<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) is a still common disease in developing country and is found sometimes difficult to treat. Different complications can develop inspite of availability of higher antibiotics. In pre-antibiotic era, complications of acute otitis media and CSOM were very common and lead to high mortality. Inspite of initial decline in the complication of CSOM due to higher antibiotics, the incidences are still on rise. CSOM remains a serious disease, particularly in developing countries and CSOM-related complications are still found life-threatening. The aim and objective was to study various clinical presentations and management of CSOM related complications.</p><p class="abstract"><strong>Methods:</strong> All patients of chronic supurrative otitis media with intra or extracranial complication who were admitted in Department of Otorhinolaryngology Head and Neck surgery, Sir. T. General Hospital, Government Medical College, Bhavnagar from July 2015 to December 2018 was included in this study. Data of clinical presentation, associated complication, management, and follow-up were analysed.  </p><p class="abstract"><strong>Results:</strong> Out of 250 patients of CSOM admitted during these 3 years in ENT Department, 36 patients presented with CSOM related complications. 15 patients presented with intracranial complications and 21 patients presented with extracranial complications.</p><p class="abstract"><strong>Conclusions:</strong> Inspite of availability of higher antibiotics, CSOM related complications are still common. In all the patients require higher intravenous antibiotics (which crosses blood brain barrier) followed by mastoid surgeries.</p>

Tracheostomy is the creation of a stoma at the surface of skin, which leads into trachea. In the critically ill patients, it is one of the most frequently done procedure especially in intensive care unit (ICU) for those requiring prolonged mechanical ventilation. About 24% of all patients in ICU need tracheostomy (Esteban et al. in Am J Respir Crit Care Med 161:1450–1458, 2000). Historically it had a high complication rate and so many authors suggested that it should be done only in operating room (Dayal and Masri in Laryngoscope 96:5862, 1986). A standardized procedure to reduce complications was described by Jackson (Laryngoscope 19:285–290, 1909). The aim of the study is to observe and analyze the outcome of bedside open tracheostomy, in relation to its safety, complications and simplicity. Study consists of 200 patients who underwent bedside tracheostomies in a tertiary care center from 2014 to 2017 in medical/surgical/paediatric ICU’s. All the procedures followed a standard protocol. In all the surgeries, two E.N.T. surgeons were scrubbed and did the procedure, assisted by two ICU nurses. One anesthetist who administered sedation and monitored the patient. If coagulation disturbances were present in elective case then they were corrected prior to the procedure. We all want the latest, safest, simplest and cheapest available technique in medical practice. Bedside tracheostomy is one such procedure. It is better than tracheostomy in operating room for patients who need prolonged mechanical ventilation in ICU as it eliminates the need of patient transport to OR and its associated complications and also minimizing cost. Training programs need to be provided to the assisting staff for better procedural outcome.

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<p class="abstract"><strong>Background:</strong> Reconstruction following advanced oral cancer is a formidable task in developing country, with poor infrastructure and heavy chunk of advanced stage (T3-T4) oral malignancy. Options available for reconstructions are regional pedicle flaps and microvascular free flaps. Pedicle flaps particularly the pectoralis major myocutaneous (PMMC) flap have an easy learning curve for most of surgeons. Pectoralis major myocutaneous flap is regarded as the workhorse for reconstruction in many head and neck surgeries.</p><p class="abstract"><strong>Methods:</strong> A study was undertaken on patients of soft tissue defects of head and neck region after resection of tumor of oral cavity (squamous cell carcinoma). Total 60 patients, who were managed in ENT department, Sir T hospital, Bhavnagar from 2016-19 were included in this study.  </p><p class="abstract"><strong>Results:</strong> Gingivo-buccal complex was the most common site observed for oral malignancy and majority of patients were in TNM stage-I, II, III in this study. Apart from total flap necrosis observed in 1 patient, in rest all the patients PMMC flap very well survived with some major/minor, flap related and unrelated complications.</p><p class="abstract"><strong>Conclusions:</strong> The PMMC flap is effective in reconstruction of defect after excision of oral cavity cancers in developing country with heavy chunk of oral cavity cancer patients. In spite of several minor flap related and flap unrelated complications, PMMC flap survival rate is high and total flap necrosis rate is very low.</p>

<p class="abstract"><strong>Background:</strong> Fungal sinusitis is more commonly found in immunocompromised patients with systemic illnesses, e.g., uncontrolled diabetes mellitus, chronic renal failure, patient on prolonged systemic steroid therapy, hematological malignancies, HIV/AIDS, etc. Invasive fungal sinusitis is subdivided into acute and chronic. Less than 4 weeks duration separates the acute stage from the chronic stage of the disease. Management of invasive fungal sinusitis consists of sinonasal debridement with or without Caldwell-Luc surgery followed by antifungal therapy.</p><p class="abstract"><strong>Methods:</strong> Total 30 cases of both types of invasive fungal sinusitis were included in this study. The demographic profile, clinical presentation, underlying immunocompromised status, complication, mortality and management of all these 30 patients were analyzed.  </p><p class="abstract"><strong>Results:</strong> Invasive fungal sinusitis was most commonly observed in 3^rd and 4^th decade of life with male predominance. Prolonged uncontrolled diabetic mellitus was the most common underlying immunocompromised status. Mucor was the most common isolated fungal species. Preseptal cellulitis was the most common complication.</p><p class="abstract"><strong>Conclusions:</strong> For early detection of mucosal changes one has to do endoscopic examination in all immunocompromised patients with symptoms like headache, facial or periorbital pain and swelling, purulent nasal discharge, etc. All clinician should think vigilantly in immunocompromised patients with above symptoms or in pyrexia of unknown origin not responding to antibiotics. To reduce mortality, one has to go for immediate sinonasal debridement even in local anaesthesia also if patient is not fit for general anaesthesia.</p><p> </p>