To determine the incidence of otogenic complications of Chronic suppurative otitis media (CSOM) and its management. The study was conducted at the tertiary referral centre and teaching hospital. An analysis was made about the clinical and operative findings, surgical techniques and approaches, the overall management and recovery of the patient. The data were then compared with the relevant and available literature. Over the study period of 12 years, a total 45 cases of CSOM with complications were reviewed. Out of these 45 cases, 20 cases had extracranial (EC) while 25 cases had intracranial (IC) complications. The prevalence of each complication was 0.17 and 0.13 %, IC and EC respectively. The commonly encountered IC complications were brain abscess, meningitis and lateral sinus thrombophlebitis. Among the EC complications, mastoid abscess followed by labyrinthitis and facial nerve palsy were encountered. The reliable warning signs and symptoms of IC complications were fever, headache, earache vestibular symptoms, meningeal signs and impairment of consciousness. Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus epidermidis were the common organism isolated. Cholesteatoma and granulation in the middle ear were the major findings in both groups of cases. Surgery was main modality of management of these conditions. We observed that two patients fail to regain full facial nerve function despite of surgery. Mortality rate was zero but morbidity was seen in 15 % (3) and 28 % (7) of cases in EC and IC group respectively. The epidemiological presentation, clinical features and results of treatment are discussed. CSOM complications, despite its reduced incidence still pose a great challenge in developing countries, as the disease present in the advanced stage leading to difficulty in management and consequently higher morbidity. In this study we emphasize the importance of the accurate and early diagnosis followed by adequate surgical therapy with multidisciplinary approach.

The aim of this study is to investigate the relationship between the presence of the cervical lymph node with central necrosis as on the preoperative imaging and postoperative histopathological identification of the lymph node extra capsular spread. This study is a prospective study conducted at J.L.N. Hospital and Research Centre, Bhilai (C.G), from August 2011 to January 2014. Thirty patients with metastatic head and neck squamous cell carcinoma were enrolled. All candidates were subjected to a detailed history taking and clinical examination. Their preoperative computed tomography (CT) scans were assessed with attention to the presence and absence of lymph node, lymph node size, shape, level, presence or absence of the lymph node central necrosis and other signs of the ECS such as thick walled enhancing nodal margin, loss of margin definition, alteration of adjacent fat planes. These patients then underwent surgery which included resection of the primary with the neck dissection. The preoperative records of the lymph node size and location were observed radio-graphically and analyzed with the resected lymph node histopathologically. These data was used for finding out correlation. Of the total 30 patients studied, 24 patients were male and 6 patients female with ratio of 4:1. The most common group of the patients were of malignancy of gingivobuccal sulcus. Out of the 30 patients 19 patients had the radiographic evidence of the central necrosis, out of which 11 had the extra capsular spread on the histological analysis. In no patients did we found histopathology extra capsular spread without central necrosis. Thus the central necrosis on the CT has the high sensitivity for detection of the extra capsular spread. Out of the 19 lymph node without extra capsular spread, 11 lymph nodes had no central necrosis on the preoperative CT, remaining 8 lymph node were having central necrosis on CT whereas post op histopathology of these 8 lymph nodes showed metastatic deposit, indicating the low specificity of the central necrosis in detection of the ECS. Lymph node central necrosis on pre-operative CT is sensitive indicator with a high negative predictive value for lymph node extra capsular spread. Future studies focusing on identifying molecular mediator involved in ECS to determine targets for adjuvant therapies in this subset of patients are recommended.

Two cases of bilateral moderate to severe sensorineural hearing loss due to oral administration of metronidazole are reported. There has been only one case report of deafness following metronidazole therapy in the world literature. The hearing loss recovered gradually in a period of four to six weeks following withdrawal of drug and oral steroid therapy. The possible mechanism of ototoxicity is discussed. Awareness by the treating physician of ototoxicity due to any drug is stressed.

Hearing loss as a side effect in patients with head and neck malignancies with chemoradiation is frequently ignored. Its effects on auditory functions are less studied and there are studies done on animals which are less reliable. The present study was undertaken to identify the type of hearing loss and also to quantify the degree of hearing loss in these patients. A prospective, descriptive study was undertaken in histologically proven head and neck cancer patients treated with cobalt 60 teletherapy who received a dose of 60-66 Grays (Gy) over a period of 6-7 weeks with concurrent Cisplatin 30 mg/m 2 once weekly for 6 weeks. The study included 40 patients (80 ears) undergoing chemoradiation. A baseline pure tone audiometry and impedance audiometry was performed in all the cases prior to the therapy and the same was repeated immediately after the completion of treatment, at 8 and 16 weeks. The changes in pure tone level thresholds and impedance from baseline were correlated with the dose of radiation and chemotherapy. Sensori neural hearing loss (SNHL) and conductive hearing loss was observed in 82.5 and 17.5 % respectively. At the end of 16 weeks, SNHL was found in 27.5, 72.5 and 82.5 % at 2, 4 and 8 kHz respectively. In addition, Eustachian tube dysfunction and Otitis media with effusion was observed in 10 and 7.5 % of patients respectively which lead to conductive hearing loss. Further, it was noted that SNHL in patients with high risk site malignancy (81.8 %) was alarmingly higher compared with low risk site malignancy (18.1 %). The hearing loss at 62, 64 and 66 Gy in comparison to 60 Gy was statistically significant. Hearing loss, specially SNHL was the predominant finding in our study with [80 % of patients showing the inner ear damage due to irradiation of head and neck malignancies. Although, all the frequencies like 2, 4 and 8 kHz were significantly affected, SNHL was more marked in the latter two frequencies. Nearly, 90 % of the patients who had SNHL belonged to high risk site category of head and neck malignancies. Increasing the radiation dosage was directly proportional to the degree of hearing loss with the dose more than 60 Gy causing significant injury to the middle and inner ear.

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Background and Aims:Airway management in anaesthesia for maxillofacial surgical procedures is tricky at times when the nasal/oral routes are contraindicated or are impossible. Tracheostomy as an alternative inherits its own complications. We present a case series of the submandibular route for tracheal intubation as an alternative.Methods:The procedure was performed in ten selected adult patients with maxillofacial/mandibular fractures associated with a fracture of skull base or nasal bone. All of them were medically stable with no need of intensive care or mechanical ventilation in post-operative period.Results:Submandibular intubation in all ten patients of panfacial fractures allowed uninterrupted surgical techniques with a secured airway. All patients were reverted to oro-tracheal tube at the end of surgery as immediate maxillomandibular fixation was not necessary. The patients were extubated after recovery from anaesthesia before they left the operating theatre. One patient in the post-operative period had a superficial infection of incision site that responded well to local treatment. No other complications were encountered in the intra-operative or post-operative period.Conclusion:In complex maxillofacial injuries, when oral or nasal intubation hampers surgeon's field of view, submandibular intubation offers an effective alternative to short-term tracheostomy along with small risk potential. There is a need to emphasise its regular application in such cases so that technique can be mastered by both surgeons and anaesthesiologist.

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