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Introduction: The primary goal of cholesteatoma surgery is to eradicate it from the middle ear cleft. However due to linear axis of illumination of the microscope, in some of the recesses or hidden areas in middle ear are not visualised. To overcome this many studies have been done on the complimentary use of endoscopes in visualising these hidden areas. Aim: To assess the outcome of complimentary use of endoscopes in addition to microscope on improved access to hidden areas in the middle ear and resultant cholesteatoma clearance. Materials and Methods: In this systematic review, Literature search was conducted using the key words both manually and electronically in PubMed, Google scholar and Directory of Open Access Journals for articles published till December 2021 at ESIC Medical College and PGIMSR, Bengaluru, Karnataka, India. The primary inclusion criteria used was all full text original, both prospective and retrospective, articles in which endoscopes were used as an adjunct to microscope for cholesteatoma clearance from middle ear cleft. Retrieved articles were reviewed by two independent authors for their eligibility for inclusion in the study. The selected original papers were analysed. Data was entered in Microsoft Excel 2007 and analysed for descriptive statistics like frequency and proportions. Results: A total of 48 studies were identified initially. After removing duplicates, screening was done for title, abstracts and full text retrieval to check for inclusion criteria being met. Six studies were found using complimentary endoscopes for cholesteatoma surgery and were analysed. Of these four were prospective and two were retrospective studies. Total 604 patients underwent endoscopic examination after microscopic clearance. Residual cholesteatoma was seen in 105 patients (17%), which were cleared with endoscopic assistance. Conclusion: Complimentary endoscopy detects residual cholesteatoma in significant number of cases during primary cholesteatoma surgery. In cholesteatoma surgery they are predominantly used as observational tools.

Background The incidence of bailout stenting post-drug coated balloon use (DCB) in the literature has been more than 10%; ranging up-to 21% in Bello trial and this variation could be due to the different criteria used to consider bailout stenting and may also reflect aggressive pre-dilatation. Our eyes are trained to expect stent like result and anything less is considered sub-optimal and this could be one of the reasons for high incidence of bailout stenting. The current recommendation is to use drug eluting stent (DES) for bailout stenting and hence raising in the possibility of drug toxicity or maybe even synergistic effect from combination of Paclitaxel (DCB) and limus (DES). Aim We have evaluated the incidence and outcomes of patients needing bailout stenting in our centre. Methods and results We evaluated all patients who were treated with DCB between January 2016-August 2017. Bailout stenting per lesion were identified and studied for endpoints which included cardiac death, target vessel MI, stent thrombosis, target lesion revascularization and target vessel revascularisation. Between the study period; 468 lesions (in 364 patients) were treated with paclitaxel DCB (Sequent Please, B Braun, Germany). Bailout stenting was required in 23 lesions (4.9%) and of which 12 (52%) was for flow limiting dissections (type C or more) and the remaining 11 was for recoil of more than 50%. Majority of the lesions were de novo (18; 78%). All bailout stenting was performed with third generation limus eluting stents. During a median follow-up of 18.14 months; range; 7–33 months, there was no cardiac death and target vessel MI occurred in 1 patient (4.3%), TLR and TVR were in 3 lesions (13%). MACE rate (combination of cardiac death, target vessel MI and TVR) was 13%. There were no cases of stent thrombosis as per the ARC definition. Conclusion One of the highlighting features of our study is very low-rates of bailout stenting. This may be due to our criteria of not stenting mild dissections (unless they are flow limiting) and also to accepting recoil of up-to 50% post-DCB use. The outcome in bailout stenting group is acceptable especially with hard endpoints (cardiac death, target vessel MI and stent thrombosis) although TLR and TVR rates were higher indicating synergistic effect of paclitaxel and limus may not offer additional benefits.

Background: Hearing loss associated with the CSOM affects the patients’ communication with others and results in poor quality of life. Degree and type of hearing loss can be assessed by pure tone audiometry, which helps in predicting the status of tympanic membrane, ossicular chain, and inner ear and also helps in preoperative planning.Methods: Patients with CSOM aged 10 years and above were included in the study. All patients underwent pure tone audiometry. With the help of air and bone conduction threshold, the degree and type of hearing loss in each ear was determined. The data collected was evaluated and results are reported as rates and proportions (%). Results: Most of the ears (83%) had mild to moderate hearing loss. Average ABG observed was 31 dB. Maximum ABG observed was 55dB on right side and 50 dB on the left side. There was mixed hearing loss in 10.9% cases.Conclusions: This study reinforces the idea of using preoperative pure tone audiometry, which not only helps in planning surgery but also helps in documenting the preoperative status of patients’ sensorineural hearing loss, if present.

Background: Hearing impairment is a common disability in children. This study is to evaluate the common high risk factors for hearing loss in our locality and to estimate hearing threshold by brain stem evoked response audiometry.Methods: 100 children under five years were subjected to brainstem evoked response audiometry. Wave V morphology was studied and hearing threshold estimated. The high risk factor(s) were analysed and degree of hearing impairment assessed. Results: 38 children were found to have hearing impairment. Most of the children had bilateral hearing impairment. Of them 30 children (79%) had profound hearing loss. Consanguineous marriage was the most common risk factor.Conclusions: Since consanguinity is the most common risk factor, health education and genetic counselling will help to decrease the incidence of autosomal recessive nonsyndromic deafness. Improvement in immunization for rubella can decrease the hearing impairment due to these infections. Due to availability of medical facilities hearing impairment due to perinatal factors have decreased.

Background: Conventional radiological methods like X-ray mastoid have limited ability to delineate the details of the complex temporal bone and cochlea-vestibular anatomy and disease pathology. This can be overcome by the use of High resolution computed tomography (HRCT) evaluation of the temporal bone. HRCT is helpful in evaluating the anatomy and pathology type and extent of disease, thereby helps in preoperative planning. Methods: The CT scan of forty five patients attending the outpatient department of otorhinolaryngology in a tertiary care centre between August 2014 to August 2017 was evaluated in this study. Each CT scan was interpreted by an otolaryngologist and a radiologist and interpretation was by consensus. The data collected was evaluated and results are reported as rates and proportions (%). Results: The study evaluated CT scan of 45 patients of which 35 were male patients and 10 were female patients with age ranging from 5 years to 75 years. Most of these patients belonged to the 21-30, 31-40 age groups [9 (20%) in each group]. Infections of middle ear cleft (all with cholesteatoma), fractures of the temporal bone, anomalies and tumors of the external auditory canal and middle ear were the pathologies observed in these CT scans with infection (otomastoiditis) [23 (51.1%)] being the most common pathology observed. Conclusions: Pre-operative CT scan may not only help in identifying the nature, extent of infectious disease including ossicular, bony erosions; it may also identify anomalies in the temporal bone and surrounding structures. Thus, HRCT temporal bone will help the surgeon in planning effective surgical strategy, reducing morbidity during the surgery.

Congenital choanal atresia (CCA) is characterized by narrowing of posterior nasal apertures in newborns present with nasal obstruction and respiratory difficulty. Although unilateral obstruction goes unnoticed at birth, bilateral case is an emergency situation because newborn is an obligate nasal breather. Here, we present an unusual case of bilateral choanal atresia in an 11-year-old girl, which is a rare finding. Surgical correction was done by transnasal approach using endoscopes and otological drill. How to cite this article Chandrashekharayya SH, Handi PS, Riyas M. Bilateral Congenital Choanal Atresia in an 11-year-old Girl: An Unusual Presentation. Clin Rhinol An Int J 2012;5(3):132-134.

Background: The anatomy of paranasal sinuses is very complicated. Evaluation of the location, extent of sino nasal diseases and anatomical variations by preoperative radiologic evaluation of the paranasal sinuses is essential in planning surgical intervention. Meticulous radiographic delineation of the small structures in this region, coupled with endoscopic evaluation, provides detailed preoperative information regarding morphology and pathology.Methods: Patients with sinonasal symptoms indicating requirement of CT scan evaluation and aged more than 10 years were included in the study. Each CT scan was interpreted by an otolaryngologist and a radiologist and interpretation was by consensus. The data collected was evaluated and results are reported as rates and proportions. Results: Sinusitis (single or multiple sinus involvement), nasal polyposis, frontal mucocele and ethmoidal carcinoma with destruction of medial wall of maxilla were the pathologies observed in these CT scans with sinusitis [22 (43.1%)] being the most common pathology observed. Deviated nasal septum [21 (41.2%)] was the most common anatomical variation observed. All patients who had concha bullosa [5 (9.8%)] were observed to have sinusitis involving multiple bilateral PNS. Based on Keros’ classification, olfactory fossa depth type I was most commonly observed followed by type II and type III.Conclusions: CT scan is important in patients undergoing endoscopic sinus surgery for sinonasal diseases where it acts as a road map in identifying the presence, extent of disease and any anatomical variations. This pre-operative CT scan evaluation improves planning and helps in significantly reducing morbidity and possible complications during surgery.