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The second wave of COVID pandemic was associated with an outbreak of Mucormycosis. The mortality rate of Mucormycosis reaches 50-80% in cases with orbital and intracranial extension (Fadda in Acta Otorhinolaryngol Ital 41:43-50, 2021). In this outbreak we found that few of these patients had bacterial invasive sinusitis mimicking fungal sinusitis. Amphotericin the only effective drug against Mucormycosis is highly toxic and expensive and not indicated in bacterial sinusitis. Our aim was to  determine the exact etiologic agent, predisposing factors and outcome of treatment of COVID associated invasive sinusitis presenting with orbital complications. It is a retrospective observational study done in 33 patients with orbital complications in COVID associated invasive sinusitis. Demographic details of the patients and clinical presentation were documented. Rhinological examination was done and a nasal swab was taken for KOH mount along with Gram`s stain and Culture and Sensitivity. All Patients underwent radiological evaluation by contrast enhanced computed tomography (CECT) or MRI. Liposomal Amphotericin B was started. Surgical debridement done. Amphotericin-B was stopped in cases reported negative for fungal elements and antibiotics administered for two weeks. Outcome of treatment was documented. A total of 33 patients were included in the study. 48.5% patients were found to have bacterial infection and 27.3% patient's fungal infections and 24.2% mixed infections.Eschar formation, necrotic tissue, erosion of the lamina papyracea was seen in both Klebsiella (33.3%) and Staphylococcal infections (16.6%) similar to Mucor and mixed infections. Persistent opthalmoplegia and deterioration of vision was associated with Mucor and mixed infections. However improvement in proptosis, ptosis, ophthalmoplegia, and vision was observed in cases associated with bacterial invasive sinusitis. Invasive bacterial sinusitis was under diagnosed during second wave of COVID. Identification of invasive bacterial sinusitis can help in de-escalation of treatment., Competing Interests: Conflict of interestThe Authors declare that there is no conflict of interest., (© Association of Otolaryngologists of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction: Chronic suppurative otitis media (CSOM) is a long standing infection of the middle ear cleft. Mastoidectomy, with or without tympanoplasty, is the preferred treatment for CSOM. However, the drill used during ear surgery generates noise that may potentially cause hearing damage in both the operated and opposite inner ear, leading to temporary or permanent hearing loss., Materials and Methods: The study included patients diagnosed with CSOM who underwent surgeries in the Otorhinolaryngology department. Postoperatively, all patients were followed up on the 7th day and 1 month after the surgery. Pure Tone Audiometry (PTA) was performed to evaluate the hearing outcomes., Results: A total of 61 patients were included in the study. The mean preoperative PTA of contralateral ear bone conduction among the study participants was 6.48. At the 7th day post-operation, the mean post-operative PTA of contralateral ear bone conduction for the same participants was 7.77. This difference was statistically significant according to the Paired T-test (P = 0.001).However, when evaluating the mean preoperative PTA of contralateral ear bone conduction (6.48) and the mean post-operative PTA at 1st month (6.02), the difference was not statistically significant (P = 0.208).Additionally, there was no statistical difference in air conduction and air-bone gap before and after surgery., Conclusion: The study suggests that mastoid drilling is associated with a significant temporary hearing loss in the contralateral ear immediately after surgery, which eventually recovers within a month. However, the hearing loss is considered negligible and not statistically significant in the long term. It is worth considering additional audiological investigations, such as otoacoustic emissions, to detect this type of hearing loss more accurately., Competing Interests: Conflict of InterestNone., (© Association of Otolaryngologists of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Chronic suppurative Otitis Media is a common ear infection in India. Canaloplasty done with tympanoplasty helps to remove bony overhangs and provide complete visibility of fibrous annulus of tympanic membrane., Aim: 1. To determine the hearing outcome in chronic otitis media (mucosal type) patients undergoing type 1 tympanoplasty with canaloplasty. 2. To determine the hearing outcome in chronic otitis media (mucosal type) patients undergoing type 1 tympanoplasty without canaloplasty. 3. To compare the hearing outcome in the above mentioned 2 groups of patients., Materials and Methods: 56 patients of 15-60 years of age with mucosal type of Chronic otitis media, with central dry perforation and intact ossicles were included in our study. They were divided into group 1 (type 1 tympanoplasty + canaloplasty) and group 2 (type 1 tympanoplasty without canaloplasty), on alternate basis. AC, BC, Air bone gap avg was assessed via pure tone audiometry at 4 frequencies preoperatively and postoperatively at 3rd and 6th month, % closure of ABG average was calculated., Results: Type 1 tympanoplasty along with canaloplasty has better hearing improvement in pure tone audiometry compared to type 1 tympanoplasty alone, as % closure of ABG at postoperative 3rd and 6th month holds significant., Conclusion: The canaloplasty provides better surgical exposure via removing bony overhangs, aids in excellent functional outcome in the form of % closure of ABG. Hence canaloplasty is added as an adjunct to routinely performed aural surgeries to enhance hearing outcome., Competing Interests: Conflict of interestNone., (© Association of Otolaryngologists of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Olfactory and/or taste dysfunction are potential neurological manifestations of coronavirus disease -2019 (COVID-19). The aim of the study was to document the prevalence of anosmia in COVID-19 positive patients and analyze the effect of various factors on the occurrence of these chemosensory dysfunction in the local population. Tertiary referral center. Prospective Study. 250 subjects who tested positive for SARS-CoV-2, by real-time polymerase chain reaction (RT-PCR) and admitted in Isolation ward were enrolled for the study. Data was collected from the subjects via oral questionnaire method, based on the AAO-HNS Anosmia Reporting Tool. Data was collected regarding the age, gender, olfactory or gustatory disturbances, history of recent travel or contact with a positive case, smoking, any associated symptoms, any co-morbid conditions and recovery time of sense of olfaction. Out of 250, 179 (71.6%) subjects were diagnosed with Olfactory dysfunction out of which majority were males, 105 (58.6%). Most of the patients were above 40 years of age ( n  = 184, 73.6%). Majority of the individuals (88 patients) had close contact with a positive case in recent past, followed by 67 patients who were health care workers, hence proving that risk of infection increases with exposure. Anosmia was present in 68.5% of all the 127 non-smokers. 66.4% had both olfactory as well as gustatory dysfunction whereas 18 patients (7.2%) were found to be totally asymptomatic. Mostly patients recovered their sense of smell within 1-2 weeks from the day of onset of anosmia. Presence of olfactory dysfunction of any degree with or without alteration in taste sensation should raise a suspicion of COVID-19 infection, especially when other classical signs are not present. In such conditions, swabs should be sent for confirmation by RT-PCR testing and till results are awaited, the individual should be shifted to quarantine facilities or advised strict self-isolation., (© Association of Otolaryngologists of India 2021.)

Pharmacotherapy forms mainstay of treatment for allergic rhinitis, and has adverse effects associated with it. Topical steroid therapy is the preferred medication and considered best for long term prophylaxis but with limited compliance. Submucosal turbinoplasty reduces the duration of treatment in comparison to topical steroid which has to be taken daily for a long time. The aim was to evaluate the outcome of submucosal inferior turbinoplasty in patients with perennial allergic rhinitis. A prospective interventional study was performed on 35 patients diagnosed with perennial allergic rhinitis, diagnosed as per ARIA criteria from July 2016 to July 2018. The severity of the disease was assessed using mini RQLQ scoring system. The patients were then subjected to bilateral submucosal inferior turbinoplasty under endoscopic guidance under local anesthesia. 50% significant improvement ( p value < 0.05) seen in symptoms were need to blow nose, sneezing, nasal obstruction, nasal discharge, watery eyes, need to rub eye, regular house work, recreational activities, sore eyes, tiredness, irritability and thirst. 100% improvement ( p value < 0.05) seen in symptoms were sleep, need to blow nose, sneezing, nasal discharge, watery eyes, need to rub eye, recreational activities and irritability. Nasal obstruction was not severe in 17 (48.5%) patients giving a very good symptom relief and improving quality of life. This is due to reduction in the erectile tissue and roominess in the nasal cavity. All patients with allergic rhinitis with associated hypertrophied turbinates should invariably be given option of inferior turbinoplasty along with proper counselling regarding its advantages and disadvantages., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2020.)

Allergic rhinitis is an IgE mediated reaction against inhaled allergens. Patients not responding to medical treatment require surgery. Most surgical procedures reduce erectile tissue of inferior turbinates. Vidian neurectomy reduces nasal hyperreactivity and secretions by reducing parasympathetic supply, but results in loss of lacrimation. Transnasal posterior nasal neurectomy is more selective denervation procedure which preserves lacrimation. There are few studies documenting the outcome of posterior lateral nasal neurectomy. Posterior lateral nasal neurectomy can be good treatment option for perennial allergic rhinitis. To assess and compare the symptom scores in patients undergoing posterior lateral nasal neurectomy and medical management for allergic rhinitis. This prospective study included 50 patients diagnosed as perennial allergic rhinitis as per the ARIA guidelines. 25 patients underwent posterior lateral nasal neurectomy and 25 patients underwent medical management using fluticasone nasal spray and Montelukast with Levocetirizine. Pre and post-treatment Total nasal symptom scores and mini rhinoconjunctivitis quality of life questionnaire scores were compared. Symptoms reduced significantly in both surgery and medical management group. However in surgery group, more patients showed more than 50% improvement in symptoms. Posterior lateral nasal neurectomy is minimally invasive treatment for patients with perennial allergic rhinitis not responding to or not complying with medical treatment., Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-021-02930-0., Competing Interests: Conflict of interestThe author declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2021.)

To document the clinical presentation, complications, management strategy and post-operative outcomes of extensive cholesteatomas. Cholesteatoma is a well demarcated cystic lesion derived from an abnormal growth of keratinizing squamous epithelium in the temporal bone. Cholesteatomas commonly involve the middle ear, epitympanum, mastoid antrum and air cells and can remain within these confines for a considerable period. Bony erosion is present confined to ossicular chain and scutum initially, but as the cholesteatoma expands, erosion of the otic capsule, fallopian canal and tegmen can occur. Erosion of the tegmen tymapani or tegmen mastoideum may lead to development of a brain hernia or cerebrospinal fluid leakage. Invasion of jugular bulb, sigmoid sinus, internal carotid artery are noticed in extensive cholesteatoma and are quite challenging and requires expertise. Neurosurgical intervention should be considered along with the otological management in the same sitting in all possible cases. A retrospective review of 12 patients were carried out to assess the clinical presentation, complications, surgical management and postoperative outcomes of extensive cholesteatomas presenting at our centre between January 2017 and December 2019. CT or MRI findings, extent of cholesteatoma intra-operatively along with the status of major neurovascular structures and disease clearance, and the post-operative outcomes including morbidity and mortality were noted. All patients underwent canal wall down mastoidectomy with or without ossiculoplasty. Post operatively all patients were treated with intravenous antibiotics and if required intravenous steroids. Amongst the 12 patients of extensive cholesteatoma (EC), all of them (100%) presented with foul smelling, purulent ear discharge. 9 (75%) patients presented with otalgia. 4 (33.33%) patients had temporal headache. 10 (83.33%) patients complained of hard of hearing. 7 (58.33%) patients gives history of vertigo at the time of presentation. In 8 (66.66%) patients there was tegmen plate erosion noticed in CT scan. In 3 (25%) patients, the disease was invading the sigmoid sinus and in 1 (8.33%) patient jugular bulb was involved. In 3 (25%) cases of EC, blind sac closure was performed. In two patients who developed cerebellar abscess, drainage procedure was performed. 2 (16.66%) patients developed sigmoid sinus thrombosis, 1 (8.33%) patient had petrositis., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2020.)

Ossicular discontinuity is the most common cause of conductive hearing loss. The use of ossicular graft material in ossicular chain reconstruction significantly improves the result in hearing. This study was conducted to compare and analyze the outcome of ossicular reconstruction using allogenic septal spur cartilage and autologous cortical bone in terms of hearing results and graft uptake rates. Study design: randomized clinical trial. Study included 112 patients visiting our ENT department. Patients between 16 and 50 years of age with history of chronic ear discharge and air-bone-gap (ABG) of > 35 dB and ossicular involvement were included in the study. The patients underwent detailed ENT examination, audiological and radiological assessment of temporal bone and those patients with evidence of ossicular erosion were subjected to ossiculoplasty with allogenic septal spur cartilage (group I) and autologous cortical bone (group II) randomly. The patients were followed up to 6 months to analyze functional and anatomical results. 50 patients out of 56 patients (90%) from group I who underwent allogenic septal cartilage ossicular reconstruction showed significant improvement in hearing as assessed by pure tone audiogram after 3 months and 6 months. Remaining 10% of patients who did not show hearing improvement on PTA were reopened after 6 months. It was observed that the stapes head got necrosed in them. 40 patients (72%) out of 56 patients (50%) from group II who underwent autologous cortical bone reconstruction showed hearing improvement. Remaining 16 patients (28%) showed no hearing improvement. They were reopened and ankylosis, dislocation of ossicle and extrusion were noted. In our study, graft uptake rates, formation of retraction pockets, and hearing improvements were analyzed. Complications like ankylosis formation, dislocation of ossicle and extrusion rates were more in the group II compared to group I. Hearing results of group I are better compared to group II and the allogenic septal cartilage being readily available is a good option for ossicular reconstruction., Competing Interests: Conflict of interestAuthors declare no conflict of interest, (© Association of Otolaryngologists of India 2020.)

This study has aimed to determine the anatomical site of labyrinthine fistula in patients of chronic suppurative otitis media at our centre. Labyrinthine fistulae (LF) are caused by abnormal communications between the inner ear and surrounding structures resulting in perilymph leakage and hearing loss. Labyrinthine fistula represents as erosive loss of the enchondral bone overlying the semicircular canals without loss of perilymph. The manifestations of fistula like vertigo, hearing loss vary in severity and complexity, commonly ranging from very mild to incapacitating. Cholesteatoma induced fistula most commonly involves lateral semicircular canal probably because of its close proximity to the middle ear, but can involve other semicircular canals and rarely cochlea. This is a retrospective analysis of 36 patients of chronic suppurative otitis media with history of vertigo undergoing tympanomastoid surgery in whom there was an evidence of labyrinthine fistula on HRCT scan of temporal bone. The incidence of patients with labyrinthine fistula presenting with vertigo, nystagmus, sensorineural hearing loss, history of vertigo were analysed. The anatomical location of the fistula was supported by Radiological evidence. Patients underwent either canal wall down mastoidectomy or cortical mastoidectomy. The anatomical site and length of the labyrinthine fistula were analysed. Amongst the 36 patients of chronic suppurative otitis media with labyrinthine fistula 22 (61.1%) patients had atticoantral disease, 4 (11.1%) patients had chronic otitis media with extensive granulation, 2 (5.5%) patients had Tubotympanic disease with polyps, 4 (11.1%) patients had Tuberculous otitis media, 1 (2.77%) patient had Tubotympanic disease with extensive tympanosclerosis eroding the dome of lateral semicircular canal, 1 (2.77%) patient had extensive cholesteatoma with cerebellar abscess, 1 (2.77%) patient had fistula in the promontory following trauma, 1 (2.77%) patient had extensive tympanosclerosis with erosion of promontory. It was noticed that, in 14 (38.88%) patients the fistula was at the centre, in 17 (47.22%) patients the fistula is towards the ampullary end of horizontal semicircular canal and in 5 (13.88%) patients the fistula was towards the non ampullary end of lateral semicircular canal. The maximum length of fistula noticed was 6 mm and the minimum length of the fistula noticed was 2 mm. Labyrinthine fistula are most commonly noticed in the ampullary end of the lateral semicircular canal. The average length of the fistula was found to be 4 mm. Careful elevation of the cholesteatoma matrix over the endosteal membrane and immediate placement of temporal fascia over the exposed fistula is important to avoid injury to the inner ear. Maximum number of fistula were seen in the atticoantral type of Chronic suppurative otitis media. Prior knowledge of anatomical location of the fistulous tract in HRCT temporal bone is important to address the fistula., Competing Interests: Conflicts of interestStudy was conducted after obtaining institutional ethical clearance. No conflicts of interest., (© Association of Otolaryngologists of India 2020.)

A mucocele is an epithelial lined mucous containing sac completely filling the sinus and capable of expansion. We report a case with unilateral frontoethmoidal mucocele in relation with type IV Kuhn cell. A 26 year old man came to the ENT department at SDUMC, Tamaka, Kolar, presenting complaints of proptosis of left eye since 3 years. After detailed examination and investigations patient was Diagnosed to have mucocele of left frontoethmoidal region. Intraoperatively we found a rare picture of type IV kuhn cells completely seated in the frontal sinus. After externally assisted modified Lothrop's approach, marsupialization of mucocele was done in the nasal cavity and symptoms of the patient relieved. We state that, in cases of frontoethmoidal mucocele, externally assisted modified Lothrop procedure offers an alternative for endoscopic management of frontoethmoidal mucocele for the complete clearance of disease., Competing Interests: Conflict of interestthe authors have declared that no competing interests exist., (© Association of Otolaryngologists of India 2018.)

Chronic otitis media (COM) may lead to partial or complete loss of tympanic membrane and erosion of the ossicles. Ossicular chain reconstruction may be done by interposition ossiculoplasty or myringostapediopexy. The aim of our study was to determine the hearing outcome in interposition ossiculoplasty and myringostapediopexy using autologous incus or cortical bone graft in intact canal wall tympanoplasty. 64 patients with COM, who underwent interposition ossiculoplasty or myringostapediopexy were included in the study. Audiometric evaluation was done after 3 months after surgery and all patients were followed up for a period of 1 year. The hearing results were compared in terms of mean pre-op and post-op Air conduction thresholds, Air-Bone gap (ABG) and hearing gain or ABG closure. In this study the mean ABG closure for interposition ossiculoplasty and myringostapediopexy was 15.4 dB and 21.8 dB, respectively. Hearing gain with cortical bone graft was higher than hearing gains with incus in both the groups, but not statistically significant. Myringostapediopexy provides marginally better hearing gain compared to interposition ossiculoplasty. Aulogous incus, and cortical bone graft are suitable autologous materials for ossicular reconstruction and provide similar hearing outcome., (© Association of Otolaryngologists of India 2018.)

Labyrinthectomy is an effective surgical procedure for the management of poorly compensated unilateral peripheral vestibular dysfunction in the presence of a nonserviceable hearing. It involves removal of labyrinthine portion of the inner ear and exenteration of the neuroepithelium. In our institution, 8 cases underwent surgical labyrinthectomy from a period of 2013-2018 for various extensive disease manifestations, age ranges from 2 to 48 years. Includes, a child of 2 years age presented with bilateral foul smelling otorrhoea with external auditory canal cartilaginous stenosis, 5 cases of extensive cholesteatoma with labrynthitis and 2 cases of purulent labrynthitis among them 1 were suffering from Tuberculosis and was on Category 1 ATT and other one suffering from extensive granulation at the tympanomastoid area which was inconclusive of the diagnosis even after histopathological examination, so treated as tuberculosis and started on prophylactic antitubercular treatment in addition to surgery. All patients except the child gave past history of giddiness, but at the time of presentation they were not having giddiness or noticeable nystagmus and all had profound unilateral sensorineural hearing loss. Thus all the patients underwent a radical mastoidectomy with total labyrinthectomy and blind sac closure in 2 patients., Competing Interests: Conflict of interestThe authors declare no conflict of interest or commercial affiliation related to this study., (© Association of Otolaryngologists of India 2019.)

Lethal midline granuloma is a rare disease, characterised by progressive unrelenting necrosis and mutilation of nose, midline facial tissues and other respiratory passages. This particular type of disease is heterogeneous in its pathogenesis, non-specificity of symptoms obscures timely and correct diagnosis and is responsible for delay in of treatment which can be detrimental as this disease calls for immediate intervention. We present a case report of 60 year old female who gave short one-month history of clinical symptoms., (© Association of Otolaryngologists of India 2019.)

Stapedius muscle even though being the smallest skeletal muscle in human body, it has a major role in otology. As many of the distinguished books in otology missed to explain much about stapedius muscle, and also considering the need for the anatomy based visit to this small muscle we felt it was important to have a exercise like this. In the dissection hall of our institution we dissected 32 cadaveric temporal bones and delineated stapedius muscle as a part of PG teaching programme to have a clear idea of the anatomy of stapedius muscle, its origin, attachment, extension, size (all dimensions). Length of the stapedius muscle varied between 9 and 11 mm. Stapedial tendon measured about 2 mm. The muscle had a classical sickle shape with tendon looking like the handle of the sickle. It has a bulky belly with a maximum breadth of 2-3 mm. It was found to be medial to midportion of vertical limb of facial nerve. All of our temporal bones measured size varied from 9 to 11 mm in length excluding stapedial tendon. Stapedial tendon measured almost 2 mm. Muscle is classical sickle shaped with tendon acting like the handle of the sickle. It has a bulky tummy which forms the maximum breadth of 1-3 mm. Why to have a clear idea about the anatomy of stapedius muscle is that, unless the anatomy is clear there is chance of confusing the muscle with that of facial nerve while doing facial nerve grafting and also while drilling for facial nerve decompression in experienced hands may get confused and decompress the muscle. Stapedius muscle said to be the smallest muscle in the body, but its not as small as its been described. Detailed awareness of the anatomy of stapedius muscle is needed so as to avoid confusion while facial nerve grafting and while drilling., Competing Interests: The author declares that they have no conflict of interest.Ethical committee clearance taken from the respective university.

The term congenital aural atresia is used to describe failure of external auditory canal to open. Thus it results in conductive hearing loss. There are ways to improve the transmission of sound to the healthy inner ear, we have performed surgery to open the ear canal and restore the natural sound-conducting mechanism to the inner ear. Thus avoiding multiple surgeries. The study was conducted among patients aged between 12 and 24 years, our study included 8 patients with aural atresia with cholesteotoma. After a detailed examination of patients were subjected to surgery. In our study with the sample size of eight patients Where, all our patients underwent canal wall down mastoidectomy with simultaneous single stage reconstruction of ossicular chain. All our patients were discharge free and Had subjective improvement in hearing with the post operative period was well accomplished to < 35 dB. In our study all eight patients who underwent canal wall down mastoidectomy had good hearing outcome. As to avoid unnecessary recurrence and complications which are usually seen in intact canal wall down mastoidectomies, we suggest canal wall down and single stage reconstruction.

Stapedotomy followed by placement of a piston prosthesis is the mainstay for surgical management of otosclerosis primarily undertaken to improve hearing in patients. Although a simple and elegant procedure, prosthesis placement in stapes surgery is difficult to master. Improper surgical technique or improper placement of prosthesis may result in complications which may require revision surgery. We here describe a training technique that is simple, inexpensive, improves the skills and can be done using easily available materials such as a disposable syringe, stapler pin and micro-forceps. Regular practice with this training module minimizes surgical time and can even be done just prior to the surgery, however, this is not a substitute for temporal bone dissections.

Stapes surgery is a highly skilled surgery among otological procedures and needs a good dexterity. To improve the skills one may need to do procedures using temporal bone dissections. We describe a procedure that is simple, inexpensive and improves the skills and can be done using easily available materials like disposable syringe, stapler pin and a forceps., Competing Interests: Compliance with Ethical StandardsNone.This article does not contain any studies with human participants or animals performed by any of the authors.

The ectopic eruption of the teeth into the nasal cavity is a rare phenomenon. We report a case of nasal tooth in the left nasal cavity in a 64-year-male. We describe the clinical and radiological findings of the case and discuss their etiology, diagnosis, complications and treatment.