Recognizing the high incidence of paranasal sinus mycoses in north India, we analysed retrospectively the clinical, mycological and management aspects of 178 patients with proven disease attending our institute. On the basis of clinical, radiological, histopathological and mycological findings, the patients could be categorized into those with allergic (8), non-invasive (92) and invasive (78) disease types. Bony erosion without mucosal invasion by fungi was seen in 16 patients with non-invasive disease. Young men from rural areas were the most commonly affected. Rhinorrhoea with nasal polyposis (45.8%) and proptosis (46.4%) was the most common presentation. Concurrent involvement of the maxillary and ethmoid sinuses was common in these patients, whereas isolated sphenoid and frontal sinuses were involved in the invasive variety only. Orbital and intracranial extensions were detected in 100% and 13.2%, respectively, of patients with the invasive type of disease. Aspergillus flavus (79.7%) was the most common isolate. Surgical debridement and sinus ventilation were adequate for the effective management of the non-invasive disease. However, adjuvant medical therapy was included in treatment of the semi-invasive and invasive varieties of the disease. Itraconazole was found to be most useful in prevention of recurrence in the invasive type. Mortality was highest (33.3%) among patients with zygomycotic infection. Invasive fungal granuloma with orbital and intra-cranial invasion is a distinct entity in terms of its clinical course and treatment compared with non-invasive fungal sinusitis, and it needs to be treated aggressively with surgical excision and postoperative itraconazole.

Twenty patients with thyroprivic hypothyroidism with a mean age of 34.8 years (range: 15-50 years) were investigated. Peripheral/central functions of the auditory system were assessed in the hypothyroid state and they were re-evaluated in the euthyroid state after treatment with levothyroxine. The mean observation period for re-evaluation was 3.7 months (range 3-7 months). Sixteen patients with hypothyroidism (80%) demonstrated hearing loss when compared with randomly selected age- and sex-matched normal subjects. Twelve of the hypothyroid patients had sensorineural hearing loss and 4 had mixed loss. Special hearing tests revealed a cochlear type of hearing loss. The tympanogram curve was of Type B in one ear of each of the 4 patients. Brainstem electric response audiometry showed prolonged, absolute latency of wave V and interpeak latencies I-III and I-V. The amplitudes of waves I, II and V were reduced. Following treatment with levothyroxine a statistically significant improvement in hearing thresholds was observed by pure-tone audiometry. Tympanogram curves returned to normal in 3 out of 4 patients. Brainstem electric response parameters did not show significant reversibility to normalcy following treatment. The results of auditory investigations suggest a causal relationship between hypothyroidism and hearing loss. The site of lesion in the auditory system is probably at several levels, viz. in the middle ear, and at cochlear and retrocochlear sites.

\s=b\ Congenital aural atresia poses a great challenge, even to a competent otologic surgeon, due to innumerable types of malformations affecting the conduction and perception of sound. Roentgenographic evaluation by plain roentgenography is inconclusive in most cases; polytomography is helping to some extent. Recent generations of high-resolution computed tomographic (CT) scanners are probably the best. Seven cases of unilateral and three cases of bilateral congenital aural atresia were evaluated with high-resolution CT. Subsequently, ten ears were operated on. Surgical findings were correlated with CT scan findings with respect to atresia plate, extent of pneumatization, ossicular anomalies, bony facial nerve canal, and inner ear.Use of CT scans bears considerable importance in the management of these types of cases. High-resolution CT scan, when targeted for maximal bony detail, is possibly the method of choice in congenital aural atresia when surgical correction is contemplated.

Radiological features of IFS are described that are different from AFS.

A total of 1,670 school going children (urban 1030 and rural 640) in the age range of 12-14 years were screened for hearing loss during a survey conducted by the Department of Otolaryngology of the Postgraduate Institute of Medical Education & Research, Chandigarh. 6.31% of cases in the urban group were found to be having hearing loss as compared to 32.81% of cases in the rural group. Secretory otitis media was found to be the commonest cause of hearing impairment in both the urban and rural group accounting for 5.33% and 33.59% respectively.