Nasal polyps (NP) are one of the most common inflammatory mass lesions of the nose, affecting up to 4% of the population. They present with nasal obstruction, anosmia, rhinorrhoea, post nasal drip, and less commonly facial pain. Their etiology remains unclear, but they are known to have associations with allergy, asthma, infection, fungus, cystic fibrosis, and aspirin sensitivity. However, the underlying mechanisms interlinking these pathologic conditions to NP formation remain unclear. Also strong genetic factors are implicated in the pathogenesis of NP, but genetic and molecular alterations required for its development and progression are still unclear. Management of NP involves a combination of medical therapy and surgery. There is good evidence for the use of corticosteroids (systemic and topical) both as primary treatment and as postoperative prophylaxis against recurrence, but the prolonged course of the disease and adverse effects of systemic steroids limits their use. Hence several new drugs are under trial. Surgical treatment has been refined significantly over the past 20 years with the advent of endoscopic sinus surgery and, in general, is reserved for cases refractory to medical treatment. Recurrence of the polyposis is common with severe disease recurring in up to 10% of patients. Over the last two decades, increasing insights in the pathophysiology of nasal polyposis opens perspective for new pharmacological treatment options, with eosinophilic inflammation, IgE, fungi and Staphylococcus aureus as potential targets. A better understanding of the pathophysiology underlying the persistent inflammatory state in NP is necessary to ultimately develop novel pharmacotherapeutic approaches. In this paper we present the newer treatment options available for better control and possibly cure of the disease.

Modern-day high performance aircraft are more powerful, more efficient, and, unfortunately, frequently produce high noise levels, resulting in noise-induced hearing loss (NIHL) in military aircrew. Military pilots are required to perform many flight duties correctly in the midst of many challenges that may affect mission completion as well as aircraft and aircrew safety. NIHL can interfere with successful mission completion. NIHL may also require aircrew to be downgraded from flying duties, with the incumbent re-training costs for downgraded personnel and training costs for new/replacement aircrew. As it is not possible to control the source of the noise without compromising the efficiency of the engine and aircraft, protecting the aircrew from hazards of excessive noise and treating NIHL are of extreme importance. In this article we discuss various personal hearing protection devices and their efficacy, and pharmacological agents for prevention and management of NIHL.

The current standard of care for surgical management of Otosclerosis is small fenestra stapedotomy, which can be done by CO Laser assisted as well as conventional techniques. Vertigo is the commonest complication after stapes surgery. The use of CO Laser has been rising recently owing to its no touch principle, high precision and possibly lower risk of vertigo post operatively. To compare the post-operative vestibular deficit in patients of Otosclerosis having undergone small fenestra stapedotomy by conventional versus CO Laser assisted technique. 80 clinically diagnosed Otosclerosis patients fulfilling the inclusion criteria were enrolled. They underwent small fenestra stapedotomy by either conventional or CO Laser assisted technique. Vestibular function was assessed objectively by measuring sway velocity using modified clinical test of sensory interaction on balance by static posturography. Subjective measurement of balance was done using Vestibular balance subscore of Vertigo Symptom Score (VSS-sf-V). The outcome measures were compared pre-operatively and at first and fourth week post-operatively. All patients had vestibular deficit 1 week post-operatively in the form of increased sway velocity and symptom scores, which reduced by 4 weeks after Stapedotomy. The vestibular deficit in the two groups was similar at 1 week after surgery. 4 weeks after surgery, the sway velocity in conventional group was significantly greater than Laser group though there was no significant difference in the symptom scores. The use of CO Laser for Stapedotomy results in lesser post-operative vestibular deficit as compared to conventional method.

<p class="abstract"><strong>Background:</strong> Deviated nasal septum is one of the most common disorders in human beings, which may lead to symptoms of nasal obstruction, headache, epistaxis, hyposmia, and post nasal drip. DNS correction may also be required to gain access during intranasal procedures like endoscopic sinus surgery, endoscopic dacryocystor-hinostomy and skull base surgery. The technique of septoplasty has evolved over the decades with a tendency towards more conservative and precise surgery. Over the last few decades endoscopic septoplasty has become increasingly popular.</p><p class="abstract"><strong>Methods:</strong> It was a cross-sectional comparative study done to compare the efficacy of endoscopic septoplasty with conventional septoplasty, conducted at a tertiary care centre over a period of 3 years. Records of 100 patients of nose and PNS disorders with DNS who were operated either by conventional or by endoscopic technique were studied. The patients were studied for the improvement in their symptoms, anatomical correction and intra-operative/post-operative complications.  </p><p class="abstract"><strong>Results:</strong> Endoscopic septoplasty group patients showed better symptomatic relief, lesser incidence of residual anterior /posterior deviation and persistent spur and less complications as compared to the conventional septoplasty group.</p><p><strong>Conclusions:</strong> In our study we found more clientele satisfaction and lesser rate of complications in endoscopic septoplasty group. We recommend all ENT specialists to be trained in nasal endoscopic septoplasty technique as it offers many advantages such as more precision in post nasal spurs with less flap tears, it can be tailor made according to the disease and can be combined with various endoscopic surgeries.</p>

The use of diced cartilage grafts in reconstructive surgery was first described by Peer in 1943 though it was not for rhinoplasty. A number of studies describing diced cartilage have followed since then, but the technique has never achieved widespread use. In recent years, however, an interest in using diced cartilage for augmentation rhinoplasty has resurfaced. As surgeons revisit this technique, it is important that this technique is subjected to critical evaluation in terms of materials, approaches, and indications of using using diced-cartilage augmentation. External rhinoplasty approach with diced cartilage as a graft was used to for augmenting the nasal dorsum in 32 patients. Cosmetic appearance improved in all cases both subjectively and objectively. Only one patient showed constriction of dorsum 09 months after surgery. None of the patient had any intra-operative complication, 02 had donor site complication in the form of aural haematoma in 01 patient and wound infection in 01 patient. Diced cartilage technique is an attractive option for use in rhinoplasties especially those requiring augmentation procedures.

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With technological improvements in body armour and increasing use of improvised explosive devices, it is the injuries to head, face and neck are the cause for maximum fatalities as military personnel are surviving wounds that would have otherwise been fatal. The priorities of battlefield surgical treatment are to save life, eyesight and limbs and then to give the best functional and aesthetic outcome for other wounds. Modern day battlefields pose unique demands on the deployed surgical teams and management of head and neck wounds demands multispecialty approach. Optimal result will depend on teamwork of head and neck trauma management team, which should also include otolaryngologist. Data collected by various deployed HFN surgical teams is studied and quoted in the article to give factual figures. Otorhinolaryngology becomes a crucial sub-speciality in the care of the injured and military otorhinolaryngologists need to be trained and deployed accordingly. The otolaryngologist's clinical knowledge base and surgical domain allows the ENT surgeon to uniquely contribute in response to mass casualty incident. Military planners need to recognize the felt need and respond by deploying teams of specialist head and neck surgeons which should also include otorhinolaryngologists.

Aeromedical implications of stapedotomy like rapid barometric changes and G forces are generally thought to put an end to the aviation career of an aviator. Aviation industry has grown tremendously in the last few decades, and aviation now is not only occupational but also recreational. The Indian Military Aviation rules state that, “Stapedectomy cases will be assessed permanently unfit for flying duties. These cases will be cautioned against flying in an unpressurised aircraft.” The basis of this is the aeromedical concerns associated with stapedotomy as clinical conditions which are of minor significance on the ground may become aggravated in the air. With an ever expanding civil and military aviation industry, the number of aviators who have undergone stapedotomy has also increased. Though grounding the aircrew is the safest option, but if medical certification is denied to all, then the majority who can fly safely will also be excluded, thus denying the organization of its trained resources. This paper discusses post otosclerosis and post stapedotomy aeromedical concerns, reviews existing literature concerning post stapedotomy aviation and various post stapedotomy aviation policies.