<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Chronic maxillary sinusitisis is one of the most frequent diseases presenting in ENT out patient department seeking medical attention^.<strong> </strong>Defects in the fontanelle region of the lateral nasal wall have been described as accessory ostia. The presence of AMO in both pre and post operated cases of chronic maxillary sinusitis can cause recirculation of mucus leading to recurrences. In the present study we will investigate the incidence of accessory ostia in patients with clinical and radiological signs of chronic maxillary sinusitis. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">The study included 100 patients visiting the out patient department of Shri Sathya Sai Medical College and Research Institute selected according to inclusion criteria with a clinical diagnosis of chronic rhino sinusitis which was confirmed by high resolution CT scan and those patients were subjected to diagnostic nasal endoscopy under local anesthesia.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The study group consisted of total 100 patients among whom 56 were male patients and 44 were female patients. Accessory maxillary ostia were detected in 23% of the cases and in rest of the 77% cases it was absent. Among the 23 cases in 35% cases accessory ostia were found to be bilateral and in 65% cases it was found to be unilateral. Among the cases where accessory ostia were seen, in 39% cases only accessory ostia were found. Where as in 17.39% cases it was associated with concha bullosa, in 65.2% cases there was deviated nasal septum and in 8.7% cases paradoxical middle turbinate were found to be present. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">To conclude, the present study revealed close association of accessory ostia with chronic maxillary rhino sinusitis. It was also found that majority of the cases accessory ostia were found to be unilateral and were frequently found in the posterior fontanelle region.</span></p>

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">C</span><span lang="EN-IN">hronic sinusitis is repeated bouts of acute infection or persistent inflammation of the sinuses. The range of anatomic variants that can interfere with the mucociliary drainage of osteomeatal complex including concha bullosa, deviated nasal septum, uncinate process variations, ethmoid bulla, paradoxical middle turbinate, agger nasi and Haller cells. This is also important in surgeon point of view to know about detail knowledge of lateral nasal wall, paranasal sinuses, surrounding vital structures and anatomical variation. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Observational case series study in which 90 cases of chronic rhinosinusitis patients attending the ENT outpatient department from November-2015 to November-2016 in Shri Sathya Sai Medical college and Hospital, who had chronic sinusitis for more than three months duration not responding to the medical line treatment and who are willing to undergo functional endoscopic sinus surgery are studied and statistically analysed.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">In our study we found anatomical variation in 93% of chronic sinusitis patients. In our study it was observed that 52% of patients with two anatomical variation, 41% patients presented with single anatomical variation and 7% patients presented with no anatomical variation. In our study deviated nasal septum was the most common anatomical variant noted followed by unilateral concha bullosa, medialized uncinate process, paradoxical middle turbinate, haller cell and agger nasi. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">In our study it was concluded that presence of anatomical variations is common in patients with chronic sinusitis. Presence of more than one anatomical variations significantly contributes to disease process.<strong> </strong>Deviated nasal septum is the most common anatomical variation in our study followed by concha bullosa, medialized uncinate process.</span></p>

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<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Allergic rhinitis is a common cause for recurrent rhinosinusitis. The microbiology in allergic nasal mucosa has not been much documented. The aim of the study is to identify the microbes in the middle meatus in patients with allergic rhinitis and to compare with the normal nasal flora. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A cross sectional study was conducted in our institute to study the nasal microbial pattern in 50 patients with allergic rhinitis and was compared with 50 normal healthy nasal flora. Nasal swabs were taken from middle meatus under endoscopic guidance in both the groups and sent for microbial analysis.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Organisms like <em>Klebsiella</em>, <em>E.coli</em>, and <em>Staphylococcus aureus</em> were predominant isolates in patients with allergic rhinitis, whereas Staph epidermidis were predominant in controls. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">This alteration in microbial flora could possibly explain recurrent sinonasal infections in patients with allergic rhinitis.</span></p>

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<p class="abstract"><span lang="EN-IN">Kartagener’s syndrome is an autosomal recessive disease characterized by the tetrad of situs inversus, bronchiectasis, sinusitis and infertility. It is a subset of a larger group of disease known as primary ciliary dyskinesia. A 23 year old male patient presented to our hospital with complaints of Right sided headache for the past 3 weeks. General Physical examination was normal except that the heart sounds were heard over the right side. Dextrocardia was suspected. Routine ENT and Diagnostic nasal endoscopy examination revealed deviated septum towards the left along with pale greyish polyp like mass in the right nasal cavity. CT PNS was ordered. It showed bilateral frontal, ethmoidal and maxillary sinusitis with Right nasal polyp. Routine Blood investigations were normal but Chest X-ray showed dextrocardia with fundal shadow over the right side and normal ECG was obtained only when the chest leads were reversed. USG abdomen confirmed the suspicion of situs inversus totalis. To rule out Kartageners syndrome HRCT Chest was done which revealed normal lungs with no findings. Sperm analysis was also done which was normal except for the count (&lt;15 million/ml). Saccharin test was performed and it was delayed (&gt;20 min). Anesthetic fitness was obtained and he was taken up for surgery - Septoplasty with fess.<em> </em>The diagnosis of kartageners syndrome was done based on clinical and radiological findings, with variation in form of no bronchiectasis and oligospermia. This type of atypical presentation of Kartagener’s syndrome might be a rare sub type of the disease which is infrequently reported.</span></p>

<p class="abstract">Fronto cutaneous fistula is a very rare entity which usually occurs as a complication of long standing frontal sinusitis leading to frontal bone osteomyelitis. Its incidence has decreased due to the wide spread use of antibiotics. In this era we would like to report a rare case of fronto cutaneous fistula secondary to sino nasal malignancy. A 65 year old female presented to the ENT out patient service of our Hospital with complaints of discharging sinus in the left forehead for 2 months. There was blurring of vision in the right eye for one year .She was a known diabetic. General examination showed that there was a mild swelling around the right orbit and the right eye was significantly proptosed. Routine ENT examination revealed that there was a suspicious nasal mass in the right nasal cavity on anterior rhinoscopy later confirmed by diagnostic nasal endoscopy. Ear and Throat were normal. Neurology opinion was obtained which stated that the findings were suggestive of an intracranial Space occupying lesion extending into the right orbit. Urgent CT was ordered. Routine laboratory investigations were normal except the ESR value which was 60 mm at end of 1 hour. CT scan showed a sinonasal mass existed centered over the right nasal cavity extending into the surrounding sinuses, near complete erosion of lamina papyracea with extension into right orbit. Biopsy of was done. The biopsy showed squamous cell carcinoma with poorly to moderately differentiated cells. However as the patient was not willing for surgery, hence chemoradiation was advised.</p>

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) is the disease of the middle ear cleft, which presents as hearing loss and ear discharge. This study aimed to assess the role of pure tone audiometry (PTA) in analysing the ossicular erosion in mucosal type of CSOM subjects.</p><p class="abstract"><strong>Methods:</strong> The current cross-sectional study was conducted among 60 people with mucosal CSOM.  Preoperative hearing was assessed by PTA. The surgeries were done and intra operative ossicular status were recorded. IBM SPSS 20 software was used for the analysis. Student t-test was used to correlate ossicular status and PTA findings.  </p><p class="abstract"><strong>Results:</strong> Among 60 subjects, 12 (20%) patients had eroded incus and 53 (88.3%) had normal stapes. The malleus was preserved in all patients. The result of our study showed that an average ABG of 58 dB at 500 Hz, 47 dB at 1 kHz, 41 dB at 2 kHz and 41 dB at 4 kHz in patients with   ossicular erosion. ABG for 500 Hz and 1 kHz were statistically significant for eroded incus. ABG for 500 Hz, 1 kHz, 2 kHz and 4 kHz were all statistically significant for eroded stapes.</p><p class="abstract"><strong>Conclusions:</strong> There is a significant difference between the PTA findings at different frequencies between intact and eroded ossicular chain. Pre-operative ABG helps us to assess the status of incus and stapes.</p>