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Background: Isolated frontal sinus involvement in mucormycosis is seen very infrequently. Recent technological advances including image guided navigation and angled endoscopes have shifted paradigm towards minimally invasive surgeries. Open approaches are still relevant for the disease of frontal sinus with lateral extension where effective clearance cannot be obtained if approached endoscopically., Objectives: The objective of this study was to describe the presentation and management of patients of mucormycosis with isolated frontal sinus involvement with help of external approaches., Materials and Methods: The available records of the patients were retrieved and analysed. The literature, the associated contributory clinical features and management techniques were reviewed., Results: 4 patients presented with isolated frontal sinus mucor involvement. 3 out of 4 patients had history of diabetes mellitus (75%). All patients had history of covid-19 infection (100%). 3 out of 4 patients had unilateral frontal sinus involvement and were operated by Lynch Howarth approach. Mean age of presentation was 46 years with male predominance. Bicoronal approach was used in one case with bilateral involvement., Conclusion: Although conservative endoscopic surgeries are preferred nowadays for frontal sinus clearance but the extensive bony destruction with lateral extension in our series of patients with isolated frontal sinus mucormycosis warranted the need for open procedures., Competing Interests: Conflict of InterestThe authors declare “No conflict of interest”.Competing InterestsThe authors have no competing interests to declare that are relevant to the content of this article., (© 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.)

Tracheobronchial foreign bodies continue to present challenges to practitioners worldwide. The major issues involve the accurate diagnosis and speedy and safe removal of the foreign bodies. The aim of this study was to to assess an epidemiological data regarding airway foreign bodies in patients presenting to our institute and to assess the role of rigid bronchoscopy for diagnosis and management of cases of foreign body aspiration. Study was conducted between December 2015 and July 2021 in Otorhinolaryngology and Head and Neck Surgery Department. 200 patients who underwent rigid bronchoscopy in above period for suspected foreign body aspiration was included in the study. All the parameters was recorded and analysed in an attempt to define the epidemiology, clinical presentation, management and associated morbidity. Descriptive statistical analysis was done using SPSS software version 22 of Windows 7. Tracheo-bronchial foreign bodies (TFB) were more common in pediatric age group. 80% of our patients with TFB were aged less than 3 years. Most common symptom was cough (70%) and the commonest sign was diminished unilateral breath sounds (72%). Peanut was the commonest (45%) foreign body. Most common site of lodgement of TFB was right main bronchus (49%). TFB aspiration is always accidental and sudden with high mortality. It is a life threatening condition and needs urgent intervention. Rigid bronchoscopy under general anesthesia represents a safe and effective tool in the management of TFB aspiration., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interests., (© Association of Otolaryngologists of India 2022.)

Laryngeal mirror (LM) is an inexpensive, portable, readily available device which can help visualize the vocal cords in difficult airway (DA) situations. We evaluated its use in improving glottic view prior to placing the airway adjuncts in simulated difficult airway.Eighty patients scheduled to undergo elective surgery under general anaesthesia with endotracheal intubation were allocated- Bougie group (Group B) and Stylet group (Group S). Direct laryngoscopy was performed and CL grade III simulated. The glottic view was obtained using laryngeal mirror and Gum Elastic Bougie (GEB)/ Styleted Endotracheal Tube (ETT) inserted under mirror view. Time taken to obtain glottic view in LM and time for successful intubation were noted.Significant improvement in glottic view with LM was observed, with the view improving to Grade I in 76.25% and grade II in 23.75% of patients. Both groups were comparable with respect to number of attempts and success rate ( p  = 0.55).The success rate was 90% in group B and 95% in group S. Time taken for intubation was less in Group S (52.44 ± 14.23 s vs. 62.805 ± 20.74 s) [ p  = 0.01]. Hence, overall stylet proved to be a better adjunct with mirror guided intubation.We recommend stylet assisted rather than GEB assisted ET intubation under LM guidance in emergency scenarios. Also, further controlled trials are recommended to know the exact location of the mirror in relation to bulb of the laryngoscope as well as different angles at which it is placed to improve the view and stabilize the assembly., Competing Interests: Conflict of interestThere was no conflict of interest either in designing and accomplishment of this study., (© Association of Otolaryngologists of India 2021.)

Chronic otitis media is a disease developing due to Eustachian tube dysfunction secondary to any insult in nasopharynx which is likely to be bilateral with different stages of disease in both ear. The objective of this study was to examine contralateral ear through otoscopic, radiological and audiological study. Study was conducted between December 2018 and July 2020 in Otorhinolaryngology and Head and Neck Suregery Department. The Contralateral ear was defined as the ear with no tympanic membrane perforation and with no symptoms in patients of unilateral chronic otitis media. Otoscopy, Pure tone audiometry and HRCT temporal bone were done. Results were recorded and analysed. Descriptive stastical analysis was done using SPSS software version 22 of Windows 7. Grade1 pars tensa retraction which is most common abnormal finding in contralateral ear on otoscopy in both unilateral mucosal and squamosal COM patients. On otoscopy of contralateral ear 71.43% squamosal COM patients were having abnormal tympanic membrane. Hearing loss was seen in 25.71% patients of mucosal COM and 22.9% patients of squamosal COM patients. 17.1% patients of mucosal COM and 20% patients of squamosal COM show mastoid sclerosis of contralateral ear on HRCT temporal bone. Majority of patients with unilateral COM have initial findings of pathogenesis of COM in contalateral ear. These findings in contralateral ear are more common in patients with squamosal COM than patients with mucosal COM., Competing Interests: Conflict of interestThe authors declare “No conflict of interest”., (© Association of Otolaryngologists of India 2021.)

Nasal mucormycosis is a rare opportunistic infection of the nasal cavity and paranasal sinuses caused by saprophytic fungi which can rapidly lead to death. It usually affects individuals with poorly controlled diabetes mellitus (especially those with ketoacidosis), solid malignancies, iron overload, extensive burns, in patients undergoing treatment with glucocorticosteroid agents and in patients with neutropenia related to haematologic malignancies. Presentation of nasal mucormycosis is always very extensive, but in some patients, it can present in chronic indolent form also. Here, we present a case of 65-year old male with a history of exposed nasal bone after nasal trauma 8 months back. His diabetes was in control with oral hypoglycaemics. Debridement and local flap closure was done. Culture showed the growth of Lichtheimia corymbifera and in HPE, the fungus was seen branching at right angles. So, we conclude that the possibility of nasal mucormycosis should always be borne in mind so that early and effective treatment can be initiated on time to decrease the morbidity and mortality., Competing Interests: Conflict of interestThe authors declare that there is no conflict of interest., (© Association of Otolaryngologists of India 2020.)

To evaluate the role of microdebrider in patients undergoing endoscopic adenoidectomy. Prospective interventional study. Tertiary referral hospital. Twenty patients requiring adenoidectomy were included in the study. Mean operative time was found to be 31.5 min. Mean blood loss was 29.45 ml. All the patients had complete removal of adenoid mass. None of the patients had any kind of collateral damage. It gives a complete clearance of obstructive adenoids under vision thus providing reliable restoration of nasopharyngeal patency., Competing Interests: Conflict of interestThe authors have no conflicts of interest to declare that are relevant to the content of this article., (© Association of Otolaryngologists of India 2021.)

Background: Racial and social disparities exist in outcomes related to cancer and cardiovascular disease (CVD)., Objectives: The aim of this cross-sectional study was to study the impact of social vulnerability on mortality attributed to comorbid cancer and CVD., Methods: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (2015-2019) was used to obtain county-level mortality data attributed to cancer, CVD, and comorbid cancer and CVD. County-level social vulnerability index (SVI) data (2014-2018) were obtained from the CDC's Agency for Toxic Substances and Disease Registry. SVI percentiles were generated for each county and aggregated to form SVI quartiles. Age-adjusted mortality rates (AAMRs) were estimated and compared across SVI quartiles to assess the impact of social vulnerability on mortality related to cancer, CVD, and comorbid cancer and CVD., Results: The AAMR for comorbid cancer and CVD was 47.75 (95% CI: 47.66-47.85) per 100,000 person-years, with higher mortality in counties with greater social vulnerability. AAMRs for cancer and CVD were also significantly greater in counties with the highest SVIs. However, the proportional increase in mortality between the highest and lowest SVI counties was greater for comorbid cancer and CVD than for either cancer or CVD alone. Adults <45 years of age, women, Asian and Pacific Islanders, and Hispanics had the highest relative increase in comorbid cancer and CVD mortality between the fourth and first SVI quartiles, without significant urban-rural differences., Conclusions: Comorbid cancer and CVD mortality increased in counties with higher social vulnerability. Improved education, resource allocation, and targeted public health interventions are needed to address inequities in cardio-oncology., Competing Interests: Dr Gupta is supported in part by National Institutes of Health/National Cancer Institute grant P30CA008748. Dr Nohria is supported by the Catherine Fitch Fund and the Gelb Master Clinician Fund at Brigham and Women’s Hospital. All authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)

Introduction: The Montgomery T-tube is a device used as a combined tracheal stent and tracheostomy tube to prevent post-operative tracheal stenosis., Objectives: The purpose of this retrospective study is to evaluate the outcome following Montgomery T-tube stenting performed in for neck and airway injury in patients with acute blunt laryngotracheal trauma over a period of 12 years., Methods: Between 2005 and 2017, 19 patients with acute blunt laryngotracheal trauma underwent Montgomery T-tube stenting. All 19 laryngotracheal trauma patients had undergone a preoperative tracheostomy in the emergency department by an ENT surgeon. Montgomery T-tube stenting was done later through an external approach. The follow up period ranged from 2 to 10 years. The Montgomery T-tube was removed after a period ranging from 6 months to 1½ year., Results: The majority of patients in the study were in the age group of 21-30 years. A preoperative tracheostomy was done in all 19 patients. All patients except 3 underwent successful decannulation, and experienced long-term satisfactory result., Conclusion: Management of acute blunt laryngotracheal trauma is a challenging problem that demands a multidisciplinary approach. The ideal treatment option should be individualized according to the patient's condition and characteristics of injury. According to our study we suggest that cases of acute blunt laryngotracheal trauma patients should be managed following the protocol as mentioned in our study, and we strongly emphasize that Montgomery T-tube should be left for at least 1 complete year in the airway as it results in negligible chances of post-traumatic stenosis of airway later., (Copyright © 2020 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Foreign body ingestion is common in infants and children, but they can pose a difficult situation and a diagnostic problem if the foreign body is embedded in the soft tissues of the pharynx. To the best of our knowledge, this is the first case reported with such an unusually shaped foreign body having three sharp ends embedded at two different locations in the hypopharynx of a kid such small in age giving rise to respiratory as well as feeding problem. Secondly, a sharp foreign body penetrating arytenoid causing its swelling and inflammation, thus compromising the glottic opening and producing stridor is a rare phenomenon. We present a case of a 9 months old male infant who presented in ENT emergency with complaints of vomiting, refusal to accept solid as well as liquid feed for 5 days and sudden onset of abnormal grunting sounds on breathing for 1 day. Chest examination revealed intercostal retractions with decreased air entry bilaterally and conducted sounds in chest on auscultation. Abdomen examination revealed no abnormalities, and routine blood and urine investigations were also within normal limits. A metallic foreign body with three sharp ends was visualized in the neck X-ray, the retrieval of which by rigid hypopharyngoscopy relieved the symptoms., (© Association of Otolaryngologists of India 2015.)

We performed a prospective interventional study to evaluate correlations between hearing thresholds determined by pure-tone audiometry (PTA) and auditory steady-state response (ASSR) testing in two types of patients with hearing loss and a control group of persons with normal hearing. The study was conducted on 240 ears-80 ears with conductive hearing loss, 80 ears with sensorineural hearing loss, and 80 normal-hearing ears. We found that mean threshold differences between PTA results and ASSR testing at different frequencies did not exceed 15 dB in any group. Using Pearson correlation coefficient calculations, we determined that the two responses correlated better in patients with sensorineural hearing loss than in those with conductive hearing loss. We conclude that measuring ASSRs can be an excellent complement to other diagnostic methods in determining hearing thresholds.

We conducted a prospective interventional study to evaluate the role of endoscopic endonasal dacryocystorhinostomy in children. Our study population was made up of 20 patients-18 boys and 2 girls, aged 2 to 12 years (mean: 5.3)-who presented with signs and symptoms suggestive of nasolacrimal duct blockage that was refractory to conventional medical treatment. In all cases, blockage was confirmed by nasolacrimal duct syringing that demonstrated regurgitation from the opposite punctum. The primary outcome measures for success were resolution of symptoms and duct patency on lacrimal irrigation. At 6 months, 17 patients (85%) experienced complete symptomatic relief, 1 (5%) had partial relief, and 2 (10%) reported no relief. Moreover, the nasolacrimal duct was patent in 17 patients, partially patent in 2, and blocked in 1. We conclude that endoscopic endonasal dacryocystorhinostomy is a safe and effective procedure in children with nasolacrimal duct blockage when medical therapy and probing have been unsuccessful.

Competing Interests: There are no conflicts of interest.

Introduction: Tracheocutaneous fistula (TCF) is one of the recognized sequelae of a long-term tracheostomy resulting from mucocutaneous overgrowth which prevents closure of the artificial lumen at the site of tracheostomy. Primary closure of TCF has disappointing results and may lead to complications like pneumothorax, pneumomediastinum, cervicofacial subcutaneous emphysema, and depressed scar., Objective: To compare TCF repair using fistulectomy followed by rhomboid flap versus fistulectomy followed by Z plasty repair., Methods: In this prospective study, 40 patients of either sex with persistent TCF were included. All patients were randomly divided into two groups. Group I had 20 patients who underwent TCF repair using a technique in which fistulectomy was done followed by its closure in layers, and finally closing the defect using a rhomboid flap. The remaining 20 were included in group II who underwent TCF repair using a technique in which fistulectomy was done followed by layered closing, and final closure of the defect was done using Z plasty. The follow-up period was 3 months., Results: Out of 40 patients, all but 8 experienced a successful outcome without any complications, and complete aesthetic satisfaction, with improvement in phonation, and no soiling of clothes with mucus or sputum. The 8 unsuccessful patients belonged to group II (Z plasty group)., Conclusion: Both techniques have been described in the literature and are proven to give good results. Our study emphasizes the fact that in our experience, the rhomboid flap was a better alternative for TCF repair than Z plasty., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Meningioma is known to be an intracranial pathology, but it can also present extracranially. We report a case of a 55-year-old female who presented to the Ear, Nose and Throat (ENT) emergency with a complaint of epistaxis for 1 day. There was a 7-8years history of self-resolving intermittent epistaxis. Nasal examination revealed a mass from which biopsy was taken. The specimen showed meningioma on histopathological examination. The mass was excised by ENT surgeons through lateral rhinotomy incision. It was confirmed to be a meningioma by final histopathological examination. The patient was discharged on 10 th post-operative day after suture removal under stable condition and was symptom free on regular follow-ups. Worldwide there have been very less number of cases of primary extracranial meningioma causing symptoms of epistaxis, nasal obstruction and a large sinonasal mass in an elderly.

Eccrine Angiomatous Hamartoma (EAH) is a benign rare skin neoplasm characterised histologically by abnormal proliferation of sweat glands and surrounding capillaries and other dermal elements like fatty lobules and hair. It usually presents at birth or in early childhood in the form of solitary nodules mostly affecting the extremities. Here, we report a case of angiomatous hamartoma over the face which presented as a cystic swelling in preauricular region in a 55-year-old man. The late onset and a rare site for presentation of EAH prompted us to report the case. There is not even a single case of EAH arising in the "preauricular" region, reported.

Background: Ultrasound imaging is an ideal tool for stellate ganglion block (SGB) due to clarity, portability, lack of radiation, and low cost. Ultrasound guided anterior approach requires the application of pressure to the anterior neck and is associated with more risk of injury to inferior thyroid artery, vertebral artery, and esophagus. The lateral approach does not interfere with nerve or vascular structures. Blockade at the C6 vertebral level results in more successful sympathetic blockade of the head and neck with less sympathetic blockade of the upper extremity compared to sympathetic blockade at C7 vertebral level, which produces successful sympathetic blockade of upper extremity. This is helpful in patients of complex regional pain syndrome of the upper limb. Hence, we conducted a study using the lateral approach at C7 level., Materials and Methods: Ultrasound guided SGBs using lateral in-plane technique at C7 level were given in 20 patients suffering from chronic pain patients of upper extremity, head, and neck using 4 ml of 0.25% bupivacaine and 1 ml of 40 mg triamcinolone. The patients were assessed for a numeric pain intensity score (NPIS), the rise in axillary temperature, the range of motion of joints of upper extremity, and resolution of edema at various time intervals up to 3 months., Results: NPIS showed a statistically significant decrease from baseline at 30 min, which was sustained till 3(rd) month. The rise in axillary temperature after the block was statistically significant, which was sustained till 2(nd) week. The edema score decreased significantly at all-time intervals (P ≤ 0.001). The restriction of motion in all joints of upper limb decreased from 13 to 3 patients., Conclusion: There is a significant variation in the anatomy of stellate ganglion at the level of C6 and C7. Ultrasound guided lateral approach increases the efficacy of SGB by deposition of drug subfascially with real-time imaging.

Stellate ganglion block (SGB) is utilized in the diagnosis and management of various vascular disorders and sympathetically mediated pain in upper extremity, head and neck. The stellate ganglion lies medial to the scalene muscles, lateral to longus coli muscle, esophagus, trachea and recurrent laryngeal nerve, anterior to C7 transverse process and prevertebral fascia, superior to the subclavian artery and posterior to vertebral vessels. Consequently, inadvertent placement of the needle tip into these soft tissues and vessels occur with blind technique. Henceforth, various interventional modalities are being used for SGB, these have been reviewed in this paper. Various techniques of SGB have been described, and vary from the use of standard blind technique to the use of fluoroscopy, computerized tomography, magnetic resonance imaging, and radio nucleotide tracers. However, these techniques may not be practical in a clinical setting, insofar as they are time consuming, costly, and may involve radiation exposure. The use of fluoroscopy does not visualize the blood vessels close to the stellate ganglion. Ultrasounds are the alternative. They help in visualization of soft tissues to prevent complications and help in deposition of drug subfascially, under direct visual control.

Background: Appropriate use criteria (AUC) for transthoracic echocardiography (TTE) were developed to address concerns regarding inappropriate use of TTE. A previous pilot study suggests that an educational and feedback intervention can reduce inappropriate TTEs ordered by physicians in training. It is unknown if this type of intervention will be effective when targeted at attending level physicians in a variety of clinical settings., Aims: The aim of this international, multicenter study is to evaluate the hypothesis that an AUC-based educational and feedback intervention will reduce the proportion of inappropriate echocardiograms ordered by attending physicians in the ambulatory environment., Methods: In an ongoing multicentered, investigator-blinded, randomized controlled trial across Canada and the United States, cardiologists and primary care physicians practicing in the ambulatory setting will be enrolled. The intervention arm will receive (1) a lecture outlining the AUC and most recent available evidence highlighting appropriate use of TTE, (2) access to the American Society of Echocardiography mobile phone app, and (3) individualized feedback reports e-mailed monthly summarizing TTE ordering behavior including information on inappropriate TTEs and brief explanations of the inappropriate designation. The control group will receive no education on TTE appropriate use and order TTEs as usual practice., Conclusions: The Echo WISELY (Will Inappropriate Scenarios for Echocardiography Lessen Significantly in an education RCT) study is the first multicenter randomized trial of an AUC-based educational intervention. The study will examine whether an education and feedback intervention will reduce the rate of outpatient inappropriate TTEs ordered by attending level cardiologists and primary care physicians (www.clinicaltrials.gov identifier NCT02038101)., (Copyright © 2015 Elsevier Inc. All rights reserved.)

We conducted a prospective, comparative, interventional study to evaluate the role of intranasal septal splints and to compare the results of this type of support with those of conventional nasal packing. Our study population was made up of 60 patients, aged 18 to 50 years, who had undergone septoplasty for the treatment of a symptomatic deviation of the nasal septum at our tertiary care referral hospital. These patients were randomly divided into two groups according to the type of nasal support they would receive: 30 patients (25 men and 5 women, mean age: 23.3 yr) received bilateral intranasal septal splints and the other 30 (26 men and 4 women, mean age: 22.4 yr) underwent anterior nasal packing. Outcomes parameters included postoperative pain and a number of other variables. At 24 and 48 hours postoperatively, the splint group had significantly lower mean pain scores (p < 0.05). At 48 hours, the splint group experienced significantly fewer instances of nasal bleeding (p < 0.01), swelling over the face and nose (p < 0.01), watering of the eyes (p < 0.01), nasal discharge (p = 0.028), nasal obstruction (p < 0.001), and feeding difficulty (p = 0.028). Likewise, mean pain scores during splint or pack removal were significantly lower in the splint group (p < 0.01). At the 6-week follow-up, only 2 patients (6.7%) in the splint group exhibited a residual deformity, compared with 8 patients (26.7%) in the packing group (p = 0.038). Finally, no patient in the splint group had an intranasal adhesion at follow-up, while 4 (13.3%) in the packing group did (p < 0.05). We conclude that intranasal septal splints result in less postoperative pain without increasing postoperative complications, and thus they can be used as an effective alternative to nasal packing after septoplasty.

The incidents of foreign body ingestion in infants and children are usually viewed as accidents, but these events may be a form of child abuse. We are reporting a case of child abuse who presented with multiple foreign bodies in the gastrointestinal tract. Physicians are required to report abuse when they have reason to believe or to suspect that it occurred. The purpose of reporting is not punishment of the perpetrator - it is the protection of the child. It is certainly in the best interest of the child, because child abuse is a recurrent and usually escalating problem that exposes the child to substantial risk., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Meningioma is a tumour most commonly located intracranially that may rarely extend extracranially. Ectopic meningioma presenting as parapharyngeal mass is a rare entity. We report a case of an 18-year-old female who presented with a complaint of swelling below the right angle of mandible associated with difficulty in swallowing for the last 3 months. The swelling measured 1.5 × 1 cm and was firm, fixed, non-pulsatile, non-transilluminant and non-tender. Computer tomography revealed a heterogenous enhancing mass with foci of calcification in parapharyngeal space without any intracranial component. Intraoral fine needle aspiration cytology was performed. A cytological diagnosis of spindle cell lesion of neural origin with the closest possibility of meningioma was rendered. Excision biopsy confirmed the diagnosis of ectopic parapharyngeal meningioma. It is important for clinicians and pathologists to be aware of this entity at the unusual site., (Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2012.)

Angiokeratoma circumscriptum is rare cutaneous disorder. It usually presents as multiple,red, blue or black asymptomatic papules on lower extremities. Oral involvement, common in systemic form, is rare in localized forms. We report a case of angiokeratoma circumscriptum of tongue, involving both dorsal and ventral aspects.

When tumor involvement of the frontal sinus occurs, it is usually the result of the direct spread of the mass from the nasal cavity or anterior ethmoid sinuses. Primary frontal sinus tumors are extremely rare. We describe a case of primary adenocarcinoma of the frontal sinus in a 53-year-old man. The patient refused surgery, so he was treated with chemotherapy followed by radiotherapy. At the 1-year follow-up, only a slight reduction of the swelling was noted. Thereafter, he was lost to follow-up. This case represents a typical example of a paranasal cancer extending beyond the bony margins, with a silent onset that simulated benign disease. The best hope for an early diagnosis of such a tumor lies in the greater use of computed tomography to assess chronic rhinosinusitis.

A 42 year old male presented with progressive difficulty in swallowing for the past 6 months. Oral examination revealed ulcer on right dorsum of tongue, which was mistaken for malignancy. Histopathology of incision biopsy specimen diagnosed it as histoplasmosis. The patient was put on oral itraconazole therapy and responded well to the treatment.

Background: Pregabalin is a potent ligand for alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system, which exhibits potent anticonvulsant, analgesic and anxiolytic activity. The pharmacological activity of pregabalin is similar to that of gabapentin and shows possible advantages. Although it shows analgesic efficacy against neuropathic pain, very limited evidence supports its postoperative analgesic efficacy. We investigated its analgesic efficacy in patients experiencing acute pain after abdominal hysterectomy and compared it with gabapentin and placebo., Methods: A randomized, double-blind, placebo-controlled study was conducted in 90 women undergoing abdominal hysterectomy who were anaesthetized in a standardized fashion. Patients received 300 mg pregabalin, 900 mg gabapentin or placebo, 1-2 hours prior to surgery. Postoperative analgesia was administered at visual analogue scale (VAS) ≥3. The primary outcome was analgesic consumption over 24 hours and patients were followed for pain scores, time to rescue analgesia and side effects as secondary outcomes., Results: The diclofenac consumption was statistically significant between pregabalin and control groups, and gabapentin and control groups; however, pregabalin and gabapentin groups were comparable. Moreover, the consumption of tramadol was statistically significant among all the groups. Patients in pregabalin and gabapentin groups had lower pain scores in the initial hour of recovery. However, pain scores were subsequently similar in all the groups. Time to first request for analgesia was longer in pregabalin group followed by gabapentin and control groups., Conclusion: A single dose of 300 mg pregabalin given 1-2 hours prior to surgery is superior to 900 mg gabapentin and placebo after abdominal hysterectomy. Both the drugs are better than placebo.

A considerable controversy surrounds the advisability and efficacy of middle turbinate resection in endoscopic sinus surgery. Some are in favor of middle turbinate preservation considering it to be important anatomic and physiological structure and others advocate middle turbinate resection as it improves nasal air flow and decreases synechiae formation. So a study was undertaken to evaluate the efficacy of middle turbinate resection in patients of chronic sinusitis undergoing Functional Endoscopic Sinus Surgery (FESS). 40 patients of chronic sinusitis were selected and divided into 2 groups, group I undergoing FESS with middle turbinate preservation and group II undergoing FESS along with middle turbinate resection. Final results were recorded 6 months after the operative procedure. 50% patients had relief in nasal obstruction in group I as compared to 88% in group II. Postoperative synechiae formation was seen in five patients in group I and in one patient in group II.

Lupus vulgaris (LV) is the commonest morphological variant of cutaneous tuberculosis. Case of LV of external nose extending to internal nose causing septal perforation is documented here. Histopathology of biopsy taken confirmed the diagnosis of LV. Patient responded well to Anti-tubercular therapy (ATT).

Laryngeal foreign bodies are not uncommon. A common difficulty encountered is a delay in diagnosis. The clinical features of a laryngeal foreign body may simulate asthma in an adult. The differentiation is necessary in the initial stages as the laryngeal foreign body can lead to sudden death due to airway obstruction. Sudden onset of wheeze in a non-asthmatic patient should arouse its suspicion. A case is reported where patient was transferred to respiratory intensive care unit for respiratory distress with wheeze which was later diagnosed as foreign body larynx.

Chronic retropharyngeal abscess secondary to tubercular spondilitis is a rare phenomenon. Anatomical location of this abscess makes it a life threatening condition requiring prompt diagnosis and treatment thus preventing morbidity and mortality. Authors are documenting a case of tubercular spondylitis of cervical region in a 12-year old male child with huge retropharyngeal abscess extending to superior mediastinum. Clinically, patient had respiratory distress but no neurological deficit. USG (Ultrasonography) guided aspirate of abscess sent for microscopy and culture showed acid fast bacilli. Multiple USG guided aspirations under antibiotic and antitubercular cover (Category I) were done. Patient is doing well at three month follow-up.

Objective: A denture as an aerodigestive tract foreign body continues to present challenges to otolaryngologists. Records of patients who presented with a denture as an aerodigestive tract foreign body were retrospectively reviewed., Methods: Records of patients treated during the last 8 years were reviewed to gather information on the age, sex, and presenting symptoms of the patient, location of the denture, radiographic findings, and endoscopic procedure required., Results: Our review identified 15 patients, with the mean and median age being 59.6 and 63 years, respectively. One patient presented with a denture in the valleculae, 4 patients with a denture in the airway, and 10 patients with a denture in the hypopharynx/esophagus. Rigid endoscopy was performed to remove the dentures in most patients. An esophagotomy was required in 1 patient., Conclusions: Fixed partial dentures should be advised by dentists, especially in patients who have predisposing factors such as old age, epilepsy, mental retardation, or alcoholism.

A study was conducted to assess the merits and demerits of endoscopic septoplasty. Fifty patients having symptomatic DNS were randomly divided into two groups of 25 patients each. One group underwent endoscopic septoplasty and other group underwent conventional septoplasty. The groups were compared regarding the complaints with pack in postoperative period, relief of symptoms after surgery and complications. The symptoms complained by the patients with pack in postoperative period and complications after surgery were significantly less in endoscopic septoplasty group.