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<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) is an infectious chronic ear disease in India characterised by discharge from ear. This is the commonest infection in children more so in low socio economic group. CSOM is caused by various gram positive and gram negative organisms.</p><p class="abstract"><strong>Methods:</strong> Study group includes CSOM patients coming to ENT Department of Kamineni Institute of Medical Sciences, Narketpally, Telangana, India. Swabs were taken from discharging ears and sent for Gram’s staining, culture and antibiotic sensitivity. The results were analysed and a protocol was devised for effective treatment of <em>Pseudomonas aeruginosa</em>.  </p><p class="abstract"><strong>Results:</strong> Total numbers of study group were 180 of. 180 patients, 84 were males and 96 were females. CSOM infection was found to be more common in 11-30 yrs age group. When the ear discharge was sent for culture and sensitivity only 106 patients out of 180, showed culture positivity. <em>Pseudomonas aeruginosa</em> was the most common organism identified. Its prevalence in the present study was 23%. <em>Methicillin Resistant Staphylococcus aureus </em>(MRSA) and <em>Klebsiella sps</em> were the next common isolates, whose prevalence was detected to be 10% and 8% respectively. <em>Pseudomonas</em> is resistant to all routine broad spectrum antibiotics like amoxicillin, ampicillin and amoxycillin - clavulanate and cephalosporins, but sensitive to ciprofloxacin, gentamycin, imipenem, meropenem, piperacillin.</p><p><strong>Conclusions:</strong> CSOM is common among children and young adults. <em>Pseudomonas aeruginosa</em> was the most common isolate (23%) in our study. As<em> Pseudomonas</em> was found to be resistant to routine antibiotics, inadvertent use of routine antibiotics will lead to the development of multidrug resistant strains in the community which are difficult to treat. Specific antibiotic treatment should be started based on the culture and antibiotic sensitivity report of the swab.</p>

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Cosmesis is an important consideration when making breast incisions, especially in young girls. Giant fibroadenomas can produce breast deformity & should be excised. There are several techniques for excision of giant firoadenoma. In our technique, we remove them through cosmetically acceptable circumaerolar incision to maintain the shape & symmetry of breast. We recommend swiss roll technique for the excision of giant fibroadenomas.