A case of toxigenicCorynebacterium ulceransinfection is presented. The diagnosis was delayed and no anti-toxin administered. A nasopharyngeal biopsy was complicated by severe haemorrhage necessitating a post nasal pack. A brief review of the pathology and treatment ofCorynebacterium ulceransis given.

Rhinosporidiosis is rare infective chronic granulomatous lesion cause by Rhinosporidium seeberi which occurs universally although endemic in South Asia, notably in Southern India and in Srilanka. The causative agent Rhinosporidium seeberi is intractable to isolation and microbiological culture and shows features of both fungi and protozoa. The great majority of cases occur in upper respiratory sites, notably the anterior nares, nasal cavity-the inferior turbinate's, septum and floor. It is a chronic disease, with frequent recurrence after surgery and occasional dissemination from initial focus .Rhinosporidial lesions in the nasal passages are Polypoidal, granular, red in colour due to pronounced vascularity, with a surface containing yellowish pin head sized spots which represents underlying mature sporangio. The organism is difficult to culture and diagnosis is based on microscopy and histological examination of the lesion. The mainstay of treatment is meticulous complete and wide surgical excision, followed by electro-cautery of the base may ablate recurrence resulting from the spillage of endospore on the adjacent mucosa and recently use of laser is also indicated. We present a thrice operated recurrent case of extensive Rhinosporidiosis involving left nose & nasopharynx where the disease was removed using bipolar cautery, microdebrider and laser assisted.

The current standard of care for surgical management of Otosclerosis is small fenestra stapedotomy, which can be done by CO Laser assisted as well as conventional techniques. Vertigo is the commonest complication after stapes surgery. The use of CO Laser has been rising recently owing to its no touch principle, high precision and possibly lower risk of vertigo post operatively. To compare the post-operative vestibular deficit in patients of Otosclerosis having undergone small fenestra stapedotomy by conventional versus CO Laser assisted technique. 80 clinically diagnosed Otosclerosis patients fulfilling the inclusion criteria were enrolled. They underwent small fenestra stapedotomy by either conventional or CO Laser assisted technique. Vestibular function was assessed objectively by measuring sway velocity using modified clinical test of sensory interaction on balance by static posturography. Subjective measurement of balance was done using Vestibular balance subscore of Vertigo Symptom Score (VSS-sf-V). The outcome measures were compared pre-operatively and at first and fourth week post-operatively. All patients had vestibular deficit 1 week post-operatively in the form of increased sway velocity and symptom scores, which reduced by 4 weeks after Stapedotomy. The vestibular deficit in the two groups was similar at 1 week after surgery. 4 weeks after surgery, the sway velocity in conventional group was significantly greater than Laser group though there was no significant difference in the symptom scores. The use of CO Laser for Stapedotomy results in lesser post-operative vestibular deficit as compared to conventional method.

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