Introduction: Sialolithiasis is the most common disease of the salivary glands. Majority of sialoliths occur in the submandibular gland and is a common cause of acute and chronic infections of the gland. The size varies from one mm to one cm. Size greater than 15 mm are considered unusual or giant sialolith. Case report: We present a case of an unusual size sialolith of 16 mm in submandibular gland duct which was removed via transoral incision. The aim of presenting this case report is to understand etio-pathogenesis, clinical presentation and management of submandibular sialolithiasis. Conclusion:  Submandicular sialolithiasis of more than 15 mm in size though rare are not uncommon. They can be managed intraorally if situated at or near the orifice.

Introduction: Underlay technique myringoplasty is most commonly used technique to repair tympanic membrane perforation by temporalis fascia graft and Trans-tympanic pop-in technique is an another technique that allows temporalis fascia graft placement medial to tympanic membrane remnant through the perforation without the need for tympano-meatal flap elevation. This study was undertaken to find the prevalence of perforated graft in underlay and Pop-in Technique Myringoplasty. Methods: This descriptive cross-sectional study was done at Manipal teaching hospital, Pokhara, Nepal and comprises of 86 patients between January 2014 and June 2015. Patients undergoing Underlay Trans-canal approach by tympano-meatal flap elevation and Trans-canal, Trans-tympanic pop-in technique were included. Sample size calculation was done and convenient sampling method was applied. Point estimate at 95% CI was done for binary data along with frequency and proportion. The descriptive statistical analysis was done. Results: The prevalence of perforated graft was 15 (17.4%) at 95% Confidence Interval (39.75-60.25%).In underlay technique there were 8 (18.60 %) perforation and 35 (81.39%) were intact while in pop-intechnique there were 7 (16.27%) perforation and 36 (83.72%) were intact. The postoperative meanPure Tone Average (PTA) of underlay was 9.53 and pop-in was 8.31. The mean Pure Tone Average(PTA) gain after underlay technique was 16.095 and pop in technique was 16.87. Conclusions: Trans-tympanic pop-in myringoplasty gives similar hearing & graft uptake results when compared with tympano-meatal flap method of underlay myringoplasty done by trans-canal.

Introduction: Otomycosis is a fungal infection of external auditory canal frequently encountered by otorhinolaryngologists. It causes discomfort to patients with varied symptoms of pruritus, otorrhea, aural fullness and earache. People with a habit of using unnecessary ear drops, cleaning ear with unsterilized objects and those who use mustard oil are all prone to otomycosis. This study aims to find out the association between otomycosis and its predisposing factors. Methods: This study was undertaken in the Department of Otorhinolaryngology of a tertiary hospital from March 2018 to February 2019 and a total of 300 clinically diagnosed cases of otomycosis were enrolled for the study. Results: The mean age ±SD of the patients was 37.7 ± 18.8 years. Females (n=172, 57.3%) were more prone to otomycosis than males (n=128, 42.7%). The most common presenting symptom was pruritus only (n=95, 31.7%) with unilateral involvement being more common. The most common predisposing factor was mustard oil instillation (n=124, 41.3%). Aspergillus niger  was the most common fungus causing otomycosis in this study (n=104, 34.7%). Positive fungal cultures were observed in 285 specimens (95%). The fungal growth (n=285) was high in patients with the history of instilling mustard oil (42.8%) into the ear, 34.0% in topical steroid containing ear drops and 23.2% in self-cleaning group. Conclusion: Otomycosis is common in people using unnecessary steroid containing ear drops, cleaning ear with unsterilized objects and instillation of mustard oil.

INTRODUCTION: Fiberoptic nasal endoscopy is a common procedure. Pretreatment with many drugs has been tried to decrease discomfort and pain related to the procedure. It was our effort to study whether they are effective in reducing pain and discomfort of the procedure. MATERIAL AND METHODS: It was a four-armed triple blind randomized controlled trial. Block randomization was done. Four arms were pretreated with placebo, decongestant spray, local anesthetic spray, and combination of decongestant and local anesthetic spray. Discomfort of pretreatment, discomfort of the procedure, pain due to procedure, ease of procedure and adverse effects were recorded by visual analogue score and analyzed by non-parametric tests. P value less than 0.05 was considered statistically significant. RESULTS: There were 40 participants in each wing making a total of 160. There were 79 males and 89 females. Discomfort of pretreatment was significantly higher is groups treated with lidocaine spray alone or in combination (p<0.001). Discomfort due to procedure was lowest in group pretreated with placebo (p=0.009) and pain was comparable throughout the groups (0.15).The procedure of nasal endoscopy was easiest in group pretreated with decongestant spray (p=0.02). Adverse effect was highest in form of burning sensation and pain in groups treated with lidocaine (p<0.001). CONCLUSION: Lidocaine spray caused a lot of discomfort in form of pain and burning sensation and was not able to decrease pain or discomfort, alone or in combination with decongestant, related to fiberoptic nasal endoscopy. Decongestant, however, made the procedure easier.

Cell phone explosions and resultant burn injuries are rarely reported in the scientific literature. We report a case of cell phone explosion that occurred when a young male was listening to music while the mobile was plugged in for charging.