine (EBM) on the kn... more Objective: To determine the effectiveness of education in evidence-based medicine (EBM) on the knowledge, competency, and skills of otolaryngology residents of Tehran University of Medical Sciences (TUMS) at Amir-Alam and Imam Khomeini Hospitals. Methods: In a quasi-experimental (before-and-after) study, all ear, nose, and throat residents of TUMS (n = 41) entered the study. The residents underwent the modified Fresno test. Then, two EBM workshops with a similar content were held on 2 separate days in each hospital, with each session lasting 6 hours. The learned material was practiced in weekly journal clubs. Six months after the workshop, the modified Fresno test was applied again, and the results were analyzed. Results: A significant improvement in the modified Fresno test score was observed. The mean score of the modified Fresno test was 57.43 AE 22.07 before the workshop and 79.26 AE 22.48 after the workshop (P < 0.001). Conclusion: The results of the study show that EBM education and practice of the learned materials in journal clubs can improve the knowledge and skills of residents. Further research with larger samples is needed to improve the precision of our findings and to increase confidence in the results.

Research paper thumbnail of Use of nasal packs and intranasal septal splints following septoplasty

International journal of oral and maxillofacial surgery, 2009

The aim of this study was to compare the efficacy of a trans-septum suturing technique with conve... more The aim of this study was to compare the efficacy of a trans-septum suturing technique with conventional nasal packing and intranasal splints in the classic septoplasty operation. The study is a prospective, randomized clinical trial. 114 patients underwent septoplasty for septal deviation and ensuing nasal obstruction. These patients were divided into two groups: packing (using intranasal septal splints and antibiotic meshes at the end of the operation) and non-packing (using four separate trans-septum through and through horizontal mattress sutures without any mesh or intranasal splint insertion). Randomization was performed using the four block randomization system. Patients who failed the regular follow-up were excluded, and the two groups were compared for postoperative bleeding, hematoma, perforation and synechiae. Patients were asked to record pain levels using a visual analogue scale. The authors found no significant statistical differences between the two groups in the para...

Research paper thumbnail of The efficacy of clarithromycin in patients with severe nasal polyposis

Acta medica Iranica, Jan 13, 2013

Although several treatments have been suggested for nasal polyposis, from medical to surgical, th... more Although several treatments have been suggested for nasal polyposis, from medical to surgical, there is no standard guideline for the management of this disease. During recent years increasing attention has been directed toward the effects of macrolide antibiotics on chronic sinusitis and nasal polyposis. In this study, the efficacy of clarithromycin on severe nasal polyposis were examined. In a Prospective, before - after study, forty patients with severe nasal polyposis received clarithromycin 500 mg twice a day for 8 weeks. At the beginning and end of treatment, the severity of patients' symptoms (using subjective analogue scale), computed tomography (CT) scan and endoscopic findings were recorded. After treatment, the severity of nasal obstruction, smelling problems, Post Nasal Discharge and rhinorrhea decreased significantly (P<0.05). Furthermore, the degree of sinus opacification in CT scan and endoscopic findings showed significant improvement. Most patients completed...

Research paper thumbnail of Sleep related quality of life before and after adenotonsillar surgery in pediatric population

International Journal of Pediatric Otorhinolaryngology, 2014

Sleep disordered breathing (SDB) is a common entity in children [1-4] with a spectrum of upper ai... more Sleep disordered breathing (SDB) is a common entity in children [1-4] with a spectrum of upper airway disorders ranging in severity from primary snoring to obstructive sleep apnea (OSA) [5]. The etiology of SDB is multifactorial and its complex interplay among anatomical, neuromuscular and predisposing genetic factors into disease [6], most common cause of SDB in children is adenotonsillar hypertrophy. Tonsillectomy and adenoidectomy are curative in 85-95% cases [7-9]. Other causes of SDB include obesity, neuromuscular disorder and craniofacial anomalies [10]. Prevalence of snoring in children is reported between 3% and 12% [1-3,11] and prevalence of OSA is 1-3% [1-3,11,12]. The symptoms of SDB include oral breathing, sleep apnea, restless sleep, frequent awakening, hard to breath, abnormal bite and snoring. It can also lead to corpulmonale or left ventricle hypertrophy, failure to thrive, systemic hypertension, and in severe cases of SDB decreasing cognitive skills, quality of life (QOL) and behavioral disturbance [2,5,13-26]. OSA 18 survey [27] is an 18-item questionnaire which has been tested and accepted for reliability and validity [28], also Brouillette score [29] is developed for screening healthy children with OSA caused by adenotonsillar hypertrophy [30]. Studies show that after tonsil surgery, significant improvement occurs in behavior, QOL and cognitive function [1,13,31,32]. The objective of the present study is to evaluate the quality of life in children with tonsillar problems, whether with obstructive or infectious surgical indications, before and after adenotonsillectomy using OSA-18 survey and Brouillette score. 2. Methods This study was a quasi-experimental study (before-after trial). Parents of children aged 3-13 years who referred to Day Clinic of

Research paper thumbnail of Evaluation of Pediatric Voice Handicap Index and Pediatric Voice Related Quality of Life before and after adenotonsillectomy in pediatric population

International journal of pediatric otorhinolaryngology, Jan 5, 2015

To study changes in Pediatric Voice Handicap Index (PVHI) and Pediatric Voice Related Quality of ... more To study changes in Pediatric Voice Handicap Index (PVHI) and Pediatric Voice Related Quality of Life (PVRQOL) before and after adenotonsillectomy in short term follow up. Quasi-experimental (before and after study). Eighty-six children aged 3-13 years (58 boys, 28 girls) with adenotonsillar problems (whether with obstructive or infectious surgical indications) who were admitted for adenotonsillectomy procedure. Parents of children were asked to complete PVHI and PVRQOL questionnaires prior to surgery and 1 month after it. Reliability of the PVRQOL and PVHI was established by evaluation of Cronbach α value. Cronbach α for PVHI was 0.92 and for PVRQOL it was 0.83. Preoperative values for the PVHI were: mean±SD; 14.39±14.65. Preoperative values for the PVRQOL were: mean±SD; 92.60±10.82. PVHI showed significant improvement after surgery: mean±SD; 2.93±6.98 (P<0.001). Postoperative PVRQOL had a significant improvement: mean±SD; 98.11±5.82 (P<0.001). Adenotonsillectomy improved PVH...

Research paper thumbnail of Endoscopic approach for excision of juvenile nasopharyngeal angiofibroma: complications and outcomes

American Journal of Otolaryngology, 2010

The purposes of this study are to report the efficacy of the endoscopic approach for juvenile nas... more The purposes of this study are to report the efficacy of the endoscopic approach for juvenile nasopharyngeal angiofibroma (JNA) and to compare its related intra-and postoperative complications with findings from traditional approaches in the literatures. This study is a retrospective report of 47 cases of JNA that were treated with nasal endoscopic surgery between 1998 and 2005. According to the staging system by Radkowski et al (Arch Otolaryngol Head Neck Surg. 1996;122:122-129), the staging of the included patients were the following: 21 in stages IA to IIB, 22 in IIC, 3 in IIIA, and 1 in IIIB. Five patients were embolized before surgery. The mean blood hemorrhage in embolized patients was 770 mL, whereas in nonembolized patients, it was 1403.6 mL. In the follow-up period (mean, 2.5 years), the recurrence was found in 9 patients (19.1%), and mean time of recurrence was 17 months after surgery. The rupture of cavernous sinus occurred in 2 cases with no mortality. The mean hospital stay was 3.1 days in all cases and 1.8 days in embolized patients. The findings of this study demonstrate that endoscopic resection of JNA is a safe and effective technique because of decrease in blood loss, hospitalization, and recurrence rate, especially in tumors that are not extended through intracranial space. It is therefore strongly recommended that this modality is implemented as the first surgical step for tumors with stages I to IIIA of the Radkowski's staging system.

Research paper thumbnail of The Draf III septal flap technique: A preliminary report

American Journal of Otolaryngology, 2013

Methods and Materials: We introduced a new technique for reconstructing frontal recess mucosa and... more Methods and Materials: We introduced a new technique for reconstructing frontal recess mucosa and prevention of restenosis following Draf III operation; we covered the posterior wall of the common recess with a vascular mucosal flap from nasal septum. Results: During a 6-month period we used septal flaps based on anterior ethmoidal artery on four patients who had undergone endoscopic Draf III operation. During a 3-month follow-up period, frontal recess stenosis did recur in any of the patients. Conclusion: Applying a precise and astute surgical method along with reconstructing common recess mucosa will improve the outcomes of endoscopic frontal sinus drill-out. We strongly recommend application of septal mucosal flap based on the anterior ethmoidal artery during Draf III operation to decrease the incidence of scar and recurrence of common frontal recess stenosis.

Research paper thumbnail of Reporting a Right Sided 4TH Branchial Anomaly, Case Report and Reporting the Technical Issues

Background: Fourth branchial pouch anomaly (4BPA) is a rare condition that often presents an extr... more Background: Fourth branchial pouch anomaly (4BPA) is a rare condition that often presents an extreme diagnostic and therapeutic challenge. It usually causes recurrent left thyroid or perithyroid tissue inflammation, but it can be situated in the right side too. Case presentation: In this case report we present a nine-year-old girl with right sided 4BPA. She was referred for evaluation of recurrent right muscular space mass and fistula that was unresponsive to any medical or surgical procedures. This paper demonstrates the proper technical issues about diagnostic work up and surgical approach that we used to manage her dilemma. Conclusion: In patients with both skin fistula and pyriform sinus opening, external cannulation is more convenient and less traumatizing than internal cannulation.

Research paper thumbnail of Publication bias in otorhinolaryngology meta-analyses in 2021

Systematic Reviews, 2024

Introduction One concern in meta-analyses is the presence of publication bias (PB) which leads to... more Introduction One concern in meta-analyses is the presence of publication bias (PB) which leads to the dissemination of inflated results. In this study, we assessed how much the meta-analyses in the field of otorhinolaryngology in 2021 evaluated the presence of PB. Methods Six of the most influential journals in the field were selected. A search was conducted, and data were extracted from the included studies. In cases where PB was not assessed by the authors, we evaluated the risk of its presence by designing funnel plots and performing statistical tests. Results Seventy-five systematic reviews were included. Fifty-one percent of them used at least one method for assessing the risk of PB, with the visual inspection of a funnel plot being the most frequent method used. Twentynine percent of the studies reported a high risk of PB presence. We replicated the results of 11 meta-analyses that did not assess the risk of PB and found that 63.6% were at high risk. We also found that a considerable proportion of the systematic reviews that found a high risk of PB did not take it into consideration when making conclusions and discussing their results.

Research paper thumbnail of Comparison of different approaches to the reduction of anterior temporomandibular joint dislocation: a randomized clinical trial

International Journal of Oral and Maxillofacial Surgery, 2016

This randomized clinical trial was designed to compare three different reduction methods for ante... more This randomized clinical trial was designed to compare three different reduction methods for anterior temporomandibular joint (TMJ) dislocation. The three methods evaluated were the conventional method, wrist pivot method, and extraoral method. The study sample comprised 90 consecutive patients suffering from anterior dislocation of the TMJ, who were allocated randomly to one of the three groups. This study found success rates of 86.7% for the conventional method, 96.7% for the wrist pivot method, and 66.7% for the extraoral method. The extraoral method was more difficult for the physician and the patient than the other two methods. For the patients, the wrist pivot method was easier than the other methods. For the doctors, the extraoral method was significantly more difficult than the other methods. In conclusion, due to the absence of a biting risk with the extraoral method and the lack of a significant difference in success between this method and the conventional method, the extraoral method could be considered the appropriate first-line treatment where there is a risk of the patient biting the surgeon's hand. Given the overall benefits of the wrist pivot method, this method could be considered the first-line and gold standard treatment modality in other cases.

Research paper thumbnail of Publication bias in otorhinolaryngology meta-analyses in 2021

IntroductionOne concern in meta-analyses is the presence of publication bias (PB) which leads to ... more IntroductionOne concern in meta-analyses is the presence of publication bias (PB) which leads to the dissemination of inflated results. In this study, we assessed how much the meta-analyses in the field of otorhinolaryngology in 2021 evaluated the presence of PB.MethodsSix of the most influential journals in the field were selected. A search was conducted, and data were extracted from the included studies. In cases where PB was not assessed by the authors, we evaluated the risk of its presence by designing funnel plots and performing statistical tests.Results75 systematic reviews were included. 51% of them used at least one method for assessing the risk of PB, with the visual inspection of a funnel plot being the most frequent method used. 29% of the studies reported a high risk of PB presence. We replicated the results of 11 meta-analyses that did not assess the risk of PB and found that 63.6% were at high risk.DiscussionOur results indicate that systematic reviews published in som...

Research paper thumbnail of Hearing status in patients with vitiligo

DOAJ (DOAJ: Directory of Open Access Journals), Jun 1, 2019

Background: Vitiligo is an acquired disorder characterized by depigmented macules and patches tha... more Background: Vitiligo is an acquired disorder characterized by depigmented macules and patches that result from a progressive loss of functional melanocytes. During embryogenesis, precursor cells of melanocytes (melanoblasts) migrate not only to the epidermis and hair follicles but also to the leptomeninges, uveal tract of the eye, and inner ear. Thus, it has been proposed that these organs may be involved in vitiligo, as well. Objective: This study was designed to evaluate the frequency and characteristics of hearing loss by means of audiometry and distortion product otoaucostic emission (DPOAE) in patients with vitiligo. Methods: Fifty-three patients with vitiligo and 52 age-and sex-matched healthy subjects were enrolled in this case-control study. After a complete otological examination, comprehensive audiological evaluations including pure tone audiometry (PTA) and DPOAE were performed for all participants and the results were compared between the two groups. Results: Neither PTA nor DPOAE showed significant difference between the two groups in any of the evaluated frequencies (0.75-8 KHz). Furthermore, in patient group, there was no association between PTA/DPOAE and age, gender, duration of the disease, presence of halo nevus, type of vitiligo, extent of involvement, and positive family history of vitiligo. Conclusion: Vitiligo patients have normal hearing status.

Research paper thumbnail of Distinguishing Characteristics of COVID-19-Associated Mucormycosis; a Case Series

Archives of academic emergency medicine, 2022

Research paper thumbnail of ORIGINAL REPORT The Efficacy of Clarithromycin in Patients with Severe Nasal Polyposis

Although several treatments have been suggested for nasal polyposis, from medical to surgical, th... more Although several treatments have been suggested for nasal polyposis, from medical to surgical, there is no standard guideline for the management of this disease. During recent years increasing attention has been directed toward the effects of macrolide antibiotics on chronic sinusitis and nasal polyposis. In this study, the efficacy of clarithromycin on severe nasal polyposis were examined. In a Prospective, before-after study, forty patients with severe nasal polyposis received clarithromycin 500 mg twice a day for 8 weeks. At the beginning and end of treatment, the severity of patients' symptoms (using subjective analogue scale), computed tomography (CT) scan and endoscopic findings were recorded. After treatment, the severity of nasal obstruction, smelling problems, Post Nasal Discharge and rhinorrhea decreased significantly (P<0.05). Furthermore, the degree of sinus opacification in CT scan and endoscopic findings showed significant improvement. Most patients completed th...

Research paper thumbnail of Inaccuracy of Standard 2D Photography for the Diagnosis of Cephalic Malposition of Lateral Crural Cartilages

Facial Plastic Surgery, 2021

Lateral crural cephalic malposition (LCCM) is a well-known deformity of the nasal tip which contr... more Lateral crural cephalic malposition (LCCM) is a well-known deformity of the nasal tip which contributes to functional disturbances of the external nasal valve. Accurate diagnosis of this deformity helps surgeons plan for better outcomes. A total of 176 candidate patients for primary rhinoplasty underwent standard 2D medical photography of the face. Senior authors analyzed photography results and differentiated the patients with LCCM. In addition, we measured the angle between the dorsal septum and lateral end of the long axis of the alar cartilage in the operation room. Ninety-five patients were diagnosed with LCCM on photography. As much as 31.3% (55) of all the patients had LCCM in intraoperative measurements. The sensitivity and specificity of 2D photography for diagnosing LCCM were 0.7924 and 0.5391, respectively. The main surgical techniques for correction of LCCM were alar repositioning (34.3% in total, 56% in LCCM patients) and lateral crural strut graft (43.8% in total, 69% ...

Research paper thumbnail of Integrated Internal Stabilization for Saddle Nose Surgery

Iranian Journal of Otorhinolaryngology, 2016

Introduction: Correction of Saddle nose deformity is one of the most challenging issues in facial... more Introduction: Correction of Saddle nose deformity is one of the most challenging issues in facial plastic surgery. Materials and Methods: In this study, a single structure in the form of L-strut was attempted to be created by using one 0.035" Kirschner wire and an autologous costal graft out of the 10th and 11th ribs. This study involved 13 cases, most of whom were traumatic. The corrective surgical techniques used in this study will be described in detail. Results: There was no warping, no rejection, and no infection in the created L-strut and patients’ satisfaction was very good during the follow up period. Conclusion: Surgical correction of a saddle-shaped nose using the described technique seems to be an acceptable and uncomplicated technique, and the cosmetic result is totally acceptable.

Research paper thumbnail of A Comparison between Cold Dissection Tonsillectomy and Harmonic Scalpel Tonsillectomy

Iranian Journal of Otorhinolaryngology, 2017

Introduction: This study aimed to compare operation time, intraoperative bleeding and postoperati... more Introduction: This study aimed to compare operation time, intraoperative bleeding and postoperative pain between cold dissection tonsillectomy and harmonic scalpel tonsillectomy. Materials and Methods: In this single-blinded clinical trial, 32 patients aged 14–48 were enrolled. Each patient randomly underwent tonsillectomy using the harmonic scalpel on one side and cold dissection on the other side. Operation time and bleeding volume were measured during surgery. The pain intensity level on each side was recorded on the first and seventh postoperative days. Results: The mean volume of intraoperative bleeding was 9.59 ml on the harmonic side and 74.38 ml on the cold dissection side; which represents a significantly lower amount on the harmonic side (P<0.001). The mean time of tonsillectomy was 427.63±196.32 s for the harmonic side and 711 271.88 s for the cold dissection side (P<0.001). The mean pain intensity level on the first postoperative day was 3.88 on the harmonic side...

Research paper thumbnail of Endoscopic pericranial flap design for the restoration of nasal mid-vault lining defects

International Journal of Oral and Maxillofacial Surgery, 2018

Despite progress made in nasal reconstruction, the restoration of a large defect, including the w... more Despite progress made in nasal reconstruction, the restoration of a large defect, including the whole septum and mid-nasal vault structures, remains a challenge. The pericranial flap (PCF) is used widely for the reconstruction of anterior cranial fossa defects. This article presents a surgical technique for nasal lining restoration with an endoscopic PCF design. This technique was used in patients with huge intranasal tumours. Two patients with nasal eosinophilic angiocentric fibrosis were treated. The structural involvement was similar in each case. The tumour was resected completely by combined endoscopic and external methods through an open rhinoplasty approach. The resulting defect included the whole nasal septum, bilateral upper lateral cartilage, and the entire mid-nasal vault mucosal lining. Reconstruction was achieved by endoscopic PCF design for internal lining reconstruction and rib cartilage for framework repair. The first patient was followed up for 18 months and the second for 8 months. No infection occurred in the postoperative period. Framework stability and texture were good, and both nasal shapes were acceptable. In conclusion, this endoscopic PCF approach for restoring the internal nasal lining appears to be a good choice in selected cases.

Research paper thumbnail of Hearing status in patients with vitiligo

Clinical, Cosmetic and Investigational Dermatology, 2019

Background: Vitiligo is an acquired disorder characterized by depigmented macules and patches tha... more Background: Vitiligo is an acquired disorder characterized by depigmented macules and patches that result from a progressive loss of functional melanocytes. During embryogenesis, precursor cells of melanocytes (melanoblasts) migrate not only to the epidermis and hair follicles but also to the leptomeninges, uveal tract of the eye, and inner ear. Thus, it has been proposed that these organs may be involved in vitiligo, as well. Objective: This study was designed to evaluate the frequency and characteristics of hearing loss by means of audiometry and distortion product otoaucostic emission (DPOAE) in patients with vitiligo. Methods: Fifty-three patients with vitiligo and 52 age-and sex-matched healthy subjects were enrolled in this case-control study. After a complete otological examination, comprehensive audiological evaluations including pure tone audiometry (PTA) and DPOAE were performed for all participants and the results were compared between the two groups. Results: Neither PTA nor DPOAE showed significant difference between the two groups in any of the evaluated frequencies (0.75-8 KHz). Furthermore, in patient group, there was no association between PTA/DPOAE and age, gender, duration of the disease, presence of halo nevus, type of vitiligo, extent of involvement, and positive family history of vitiligo. Conclusion: Vitiligo patients have normal hearing status.

Research paper thumbnail of Efficacy of systemic and intratympanic corticosteroid combination therapy versus intratympanic or systemic therapy in patients with idiopathic sudden sensorineural hearing loss: a randomized controlled trial

European Archives of Oto-Rhino-Laryngology, 2017

Objective The present study was conducted to compare the rates of recovery from idiopathic sudden... more Objective The present study was conducted to compare the rates of recovery from idiopathic sudden deafness after the treatment with oral and intratympanic corticosteroids in both mono and combination therapies. Study design Triple-blind randomized clinical trial. Settings Tertiary referral hospital. Subjects and methods A total of 112 patients who were admitted to the ENT emergency department randomly divided into three groups: an oral corticosteroid plus intratympanic placebo (systemic corticosteroid monotherapy group); an intratympanic corticosteroid plus oral placebo group (IT monotherapy group); and a combination therapy group (IT plus systemic combination group). All patients were treated additionally with antiviral and proton pomp inhibitor. An audiometry was performed once before beginning the therapies and again at the end of the therapy. Results Of the total of 112 patients, 32 received intratympanic (IT) corticosteroids, 45 were receiving systemic corticosteroids, and 35 were receiving a combination of the two. A total of 74 patients (66.1%) responded positively [response to treatment was calculated as gain of at least 10 dB in 10 dB in average threshold or with the minimum improvement of 15% in speech discrimination scores (SDS)] to corticosteroid therapy. No significant differences were observed between the three groups (IT, systemic group, and combination therapy group) in their overall response to treatment (p = 0.5). Patients who suffered from concomitant tinnitus and dizziness responded less positively to the treatment (p < 0.002). Positive family history of SSNHL seems to be negative prognostic factors in the response to treatment (p < 0.001). The response to treatment was not related to the pattern (p = 0.04) and initial severity of hearing loss (p = 0.9). Conclusion This study did not find any difference in the rate of hearing improvement between systemic, intratympanic, and combined corticosteroid therapy for sudden hearing loss. Level of evidence 1b.

Research paper thumbnail of Determining effectiveness of EBM education in otolaryngology residents using modified fresno test

The Laryngoscope, 2019

Objective: To determine the effectiveness of education in evidence-based medicine (EBM) on the kn... more Objective: To determine the effectiveness of education in evidence-based medicine (EBM) on the knowledge, competency, and skills of otolaryngology residents of Tehran University of Medical Sciences (TUMS) at Amir-Alam and Imam Khomeini Hospitals. Methods: In a quasi-experimental (before-and-after) study, all ear, nose, and throat residents of TUMS (n = 41) entered the study. The residents underwent the modified Fresno test. Then, two EBM workshops with a similar content were held on 2 separate days in each hospital, with each session lasting 6 hours. The learned material was practiced in weekly journal clubs. Six months after the workshop, the modified Fresno test was applied again, and the results were analyzed. Results: A significant improvement in the modified Fresno test score was observed. The mean score of the modified Fresno test was 57.43 AE 22.07 before the workshop and 79.26 AE 22.48 after the workshop (P < 0.001). Conclusion: The results of the study show that EBM education and practice of the learned materials in journal clubs can improve the knowledge and skills of residents. Further research with larger samples is needed to improve the precision of our findings and to increase confidence in the results.

Research paper thumbnail of Use of nasal packs and intranasal septal splints following septoplasty

International journal of oral and maxillofacial surgery, 2009

The aim of this study was to compare the efficacy of a trans-septum suturing technique with conve... more The aim of this study was to compare the efficacy of a trans-septum suturing technique with conventional nasal packing and intranasal splints in the classic septoplasty operation. The study is a prospective, randomized clinical trial. 114 patients underwent septoplasty for septal deviation and ensuing nasal obstruction. These patients were divided into two groups: packing (using intranasal septal splints and antibiotic meshes at the end of the operation) and non-packing (using four separate trans-septum through and through horizontal mattress sutures without any mesh or intranasal splint insertion). Randomization was performed using the four block randomization system. Patients who failed the regular follow-up were excluded, and the two groups were compared for postoperative bleeding, hematoma, perforation and synechiae. Patients were asked to record pain levels using a visual analogue scale. The authors found no significant statistical differences between the two groups in the para...

Research paper thumbnail of The efficacy of clarithromycin in patients with severe nasal polyposis

Acta medica Iranica, Jan 13, 2013

Although several treatments have been suggested for nasal polyposis, from medical to surgical, th... more Although several treatments have been suggested for nasal polyposis, from medical to surgical, there is no standard guideline for the management of this disease. During recent years increasing attention has been directed toward the effects of macrolide antibiotics on chronic sinusitis and nasal polyposis. In this study, the efficacy of clarithromycin on severe nasal polyposis were examined. In a Prospective, before - after study, forty patients with severe nasal polyposis received clarithromycin 500 mg twice a day for 8 weeks. At the beginning and end of treatment, the severity of patients' symptoms (using subjective analogue scale), computed tomography (CT) scan and endoscopic findings were recorded. After treatment, the severity of nasal obstruction, smelling problems, Post Nasal Discharge and rhinorrhea decreased significantly (P<0.05). Furthermore, the degree of sinus opacification in CT scan and endoscopic findings showed significant improvement. Most patients completed...

Research paper thumbnail of Sleep related quality of life before and after adenotonsillar surgery in pediatric population

International Journal of Pediatric Otorhinolaryngology, 2014

Sleep disordered breathing (SDB) is a common entity in children [1-4] with a spectrum of upper ai... more Sleep disordered breathing (SDB) is a common entity in children [1-4] with a spectrum of upper airway disorders ranging in severity from primary snoring to obstructive sleep apnea (OSA) [5]. The etiology of SDB is multifactorial and its complex interplay among anatomical, neuromuscular and predisposing genetic factors into disease [6], most common cause of SDB in children is adenotonsillar hypertrophy. Tonsillectomy and adenoidectomy are curative in 85-95% cases [7-9]. Other causes of SDB include obesity, neuromuscular disorder and craniofacial anomalies [10]. Prevalence of snoring in children is reported between 3% and 12% [1-3,11] and prevalence of OSA is 1-3% [1-3,11,12]. The symptoms of SDB include oral breathing, sleep apnea, restless sleep, frequent awakening, hard to breath, abnormal bite and snoring. It can also lead to corpulmonale or left ventricle hypertrophy, failure to thrive, systemic hypertension, and in severe cases of SDB decreasing cognitive skills, quality of life (QOL) and behavioral disturbance [2,5,13-26]. OSA 18 survey [27] is an 18-item questionnaire which has been tested and accepted for reliability and validity [28], also Brouillette score [29] is developed for screening healthy children with OSA caused by adenotonsillar hypertrophy [30]. Studies show that after tonsil surgery, significant improvement occurs in behavior, QOL and cognitive function [1,13,31,32]. The objective of the present study is to evaluate the quality of life in children with tonsillar problems, whether with obstructive or infectious surgical indications, before and after adenotonsillectomy using OSA-18 survey and Brouillette score. 2. Methods This study was a quasi-experimental study (before-after trial). Parents of children aged 3-13 years who referred to Day Clinic of

Research paper thumbnail of Evaluation of Pediatric Voice Handicap Index and Pediatric Voice Related Quality of Life before and after adenotonsillectomy in pediatric population

International journal of pediatric otorhinolaryngology, Jan 5, 2015

To study changes in Pediatric Voice Handicap Index (PVHI) and Pediatric Voice Related Quality of ... more To study changes in Pediatric Voice Handicap Index (PVHI) and Pediatric Voice Related Quality of Life (PVRQOL) before and after adenotonsillectomy in short term follow up. Quasi-experimental (before and after study). Eighty-six children aged 3-13 years (58 boys, 28 girls) with adenotonsillar problems (whether with obstructive or infectious surgical indications) who were admitted for adenotonsillectomy procedure. Parents of children were asked to complete PVHI and PVRQOL questionnaires prior to surgery and 1 month after it. Reliability of the PVRQOL and PVHI was established by evaluation of Cronbach α value. Cronbach α for PVHI was 0.92 and for PVRQOL it was 0.83. Preoperative values for the PVHI were: mean±SD; 14.39±14.65. Preoperative values for the PVRQOL were: mean±SD; 92.60±10.82. PVHI showed significant improvement after surgery: mean±SD; 2.93±6.98 (P<0.001). Postoperative PVRQOL had a significant improvement: mean±SD; 98.11±5.82 (P<0.001). Adenotonsillectomy improved PVH...

Research paper thumbnail of Endoscopic approach for excision of juvenile nasopharyngeal angiofibroma: complications and outcomes

American Journal of Otolaryngology, 2010

The purposes of this study are to report the efficacy of the endoscopic approach for juvenile nas... more The purposes of this study are to report the efficacy of the endoscopic approach for juvenile nasopharyngeal angiofibroma (JNA) and to compare its related intra-and postoperative complications with findings from traditional approaches in the literatures. This study is a retrospective report of 47 cases of JNA that were treated with nasal endoscopic surgery between 1998 and 2005. According to the staging system by Radkowski et al (Arch Otolaryngol Head Neck Surg. 1996;122:122-129), the staging of the included patients were the following: 21 in stages IA to IIB, 22 in IIC, 3 in IIIA, and 1 in IIIB. Five patients were embolized before surgery. The mean blood hemorrhage in embolized patients was 770 mL, whereas in nonembolized patients, it was 1403.6 mL. In the follow-up period (mean, 2.5 years), the recurrence was found in 9 patients (19.1%), and mean time of recurrence was 17 months after surgery. The rupture of cavernous sinus occurred in 2 cases with no mortality. The mean hospital stay was 3.1 days in all cases and 1.8 days in embolized patients. The findings of this study demonstrate that endoscopic resection of JNA is a safe and effective technique because of decrease in blood loss, hospitalization, and recurrence rate, especially in tumors that are not extended through intracranial space. It is therefore strongly recommended that this modality is implemented as the first surgical step for tumors with stages I to IIIA of the Radkowski's staging system.

Research paper thumbnail of The Draf III septal flap technique: A preliminary report

American Journal of Otolaryngology, 2013

Methods and Materials: We introduced a new technique for reconstructing frontal recess mucosa and... more Methods and Materials: We introduced a new technique for reconstructing frontal recess mucosa and prevention of restenosis following Draf III operation; we covered the posterior wall of the common recess with a vascular mucosal flap from nasal septum. Results: During a 6-month period we used septal flaps based on anterior ethmoidal artery on four patients who had undergone endoscopic Draf III operation. During a 3-month follow-up period, frontal recess stenosis did recur in any of the patients. Conclusion: Applying a precise and astute surgical method along with reconstructing common recess mucosa will improve the outcomes of endoscopic frontal sinus drill-out. We strongly recommend application of septal mucosal flap based on the anterior ethmoidal artery during Draf III operation to decrease the incidence of scar and recurrence of common frontal recess stenosis.

Research paper thumbnail of Reporting a Right Sided 4TH Branchial Anomaly, Case Report and Reporting the Technical Issues

Background: Fourth branchial pouch anomaly (4BPA) is a rare condition that often presents an extr... more Background: Fourth branchial pouch anomaly (4BPA) is a rare condition that often presents an extreme diagnostic and therapeutic challenge. It usually causes recurrent left thyroid or perithyroid tissue inflammation, but it can be situated in the right side too. Case presentation: In this case report we present a nine-year-old girl with right sided 4BPA. She was referred for evaluation of recurrent right muscular space mass and fistula that was unresponsive to any medical or surgical procedures. This paper demonstrates the proper technical issues about diagnostic work up and surgical approach that we used to manage her dilemma. Conclusion: In patients with both skin fistula and pyriform sinus opening, external cannulation is more convenient and less traumatizing than internal cannulation.