The study is aimed to assess the scope of endoscopic stapedotomy in overcoming technical challenges faced during conventional stapedotomy using operating microscope. Sixty-four patients with clinical and audiological diagnosis of otosclerosis were randomly assigned into one of the 2 groups—one underwent conventional stapedotomy using operating microscope, while the other group underwent endoscopic stapedotomy, the operating surgeon being the same for both groups, for all cases. The 2 groups were observed in terms of extent of the postero-superior canal bone curettage/drilling, chorda tympani repositioning, visualization of footplate area, surgical time from first incision to ear packing, post-operative morbidity in terms of post-operative pain, vertigo, hearing outcome, and changes in taste sensation. It was observed that irrespective of the width of the external auditory canal, endoscopic approach offered better access to the footplate area requiring lesser bone removal and chorda tympani repositioning. The operating time, post-operative pain, and changes in taste sensation were significantly less in the endoscopic group. However, no difference was noted in terms of the post-operative hearing outcome and incidence of vertigo. Endoscopic stapedotomy has clear advantages in terms of the technicality and accessibility to the working area as well as faster recovery.

Objectives To compare endoscopic transcanal approach to attic cholesteatoma with conventional microscopic transcanal technique Methods Seventy‐eight patients diagnosed with attic cholesteatoma were randomly assigned into two groups—one undergoing endoscopic approach and the other microscopic technique. The two groups were compared in terms of area of exposure, access to hidden areas in terms of Middle Ear Structural Visibility Index (MESVI), intraoperative time, postoperative pain, vertigo, long‐term hearing, and surgical outcomes. Results The mean area of exposure in endoscopic atticotomy required was less than that in microscopic group and was found to be statistically significant. The median MESVI for endoscopic group better than that for microscopic group (P < .0001). The mean operating time in endoscopic approach was less than that in case of microscopic approach, with P < .05. The median postoperative pain score in the endoscopic group was less than that in microscopic group (P < .05). No significant difference was found between two groups in terms of vertigo experienced at the end of first week and air‐bone gap closure. When long‐term surgical outcomes were assessed at 1 year, in endoscopic group, one patient had disease recurrence, one cartilage displacement, one perforation, and two had retraction pocket formation. In the microscopic group, two patients had recurrence, four cartilage displacement, one perforation, and five retraction pocket formation. Conclusion Endoscopic management of limited attic cholesteatoma has definite advantages over the conventional microscopic approach. Level of Evidence 1 Laryngoscope, 130:2461–2466, 2020

Myringoplasty aims to reconstruct the tympanic membrane, restoring protection to the middle ear and improve hearing. Success of Myringoplasty in terms of anatomical closure is influenced by many factors. This study focuses on the influence of size and site of tympanic membrane perforation on success rate of Myringoplasty. This is a prospective study of 60 patients who underwent myringoplasty and were then followed up for 6 months from the date of operation. Patients with dry perforation, with good cochlear reserve, intact and mobile ossicular chain, functioning Eustachian tube were selected randomly for the operation. Video Otoendoscopy of all cases with storz 0 degree endoscope were done. All images were recorded on the computer [DELL VOSTRO 3400]. Using 'Image J' [version 1.35j] geometrical package, the area of perforation (P) and the entire area of the tympanic membrane (T) were calculated. Then, the percentage area of the perforation [P/T 9 100 %] for each ear was obtained. Site of perforation also documented. Success rate for pin-point and small perforations was 100 %, for medium size 80 %, and for large & subtotal perforations 69.2 and 42.9 % respectively. We regard size of the perforation as a major factor that influences success of Myringoplasty. Site of perforation failed to be a statistically significant influencing factor in this study.

Background Mastoidectomy is associated with extensive bone-drilling which makes it a major aerosol generating procedure. Considering the ongoing COVID-19 global pandemic, it is essential to devise methods to minimize aerosolization and hence ensure safety of the healthcare workers during the operative procedure. Methods Two disposable surgical drapes are used to create a closed pocket prior to commencement of mastoid bone-drilling. This limits aerosolization of bone-dust in the external operating theatre environment. Conclusion Two-drape closed pocket technique is an easy, cost-effective and safe method to limit aerosolization of tissue particles during mastoidectomy.

Objective The aim of this study was to assess change in temperature, audiometric outcomes and post-operative complications following exposure to different light sources during endoscopic ear surgery. Method A total of 64 patients diagnosed with chronic otitis media with central perforation and pure conductive hearing loss underwent endoscopic type 1 tympanoplasty. The patients were randomised into two groups based on the light source used: xenon or light-emitting diode. Temperature was measured using a K type thermocouple at the promontory and round window niche. Mean temperature change with respect to operating time, mean audiometric change, incidence of vomiting in the first 24 hours, vertigo and tinnitus at the end of the first week were observed. Results Mean temperature change showed a statistically significant difference with increasing length of operating time with the xenon light source and when the two light sources were compared for a particular time interval. Mean audiometric change showed statistically significant deterioration at higher frequencies (4, 6 and 8 kHz) with the xenon light source but only at 8 kHz for the light emitting diode source. When the mean audiometric change was compared between light sources for a particular frequency, statistical significance was found at 4, 6 and 8 kHz. Post-operative complications were vomiting, vertigo and tinnitus (p-values of 0.042, 0.099 and 0.147, respectively, between two groups). Conclusion Light emitting diodes are associated with less significant middle-ear temperature rises and audiometric changes at higher frequencies when compared to xenon light sources. Hence, xenon should be replaced with cooler light sources.

Background: Skin adnexal tumors (SAT) encompass a wide spectrum of benign and malignant tumors that differentiate toward one or more adnexal structures found in normal skin. Overall incidence of SATs is low yet they can be challenging to diagnose. Our study aims at analysis of histopathological spectrum of various SATs according to age, sex and anatomic locations along with histopathological features.Methods: It was a retrospective cross-sectional study conducted over a period of 2 years from June 2017 to May 2019. All cases were retrieved from department registries and analyzed.Results: Out of the total 4013 biopsies, 25 cases were diagnosed as SATs comprising 44% of tumors with eccrine sweat gland differentiation followed by tumors showing hair follicle differentiation (32%), sebaceous differentiation (16%) and apocrine gland differentiation (8%). The age ranged from 4 years to 68 years and male: female ratio was 1:1.5. Most of the tumors were benign (84%) while only 16% were malignant. Pilomatricoma (19%) was the most common benign tumor while sebaceous carcinoma (75%) was the most common malignant tumor.Conclusions: Skin adnexal tumors are relatively rare neoplasm. Malignant cases are less common than benign ones. Histopathology is quite essential for diagnostic point of view.

Since late 2019, SARS-CoV2 pandemic has spread worldwide. After several generations without a severe pandemic, the mixture of health and economic crisis has hit populations in all continents. The high degree of connectivity that States share, enabled by the current transportation and communication technologies, caused different regions of the world to be affected by coronavirus disease at almost the same time. Yet States responses to the SARS-CoV2 pandemic were not the same. This brief focuses on the BRICS countries individual, bilateral and collective responses to the international health crisis caused by coronavirus disease, from the early detection of COVID-19 cases in China in late December 2019 to the current surge of cases in Brazil.

Objectives/Hypothesis To compare endoscopic ossiculoplasty with conventional microscopic technique in terms of postoperative hearing outcomes and complications. Study Design Randomized controlled trial. Methods One hundred eighteen patients diagnosed with ossicular chain discontinuity were randomly assigned into two groups, one undergoing endoscopic ossiculoplasty and the other undergoing ossiculoplasty by the microscopic technique, with the operating surgeon being same for both groups. The two groups were compared in terms of operative time, postoperative air‐bone gap, mean air‐bone gap closure, and incidence of complications. Teflon prostheses (partial ossicular chain replacement prosthesis [PORP] and total ossicular chain replacement prosthesis [TORP]) were used for reconstruction in all cases. Results Endoscopic ossiculoplasty with PORP rendered a statistically significant mean postoperative air‐bone gap and air‐bone gap closure at 1 month when compared to that of microscopic PORP ossiculoplasty. However, there was no significant difference between the two techniques in terms of mean postoperative air‐bone gap and air‐bone gap closure at 3 and 6 months. In the TORP ossiculoplasty cases, there was no significant difference in mean postoperative air‐bone gap and air‐bone gap closure at 1, 3, and 6 months. In terms of operative time and incidence of complications, no statistical significance was found between the two groups. Conclusions Endoscopic ossiculoplasty appears to provide superior visualization and better early audiological outcome (in PORP ossiculoplasty cases) when compared to microscopic technique. However, long‐term audiological outcomes and incidence of complications remain comparable. Level of Evidence 1 Laryngoscope, 130:797–802, 2020