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Introduction: Patients with a mucosal type of chronic otitis media (COM) usually have recurrent ear discharge and conductive hearing loss. It is characterized by the central perforation of the tympanic membrane. Myringoplasty is an operation performed to repair tympanic membrane perforation when there is no ossicular damage. It helps to prevent ear discharge and improves hearing. Different techniques used for myringoplasty are underlay and overlay. Underlay technique is an effective procedure for tympanic membrane repair. Methods: 125 patients who underwent underlay myringoplasty over two years in a tertiary care center in Kerala were included in the study. Patients with actively discharging ears were excluded from the study. Results: The majority of the patients were in the age group of 20-29 years (49.6%). There were 47 males (37.6%) and 78 females (62.4%). In 63 patients the surgery was done on the right side (50.4%) and in 62 patients on the left side (49.6%). Maximum preoperative hearing loss was in the range of 30-34 dB (39.2%). 100 patients (80%) showed successful graft uptake with the improvement of hearing in the range of 10-15 dB. Eight patients (6.4%) showed small residual perforation with the improvement of hearing. In 17 patients (13.6%) there was a complete rejection of graft with continuous ear discharge and no improvement in hearing. Conclusion: Underlay myringoplasty is an effective surgical technique for the repair of tympanic membrane perforations in terms of graft take up and improvement of hearing.

Background: Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo. In this condition, the vertigo is precipitated by certain head movements. BPPV is diagnosed by Dix-Hallpike positional test. Various repositioning maneuvers and treatment modalities exist for the management of this condition. Semont maneuver is a simple procedure for the treatment of posterior semicircular canal BPPV.Methods: This non randomized controlled study was conducted in the ENT Department of a tertiary care hospital at Thiruvananthapuram over a period of one year. Hundred patients with posterior semicircular canal BPPV were included in the study. Fifty patients treated with Semont maneuver were compared with 50 patients who were treated with betahistine 16 mg three times daily. Outcomes were measured by relief of vertigo and negative Dix- Hallpike positional test during follow up examination.Results: The most common age group affected by BPPV was 50-60 years. Right side was more affected than the left. There was a female preponderance. 84% patients treated with Semont maneuver were cured at the end of the first week and 90% at the end of the second week. The percentage of patients cured with betahistine were 48% at the end of first week and 56% at the end of second week. Conclusions: The Semont maneuver was very effective in the treatment of BPPV. It helps to reduce the long-term use of medicines in our population.

Epistaxis is a common nasal symptom seen in all age groups. It often presents as an emergency. An attempt should always be made to find any local or systemic cause for it because epistaxis is a sign and not a disease per se. Objectives: To evaluate the local causes of epistaxis using rigid nasal endoscope for specific treatment planning. Methods: This was a prospective study which included 50 patients with epistaxis who attended the Otolaryngology outpatient department of SUT Academy of Medical Sciences, Trivandrum over a period of one year. Rigid nasal endoscopy under local anesthesia was done for these patients for whom both anterior and posterior rhinoscopy could not reveal any local causes. Results: Nasal endoscopy helped in finding the local causes for epistaxis. Epistaxis was more common in males (66%) and majority was in the age group of 21-30 years (46%). The causes were posterior deviation of nasal septum with spur (24%), bleeding points on the nasal septum (12%), rhinosporidiosis (10%), infected polyp (10%), deviated nasal septum with allergic rhinitis (8%), congested adenoids (8%), deviated nasal septum with sinusitis (4%), nasopharyngeal mass (4%), and miscellaneous conditions (6%). In 6% patients, no significant local cause was detected. All the patients were treated according to the endoscopic findings. Conclusion: Nasal endoscope is an important tool in diagnosis and treatment of local causes of epistaxis.

Hoarseness due to left recurrent laryngeal nerve paralysis (LRLN) caused by identifiable cardiovascular disease is described as Ortner’s syndrome or Cardiovocal syndrome. This was first described by Ortner in 1897 to describe left recurrent laryngeal nerve palsy secondary to Mitral Stenosis. The common conditions which gave rise to Ortners’ syndrome include mitral stenosis, mitral valve prolapse, aortic aneurysm, septal defect, following cardiothoracic surgery, high altitude pulmonary hypertension, ductal aneurysm, aortic dissection etc. Herewith we are presenting an unusual presentation of Aortic arch aneurysm.