Nasal obstruction due to deviated nasal septum is a common problem encountered by otolaryngologists. A variety of surgical procedures have been tried in the treatment of the same. This study was conducted to evaluate the outcomes and complications of endoscopic and conventional septoplasty. This is a prospective, randomized study. Fifty patients with symptomatic deviated nasal septum were included in the study, 25 of them underwent conventional septoplasty and the rest underwent endoscopic septoplasty. The difference in the functional outcome of both the surgeries was insignificant. There was a significant difference with respect to complications. Endoscopic septoplasty had better outcome with respect to complications. It is easier to correct posterior deviations and isolated spurs with endoscopic septoplasty. Complications are lesser with endoscopic septoplasty.

Effectiveness of endoscopic posterior nasal neurectomy for the treatment of intractable rhinitis INTRODUCTIONRhinitis is an inflammatory condition affecting the lining of the nose, characterized by nasal congestion, rhinorrhea, itching, sneezing and/or post-nasal discharge 1 . More than 20% of the population is affected by chronic rhinitis [2][3][4] . Depending on whether an allergic etiology is implicated, non-infectious rhinitis can be subdivided into allergic and non-allergic. With 600 million of world's population affected, allergic rhinitis is the most prevalent atopic disorder. The incidence of allergic rhinitis is on steady increase 5 . Various etiological factors have been postulated for chronic rhinitis -these include allergy, occupational exposures, hormonal changes, smoking, xylometazoline abuse, etc. The standard treatment strategy is medical (histamine antagonists, leukotriene receptor antagonists, intranasal corticosteroids, etc.) But many times, these therapies show limited effectiveness and cause substantial burden for treatment cost on the long term. In addition, the symptoms of intractable rhinitis can cause social embarrassment with a profound effect on patients' quality of life.Surgical management can be considered in such patients with intractable rhinitis. Various surgical techniques have been documented including Vidian neurectomy 6 , posterior nasal neurectomy, inferior turbinate reduction, with varying success rates [5][6][7][8] . In view of this, we are studying the effectiveness of posterior nasal neurectomy (PNN) in patients who have intractable rhinitis, refractory to maximum medical therapy. The outcome is assessed with patient's level of satisfac-ABSTRACT BACKGROUND. Chronic rhinitis is a clinical condition affecting more than 20% of the world population. The standard treat-

<p class="abstract"><strong>Background:</strong> Aplasia or agenesis of frontal sinuses is not uncommon in the literature. Previous studies have shown unilateral aplasia varying from 1-10% and bilateral agenesis of frontal sinus in 3-10% of patients. It is critical for the operating surgeon to be well aware of the normal anatomy and the variations while doing procedures like endoscopic sinus surgeries, cranialisation of frontal sinuses, frontal sinus trephination, and during anterior skull base procedures. The aim of this study is to demonstrate the incidence of anatomic variations of frontal sinus among Indian populations<span lang="EN-IN">. </span></p><p class="abstract"><strong>Methods:</strong> We did a cross sectional study on computed tomography (CT) scan of head, nose and paranasal sinuses in 730 patients above the age of 10 years. We excluded pregnant ladies, patients with prior sinus surgeries, sinonasal tumors, nasal polyposis, craniofacial trauma<span lang="EN-IN">.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">We observed an incidence of 6.2% of unilateral aplasia of frontal sinus (2.2% in males and 4.0% in females, 3.7% right side and 2.5% left side) and 2.5% of bilateral frontal sinus aplasia (0.95% in males and 1.5% in females). </span></p><p class="abstract"><strong>Conclusions:</strong> Frequent occurrence of frontal sinus aplasia highlights the need to gain a thorough knowledge of the normal anatomy and its variations in order to navigate safely through the nose during basic endoscopic sinus or anterior skull base surgeries to avoid complications<span lang="EN-IN">.</span></p>

Introduction Approximately 20% of patients with tracheostomy are discharged from hospital with the tracheostomy  tube in situ. Proper long term care and management of such tracheostomy patients remains as a challenge to care givers. Fracture of metallic tracheostomy tube (TT) with aspiration of the fragment into tracheobronchial airway is a rare complication of  tracheostomy. Case Report Here we are presenting a case of a 42-year-old male patient, presented to the emergency department with complaint of mild respiratory distress following aspiration of fractured metallic TT and a novel method in removing the dislodged fragment. Discussion A detailed review of literature has been included to discuss different aspects of aspiration of fractured fragment of tracheostomy tube and best practice recommendations for proper tracheostomy care. Conclusion Educating the care-giver about care of the tracheostomized patient in general and care of the tracheostomy tube in particular, may help reduce accidental complications.

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Background: Acute otitis media (AOM) is the most common childhood illness necessitating medical therapy for children younger than 5 years. Long-term and exclusive breastfeeding is associated with protection against AOM. However, faulty feeding position and habits can lead to the occurrence of AOM in infants. Objectives: The aim of this study is to assess the risk of occurrence of AOM with faulty feeding positions during the 1st year of life. Materials and Methods: All breastfed infants <1 year with a provisional diagnosis of AOM, during August 2015 - January 2016 (6 months), were included in the study. Syndromic children, children with craniofacial anomalies, bottle-fed infants, and those not willing to participate in the study were excluded from the study. Demographic details and detailed history, especially, the feeding position were collected from the parents. Diagnosis of AOM was confirmed by a senior ENT surgeon after otoscopic examination. Results: 118 children with AOM were statistically analyzed. They aged between 1 month and 12 months with a mean of 6.8 and standard deviation of 4.1 months. There were 68 (57.62%) males and 50 (42.37%) females. No statistical significance was observed for sex or laterality with AOM. A statistically significant correlation was observed between AOM and age groups, AOM and position of the baby. Conclusion: In this study, we have observed that feeding the infant in supine position significantly increases the risk of AOM in infants.

Background: Hearing loss in early life can have deleterious effects on child’s psychosocial, scholastic and social-emotional development. Early identification and timely intervention can provide the child with better speech and language development. This study has been done to estimate the prevalence of hearing impairment among high risk infants as per Joint Committee on Infant Hearing (JCIH) criteria and to study the risk factors associated with neonatal hearing impairment.Methods: This multicentric observational study was conducted among 613 high risk infants admitted and discharged from neonatal intensive care units (NICU) of Academy of Medical Sciences, Kannur, Kerala and Sri Siddhartha Medical College and Research Centre, Tumakuru, Karnataka, India (level III neonatology units with an NICU admissions of average around 1200 per year), during the period August 2015 - August 2016 (12 months). The babies were selected based on the JCIH 2007 criteria. All babies were subjected to behavioral audiometry (BA) and Oto Acoustic Emissions (OAE), preferably within 3 weeks. Those failing OAE were reevaluated at 6th week and with Auditory brain stem response (ABR) within 3 months time. Results: A total of 613 high risk babies were screened. 42 (6.76%) among them were having hearing impairment. The most common risk factors associated with hearing impairment was NICU stay for more than 24 hours, prematurity, low birth weight and meningitis/sepsis etc.Conclusions: Hearing impairment among high risk babies is not a rare condition. In our study, the prevalence was 6.76%. Low birth weight, admission to NICU for more than 24 hours, low APGAR, meningitis/sepsis, maternal and neonatal complications are significant risk factors for hearing impairment among neonates. This highlights the need for neonatal screening. Though we recommend a universal screening program, at least a targeted approach should be practiced in neonatal care. Those babies who are found to have hearing impairment should be closely followed up with early intervention and rehabilitation.

<p class="abstract"><strong>Background:</strong> Uncinate process (UP) is a part of ethmoid bone, which is a thin sickle shaped projection on the lateral wall of nose. UP extends from the frontal recess superiorly and inferiorly to the ethmoid process of inferior turbinate. Various studies have shown that superior attachment of uncinate process (SAUP) is the key to frontal recess region in endoscopic sinus surgeries (ESS). But these studies have yielded conflicting results, showing multiple patterns and classifications of superior attachment of uncinate process. Knowing the anatomic variations of SAUP will help the surgeon to plan the endoscopic sinus surgery and to avoid the unwanted complications. Hence this study was conducted to observe and classify the superior attachment of uncinate process and to localize the frontal sinus outflow tract<span lang="EN-IN">. </span></p><p class="abstract"><strong>Methods:</strong> We did a retrospective cross sectional study, consisting of 100 patients including both sexes, above the age of 10 years. We excluded pregnant ladies, patients with prior sinus surgeries, sinonasal tumours, nasal polyposis, and craniofacial trauma<span lang="EN-IN">.  </span></p><p class="abstract"><strong>Results:</strong> We observed Type I SAUP, in 67.5% (n=135) cases, Type II SAUP in 18.5% (n=37), Type III attachment in 9.5% (n =19) and Type IV in 4.5% (n=9). Bilaterally similar attachments observed in 96% cases. Rest of the cases (4%), the attachment patterns was varying between sides<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The site of SAUP is highly variable. The most common type of SAUP is Type I (67.5%) followed by Type II (18.5%), Type III (9.5%) and Type IV (4.5%)<span lang="EN-IN">.</span></p>