No abstract

A female patient in her early sixties had problems of recurrent syncopal attacks and panic attacks over the last 5 years. She had been initially managed for an anxiety disorder with psychiatric medications. During one of those episodes, she was brought to our hospital in an unconscious state with a low blood sugar level of 43 mg/dL. She was suspected to have a neuroendocrine tumour and diagnosis was established by supervised fasting up to 72 hours and imaging. Her recorded blood sugar during fasting was 37 mg/dL. She underwent surgery and presently remains asymptomatic. Physicians should have a high suspicion of insulinoma in patients presenting with repeated episodes of hypoglycaemic symptoms in the absence of any cognizable cause.

<p>A thorough evaluation of nasal masses along with early management of the disease can prevent complications and further deterioration of the disease to a larger extent.<strong> </strong>Nasal mass occurring in the nose with symptoms of epistaxis is a sign of suspicion of malignancy. Patients can have variable presentations according to the site and extent of the infection. This article comprises of study done on 3 patients who presented to the ear, nose, and throat (ENT) out patient department with nasal mass with bleed. All three of the patients were subjected to clinical examination, diagnostic nasal endoscopy, radiological evaluation, surgical intervention and histopathological assessment. Thorough evaluation helps the operating surgeon to come to a specific diagnosis so that the chances of diagnosing rare cases does not get ruled out and helps the further deterioration of the disease.</p>

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Chronic suppurative otitis media is an inflammation of the mucoperiosteal lining of the middle ear cleft. 10% of Indian population suffers from hearing impairment. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">The study comprises of 60 patients admitted in the department of ENT and head and neck surgery, AJIMS, Mangalore between June 2015 and May 2017. All patients suffered from CSOM, tubotympanic type. Selection criteria was patients with CSOM, TTD type with no or minimal SNHL, AB gap more than 20dB, absence of ossicular defects, no history of previous ear surgery and was operated on worse hearing ear. Exclusion criteria were atticoantral disease, ossicular defects, previous ear surgery, otomycosis and systemic diseases.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The majority of the patients were between the age group of 20-40 years. Out of the 60 patients, 28 were male and 32 female. 8 patients with moderate size and 20 with large perforations underwent underlay myringoplasty. For onlay corresponding numbers were 17 and 13. 26 patients (86.7%) who underwent underlay and 27 patients (90%) who underwent overlay had good hearing improvement. 43.3% of the group had significant hearing improvement at 6 months follow up. 20 patients had pneumatised and 40 patients had sclerotic mastoids in the study. Graft take up was 90% for underlay and 96.6% for overlay. The hearing loss was more with larger perforations.18 patients with large perforations who underwent underlay had good hearing improvement versus 13 for overlay whereas for moderate perforations, only 8 patients had good hearing improvement for underlay versus 15 for overlay. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">The hearing improvement obtained with underlay and overlay myringoplasty are comparable. The cellularity of mastoid has no influence on the hearing improvement. The size of the perforation correlates well with the degree of hearing loss. Underlay myringoplasty seems to give better results for large perforations, overlay for moderate sized ones.</span></p><p class="abstract"> </p>

<p class="abstract"><strong>Background:</strong> One of the common causes for nasal obstruction in children is adenoid hypertrophy. It is common indication for surgical removal in these patients due to multiple morbidities. In severe symptoms adenoidectomy is recommended, however there are limitations for surgery like cleft palate.The safety of nasal steroid spray has been well reported. The aim of the current study is to determine the effectiveness of adenoidectomy verses mometasone nasal spray in treatment of children with adenoid hypertrophy.</p><p class="abstract"><strong>Methods:</strong> Randomized prospective study was conducted in the department of ENT on 60 children who met the inclusion criteria. They were randomized into 2 groups and pre-treatment scoring was accessed. Group A underwent adenoidectomy and Group B underwent mometasonefuroate nasal spray therapy. Patients were evaluated on 40th day, 4th month.  </p><p class="abstract"><strong>Results:</strong> During the 40th day follow up post treatment, a significant difference was found with no nasal obstruction in 93.3% patients who underwent adenoidectomy compared to 63.3% for those treated with MF nasal. At follow up after 4 months, 93.3% patients in group A had had improvement in clinically as compared to 76.6% in group B were nasal obstruction was relived. In group A, there was significant reduction in adenoid grading after adenoidectomy compared to MF nasal spray at 40 days follow up (p≤0.001). However long term MF nasal spray also associated with significant reduction in the size.</p><p class="abstract"><strong>Conclusions:</strong> In patients were adenoidectomy is contraindicated, long term MF nasal spray treatment has good efficacy in treatment of nasal obstruction due to adenoid hypertrophy.</p>