Effectiveness of endoscopic posterior nasal neurectomy for the treatment of intractable rhinitis INTRODUCTIONRhinitis is an inflammatory condition affecting the lining of the nose, characterized by nasal congestion, rhinorrhea, itching, sneezing and/or post-nasal discharge 1 . More than 20% of the population is affected by chronic rhinitis [2][3][4] . Depending on whether an allergic etiology is implicated, non-infectious rhinitis can be subdivided into allergic and non-allergic. With 600 million of world's population affected, allergic rhinitis is the most prevalent atopic disorder. The incidence of allergic rhinitis is on steady increase 5 . Various etiological factors have been postulated for chronic rhinitis -these include allergy, occupational exposures, hormonal changes, smoking, xylometazoline abuse, etc. The standard treatment strategy is medical (histamine antagonists, leukotriene receptor antagonists, intranasal corticosteroids, etc.) But many times, these therapies show limited effectiveness and cause substantial burden for treatment cost on the long term. In addition, the symptoms of intractable rhinitis can cause social embarrassment with a profound effect on patients' quality of life.Surgical management can be considered in such patients with intractable rhinitis. Various surgical techniques have been documented including Vidian neurectomy 6 , posterior nasal neurectomy, inferior turbinate reduction, with varying success rates [5][6][7][8] . In view of this, we are studying the effectiveness of posterior nasal neurectomy (PNN) in patients who have intractable rhinitis, refractory to maximum medical therapy. The outcome is assessed with patient's level of satisfac-ABSTRACT BACKGROUND. Chronic rhinitis is a clinical condition affecting more than 20% of the world population. The standard treat-

Introduction Approximately 20% of patients with tracheostomy are discharged from hospital with the tracheostomy  tube in situ. Proper long term care and management of such tracheostomy patients remains as a challenge to care givers. Fracture of metallic tracheostomy tube (TT) with aspiration of the fragment into tracheobronchial airway is a rare complication of  tracheostomy. Case Report Here we are presenting a case of a 42-year-old male patient, presented to the emergency department with complaint of mild respiratory distress following aspiration of fractured metallic TT and a novel method in removing the dislodged fragment. Discussion A detailed review of literature has been included to discuss different aspects of aspiration of fractured fragment of tracheostomy tube and best practice recommendations for proper tracheostomy care. Conclusion Educating the care-giver about care of the tracheostomized patient in general and care of the tracheostomy tube in particular, may help reduce accidental complications.

Background: Acute otitis media (AOM) is the most common childhood illness necessitating medical therapy for children younger than 5 years. Long-term and exclusive breastfeeding is associated with protection against AOM. However, faulty feeding position and habits can lead to the occurrence of AOM in infants. Objectives: The aim of this study is to assess the risk of occurrence of AOM with faulty feeding positions during the 1st year of life. Materials and Methods: All breastfed infants <1 year with a provisional diagnosis of AOM, during August 2015 - January 2016 (6 months), were included in the study. Syndromic children, children with craniofacial anomalies, bottle-fed infants, and those not willing to participate in the study were excluded from the study. Demographic details and detailed history, especially, the feeding position were collected from the parents. Diagnosis of AOM was confirmed by a senior ENT surgeon after otoscopic examination. Results: 118 children with AOM were statistically analyzed. They aged between 1 month and 12 months with a mean of 6.8 and standard deviation of 4.1 months. There were 68 (57.62%) males and 50 (42.37%) females. No statistical significance was observed for sex or laterality with AOM. A statistically significant correlation was observed between AOM and age groups, AOM and position of the baby. Conclusion: In this study, we have observed that feeding the infant in supine position significantly increases the risk of AOM in infants.

<p class="abstract"><strong>Background:</strong> Uncinate process (UP) is a part of ethmoid bone, which is a thin sickle shaped projection on the lateral wall of nose. UP extends from the frontal recess superiorly and inferiorly to the ethmoid process of inferior turbinate. Various studies have shown that superior attachment of uncinate process (SAUP) is the key to frontal recess region in endoscopic sinus surgeries (ESS). But these studies have yielded conflicting results, showing multiple patterns and classifications of superior attachment of uncinate process. Knowing the anatomic variations of SAUP will help the surgeon to plan the endoscopic sinus surgery and to avoid the unwanted complications. Hence this study was conducted to observe and classify the superior attachment of uncinate process and to localize the frontal sinus outflow tract<span lang="EN-IN">. </span></p><p class="abstract"><strong>Methods:</strong> We did a retrospective cross sectional study, consisting of 100 patients including both sexes, above the age of 10 years. We excluded pregnant ladies, patients with prior sinus surgeries, sinonasal tumours, nasal polyposis, and craniofacial trauma<span lang="EN-IN">.  </span></p><p class="abstract"><strong>Results:</strong> We observed Type I SAUP, in 67.5% (n=135) cases, Type II SAUP in 18.5% (n=37), Type III attachment in 9.5% (n =19) and Type IV in 4.5% (n=9). Bilaterally similar attachments observed in 96% cases. Rest of the cases (4%), the attachment patterns was varying between sides<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The site of SAUP is highly variable. The most common type of SAUP is Type I (67.5%) followed by Type II (18.5%), Type III (9.5%) and Type IV (4.5%)<span lang="EN-IN">.</span></p>

Concha bullosa is a frequently observed anatomical variant of lateral nasal wall characterized by pneumatization and enlargement of middle turbinate. Concha bullosa is usually asymptomatic, but sometimes it can cause nasal obstruction and paranasal inflammation. Studies on association of concha bullosa with paranasal sinusitis have given contradictory findings. Here we are reporting a case of giant concha bullosa with secondary maxillary sinusitis in a 24 year old patient.