Role of high resolution computerized tomography (HRCT) of temporal bone is established in cases of atticoantral chronic suppurative otitis media (CSOM) with intracranial complications. Routine use of HRCT in management of patients of atticoantral CSOM without intracranial complications has been an issue of debate. The aim of this study was to evaluate the routine use of HRCT of temporal bone in such cases. This study was a prospective study done at LG hospital, AMC MET Medical College, Ahmedabad to evaluate and compare the temporal bone findings in HRCT and intraoperative findings in 100 patients with atticoantral CSOM. All patients underwent HRCT screening followed by surgical exploration of middle ear cleft. In extent of disease HRCT showed very high sensitivity and specificity for epitympanum (100, 94%) and mesotympanum (98, 98%) areas. It gave valuable information of disease extent in hidden areas like sinus tympani and facial recess of mesotympanum. HRCT satisfactorily delineated malleus and incus erosion but had 75% sensitivity for detecting erosion of stapes suprastructure, though specificity was of 97%. For bony anatomical landmarks HRCT showed very high sensitivity and specificity for detecting erosion of lateral semicircular canal, tegmen tympani and sinus plate. Detection of facial canal erosion on HRCT had moderate sensitivity of 75%. We concluded that routine use of HRCT is justified as a reliable preoperative tool in patients with atticoantral CSOM without intracranial complications and it helps to plan type of surgical intervention. HRCT has limited role to distinguish between granulations and cholesteatoma and also to delineate stapes supra structure and facial nerve canal.

Background Increased occurrence of mucormycosis during the second wave of COVID-19 pandemic in early 2021 in India prompted us to undertake a multi-site case–control investigation. The objectives were to examine the monthly trend of COVID-19 Associated Mucormycosis (CAM) cases among in-patients and to identify factors associated with development of CAM. Methods Eleven study sites were involved across India; archived records since 1st January 2021 till 30th September 2021 were used for trend analysis. The cases and controls were enrolled during 15th June 2021 to 30th September 2021. Data were collected using a semi-structured questionnaire. Among 1211 enrolled participants, 336 were CAM cases and 875 were COVID-19 positive non-mucormycosis controls. Results CAM-case admissions reached their peak in May 2021 like a satellite epidemic after a month of in-patient admission peak recorded due to COVID-19. The odds of developing CAM increased with the history of working in a dusty environment (adjusted odds ratio; aOR 3.24, 95% CI 1.34, 7.82), diabetes mellitus (aOR: 31.83, 95% CI 13.96, 72.63), longer duration of hospital stay (aOR: 1.06, 95% CI 1.02, 1.11) and use of methylprednisolone (aOR: 2.71, 95% CI 1.37, 5.37) following adjustment for age, gender, occupation, education, type of houses used for living, requirement of ventilatory support and route of steroid administration. Higher proportion of CAM cases required supplemental oxygen compared to the controls; use of non-rebreather mask (NRBM) was associated as a protective factor against mucormycosis compared to face masks (aOR: 0.18, 95% CI 0.08, 0.41). Genomic sequencing of archived respiratory samples revealed similar occurrences of Delta and Delta derivates of SARS-CoV-2 infection in both cases and controls. Conclusions Appropriate management of hyperglycemia, judicious use of steroids and use of NRBM during oxygen supplementation among COVID-19 patients have the potential to reduce the risk of occurrence of mucormycosis. Avoiding exposure to dusty environment would add to such prevention efforts.

Background: Dizziness and disequilibrium are common complaints in both general adult and the geriatric population. Dizziness is often used to describe the sensations of vertigo, lightheadedness, imbalance, presyncope, disorientation, and/or gait instability. The cause may be otologic, neurologic, cardiovascular, psychiatric, orthopedic or ophthalmologic. Benign paroxysmal positional vertigo(BPPV) is, by far, the most common cause of episodic vertigo. Materials and M ethods: This study was done in a tertiary care center of Ahmedabad, Gujarat, in patients above age of 20 and with BPPV. The purpose of the study was to compare the efficacy of Epley's maneuver with medical therapy versus medical therapy alone in patients of BPPV. Results: A total of 50 patients were divided into two groups: 25 to the group A which received Epley's maneuver with drug therapy and 25 to the group B which received only drug therapy. In our study, Epley's maneuver with medical therapy was found to be more effective than medicine given alone. Conclusion: This study shows that the Epley maneuver with medical therapy provides effective and longterm control of symptoms in patients with BPPV. It benefits over medical therapy alone in terms of avoiding the delay in vestibular compensation and recurrence.

Background: -High Resolution Computed Tomography (HRCT), a modification of routine CT, provides a direct visual window in the temporal bone providing minute structural details [1]. Purpose of the present study was to evaluate the normal variations, pathological processes (infections and congenital anomalies) and their extent involving the temporal bone along with their complications on HRCT and to correlate these imaging findings surgically. Aim of the Study: -To find out about the causes, different types of pathologies, male female ratio, and management accordingly. Materials and Methods: -The prospective study included 100 patients who were presented to ENT department of AMC MET MEDICAL COLLEGE with clinically suspected temporal bone or ear pathologies. After detailed clinical examination, the patients were subjected to high resolution computed tomography (HRCT) examination and most of them underwent surgery. The imaging findings were correlated with the surgical findings. The surgical findings were considered as final. Observation and Results: -Of 100 cases examined, we had 93 cases of middle ear cleft pathology (chronic Otitis media, cholesteatoma, soft tissue densities without cholesteatoma) out of which 25 cases were cholesteatoma, 22 cases of soft tissue density in mastoid cavity and 46 cases had middle ear opaque homogenous densities, 4 traumatic cases & 2 congenital pathology. Conclusion: -HRCT is a revolutionary imaging modality that helps in evaluating the distribution features, localization and assessing the extent of various pathologies affecting the temporal bone. The clinical and radiological findings showed a high level sensitivity with intraoperative findings as regards to the presence of cholesteatoma, changes of the ossicular chain and erosion of the lateral semicircular canal. Where criteria for cholesteatoma was soft tissue density in middle ear or mastoid with bony erosion, other cases in this study were 2 congenital cases in which the findings of HRCT were in co-relationship with the intraoperative finding. One case of facial nerve schwannoma was diagnosed on HRCT and confirmed intraoperatively. 4 cases of trauma that stated fracture of longitudinal segment of temporal bone with facial palsy. One needed surgical exploration for facial nerve decompression rest all improved by conservative management. Hence HRCT was very sensitive and specific with various pathologies confirmed intraoperatively.