Background: Prior to surgical management of chronic suppurative otitis media (CSOM) for the dry ear medical management is necessary. CSOM is a biofilm disease and due to this has antibiotic resistance. The pillar of its treatment included aural cleaning according to standard protocols, application of topical germ free antiseptic and use of antimicrobials. Acetic acid due to its ability in reducing the pH may be effective in reducing the growth of microorganisms. Objective: The aim of the study was to compare the efficacy of irrigation with acetic acid versus systemic antibiotics in CSOM patients. Materials & Methods: A total of 134 patients, who came to the ENT department of Sheikh Zayed Hospital, Lahore between 1st April 2020 to 30th September 2020, who had CSOM, of age 15 to 55 years and both genders were included in the study. The patients were divided randomly into two groups. Group A patients received aural toilets and irrigation with acetic acid and Group B received 500 mg of ciprofloxacin twice a day for 2 weeks. Results: The mean age (in years) of the patients in Group A was 37.45±7.32 and in Group B, it was 37.96±7.57. The efficacy of irrigation with acetic acid versus systemic antibiotics was 89.55% and 68.66% respectively and this difference between the two groups was found to be statistically significant (p=0.003). Conclusion: Irrigation with acetic acid was better than systemic antibiotics in managing patients with CSOM. Key words: Acetic acid, CSOM, Middle ear

Central giant cell granuloma (CGCG), also known as giant cell reparative granuloma, is a non-cancerous proliferative lesion of unknown etiology. It is a localized osteolytic lesion with the diverse biological behavior of aggression which most commonly affects the mandible and other jaw bones. It is a rare condition and its characteristic clinical or radiological features are still not well defined. It resembles to some neoplasms and can easily be misdiagnosed with Antro- Choanal Polyp, Angiofibroma, Squamous Cell Carcinoma and  inverted Cell papilloma.We are reporting a case of rare presentation of CGCG arising from the maxillary sinus. This is a case report of a 15 year old boy who presented with the episodes of recurrent epistaxis and nasal obstruction. Diagnosis of giant cell granuloma was made on the basis of age presentation, rare location, and histological findings of excised specimen, which revealed central giant cell granuloma. This case helps to demonstrate the wide variation in the clinical and radiological features of CGCG and highlights the significance of histological features of this lesion.

OBJECTIVE: Hemorrhage following tonsillectomy has always been a serious problem. Recently several techniques, devices and materials have been developed to reduce the intra-operative and post-operative blood loss but still no optimal methods have emerged. In this study we assessed the effectiveness of lower pole ligation in tonsillectomy ensuring the hemostasis and preventing the post-operative hemorrhage in early and late stages. MATERIALS AND METHODS: This was a hospital based retrospective study performed in the department of ENT, Aziz Fatima Hospital (Medical College) and Faisal Hospital Faisalabad from May 2014 to June 2017. During this period 310 patients underwent tonsillectomy using COLD DISSECTION TECHNIQUE. Inferior pole was ligated by Negus artery forceps as close to its junction with the lingual tonsils ensuring no tissue remnants are left and knot applied by Negus ligature carrier with Black Silk #1. Bipolar diathermy was used for tonsillar bed hemostasis. Follow-up was continued for the next 4 weeks. RESULTS: Out of 310 patients undergoing the procedure only 2 presented with reactionary hemorrhage. One of them presented after 3 hours and the cause of bleeding was appreciated as slipping of the knot from the lower pole which was shifted to OT and ligated again using the Silk # 1. Second patient presented after 2 hours with mild reactionary hemorrhage and the site was not from the lower pole, but diffuse oozing from the tonsillar bed which was conservatively dealt by cold sponging and ice cold gargles. Out of 310 only 1 patient presented after 3 weeks with secondary hemorrhage which was treated by broad spectrum antibiotics. CONCLUSION: The use of lower pole ligation in tonsillectomy affords efficient and practical hemostasis. The procedure is inexpensive and requires no special and refined equipment. The anterior and posterior tonsillar pillars remained intact thus the functional anatomy was preserved.