A high prevalence of osteoporosis was observed in elderly Indian subjects. pDXA has high negative predictive value, making it a useful tool in population screening for osteoporosis.

Nitric oxide (NO) is a biological messenger produced by mammalian cells serving various functions including regulation of blood flow, platelet function, immunity, and neurotransmission. The paranasal sinuses and nasal mucosa are a major source of exhaled NO. The aim of the study is to compare the nasal NO (nNO) levels in patients with chronic rhinosinusitis with those of common cold patients and controls and to correlate CT scores with nNO levels. The nasal concentration of NO was measured by electroluminescence in 13 healthy volunteers, in 13 patients suffering from common cold and 13 patients with chronic rhinosinusitis. The concentration of NO was correlated with symptom scores, endoscopic findings and CT findings. The measured levels of NO did not differ between healthy volunteers and common cold patients, but they were significantly lower in patients suffering from chronic rhinosinusitis. As NO is a regulator of mucociliary activity and has bacteriostatic and antiviral effects, the decreased concentration of nNO in patients suffering from sinusitis suggests that lack of NO may contribute to the pathogenesis of this disease. Thus, nNO, which is easily measured, provides a valuable non-invasive objective measure of chronic rhinosinusitis.

The WHO has designed a safe surgery checklist to enhance communication and awareness of patient safety during surgery and to minimise complications. WHO recommends that the check-list be evaluated and customised by end users as a tool to promote safe surgery. The aim of present study was to evaluate the impact of WHO safety checklist on patient safety awareness in otorhinolaryngology and to customise it for the speciality. A prospective structured questionnaire based study was done in ENT operating room for duration of 1 month each for cases, before and after implementation of safe surgery checklist. The feedback from respondents (surgeons, nurses and anaesthetists) was used to arrive at a customised checklist for otolaryngology as per WHO guidelines. The checklist significantly improved team member's awareness of patient's identity (from 17 to 86%) and each other's identity and roles (from 46 to 94%) and improved team communication (from 73 to 92%) in operation theatre. There was a significant improvement in preoperative check of equipment and critical events were discussed more frequently. The checklist could be effectively customised to suit otolaryngology needs as per WHO guidelines. The modified checklist needs to be validated by otolaryngology associations. We conclude from our study that the WHO Surgical safety check-list has a favourable impact on patient safety awareness, team-work and communication of operating team and can be customised for otolaryngology setting.

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Importance; The use of endoscope for the ear has opened up new approaches to treat cholesteatoma surgically and reduce residuals. The endoscope can be used as an adjunct to the microscope or by itself. Aims and objectives:1. To evaluate the use of endoscopy in identifying the cholesteatoma remnant at the time of primary surgery with the operating microscope.2. To evaluate the effectiveness of endoscopy in assessing limited disease during cholesteatoma surgery.Design: A hospital-based, interventional, non-randomized, non-comparative and prospective study was done in 116 ears with acquired cholesteatoma. At the time of the surgery, the endoscope was used to study and identify the extent of the disease. After completion of the surgery by the standard inside-out technique using microscope and drill, the endoscope was used to identify the cholesteatoma remnants if any.Setting: This study was done in a tertiary care hospital.Participants: 116 patients with acquired cholesteatoma that were operated on. Main outcome measure:The proportion of residual disease identified with the help of endoscope at the end of standard surgery using microscope and drill. Secondary outcome measure was the proportion of cases in which endoscope was useful in decision making intra-operatively. Results:Out of 116 patients operated with the microscope, 13 had a cholesteatoma remnant at the end of surgery which was missed by the microscope but identified with the oto-endoscope. The sinus tympani was the commonest site of cholesteatoma remnant. Also in 7 cases, the endoscope helped in limiting the dissection by better identification of the extent of disease as compared to microscope during surgery. Conclusion and relevance:Endoscope is a useful adjunct to the operating microscope in cholesteatoma surgeries. It is useful in not only identifying residual disease but also in decision making by identifying the extent of the disease intra-operatively.

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Tuberculous otitis media is a rare disease that is clinically variable and nonspecific. Tuberculous otitis media can be difficult to diagnose because it can easily be confused with other acute or chronic middle ear conditions. The signs and symptoms are variable and nonspecific and often differ from classic descriptions. Furthermore, no two cases may not necessarily present itself clinically in the same manner. Cases of chronic otitis media that are unresponsive to the usual therapy or show unexpected postoperative evolution should be investigated for tuberculosis. Tuberculous otitis media should be suspected after failure of current antibiotics or persistent effusion after tympanoplasty or mastoidectomy. Because of these factors, the diagnosis is often made during surgery or postoperatively. Late diagnosis delays the start of treatment, thereby increasing the risk of complications. KEYWORDS: Tuberculous otitis media, chronic otitis media, mastoidectomy Key Messages: Tuberculous otitis media is a rare disease, which still persists in clinical practice despite effective antitubercular treatment. It may have varied modes of presentation making early diagnosis difficult. If left undiagnosed can cause significant damage to middle ear and other surrounding structures INTRODUCTION: Tuberculosis remains the leading cause of death secondary to infectious diseases worldwide in persons older than 5 years. Tuberculosis of middle ear is a comparatively rare entity usually seen in association with or secondary to pulmonary tuberculosis. Tuberculosis is one the major infectious disease with predominant involvement of lung and lymph nodes but tuberculosis of the middle ear is uncommon. Tuberculous otitis media is generally considered a disease of children and young adults, as patients <15 years of age account for 84% of all cases. Case report 1: A 19 year old female came to our institution with a history of right ear discharge since 4 yrs which was yellowish, scanty, continuous, foul smelling and non blood stained. She was treated with local and systemic antibiotics but her discharge did not reduce with medications. She also complained of decreased hearing on the right side. She had a history of abdominal Kochs 3yrs back for which she took AKT (anti Koch treatment) for 6 months. One year back she had a tubercular gluteal abscess which was drained under spinal anaesthesia. She took medications (AKT) for 9 months for the latter. Examination revealed a central perforation with granulations in middle ear. Ear swab for culture and sensitivity showed no bacterial growth. Her pure tone audiogram showed right sided severe mixed hearing loss. Schuler's view X-ray mastoid showed loss of pneumatization of right mastoid region. CBC, blood urea and electrolytes were insignificant. Chest x-ray was unremarkable.

Introduction: Malignant otitis externa is an aggressive and potentially fatal infection of ear and skull base. Few studies have attempted to frame a protocol for management of this condition. However, the applicability of protocols involving radionuclide investigations in rural areas with restricted access is a challenge. Also, treatment with oral quinolones has since been threatened as their use has become widespread and indiscriminate. Objective: Owing to lack of standardized diagnostic criterion and treatment regimes, and growing concerns regarding quinolone resistance, we reviewed cases of malignant otitis externa treated across two different socio-economic centres to identify diagnostic and management difficulties. Method: A retrospective data analysis of patients with malignant otitis externa managed in a tertiary and primary care hospital was done between December 2017 and November 2018. All relevant data was retrieved for assessment. Results: 43 patients were identified, out of these 19 were at the private institute and 24 at the charitable institute. Otalgia was the predominant symptom among all. Pseudomonas aeruginosa was the most commonly isolated organism (81% of patients). Ciprofloxacin resistance reported was 38%. The tertiary care institute used CT and Gallium scans for diagnosis, whereas primary centre employed clinical parameters and CT only. Treatment included Meropenem, Ceftazidime, Amikacin at tertiary centre and Ciprofloxacin and Streptomycin at primary centre.  Conclusions: Incidence of Ciprofloxacin resistance was high in our study confirming the growing concern documented in other studies. Access to higher antibiotics was restricted in rural areas where Streptomycin was used in combination with other drugs with promising results.