BACKGROUND Chronic Suppurative Otitis Media (CSOM) is considered to be a slowly progressive destructive disease of the middle ear. It is the most commonly encountered middle ear pathology, which disrupts the normal anatomy and physiological functioning of the ear. Otoscopic evaluation is sufficient to establish the diagnosis of the disease; however, its extent can be determined only on the basis of a High Resolution Computed Tomography (HRCT) of the temporal bone. While the most common presentation of CSOM is a discharging ear. Its complications may be masked by the disease itself, thereby giving a false presentation of a limited extent. HRCT temporal bone can help quantify the extent of the disease and hence prioritise the patients who warrant an urgent management.The aim of this study is to establish the importance of HRCT temporal bone in a patient with unsafe CSOM, even in absence of clinical suspicion of ongoing complication to improve the surgical outcome. MATERIALS AND METHODSThis study has been conducted on 50 patients who have presented to the ENT OPD at RGMC, Kalwa. RESULTSOut of 50 patients who presented with complications, 20 patients (40%) did not have any history suggestive of impending complications. The HRCT temporal bone helped in establishing the presence of these complications and allowing for prompt treatment. CONCLUSIONIt was found that presence of HRCT helps in determining lurking complications and thus helps in deciding the urgency with which tympanomastoidectomy surgery needs to be performed. KEY WORDSHRCT, Temporal Bone, Mastoid, Cholesteatoma. HOW TO CITE THIS ARTICLE: Baviskar S, Mehta L, Gori T, et al. HRCT temporal bone-a mandatory preoperative investigation for improving surgical outcome in unsafe CSOM.

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Nasofrontal masses belong to the group of congenital midface anomalies (CMFA) in paediatric age group. The usual list of differential diagnosis for such masses can be narrowed to Frontonasal dermoid, epidermoid, nasal encephalocele and nasal gliomas. Frontonasal dermoid with patent dermal sinus tract is a rare craniofacial anomaly resulting from the failure of normal embryonic development. Most of patients present in infancy or early childhood. CT, MRI and sinogram together are usually required for definitive diagnosis. Knowledge of embryonic development of nose & anterior skull base is important in understanding the pathologies of Frontonasal masses. Endoscopic 'key-hole' approach to these lesions via small incision allows better visualization & ensures complete removal.

BACKGROUND Determination of the type of microorganisms, which grow in the middle ear can help determine the appropriate antibiotic to be administered orally as well as topically. In an era of growing antibiotic sensitivity, it becomes prudent to be judicious with prescribing antibiotics. This can be easily done with the help of an ear swab. This has a positive effect in faster healing of wide mastoid cavity and can prevent the problems of a discharging cavity post-operatively. MATERIALS AND METHODS A randomised controlled trial study was conducted in the Department of ENT at Rajiv Gandhi Medical College, Kalwa from July 2017 to December 2017 on 50 patients. The patients were selected by simple random sampling method. An ear swab is first taken prior to posting the patient for a tympanomastoid surgery and following the surgery a swab is retaken on the 7th post-operative day and antibiotics may be changed based on the reports obtained. RESULTS During post-operative 3rd week visit of all 50 patients, it was observed that out of the 25 patients treated on the basis of pus culture and sensitivity reports. 23 patients (92%) responded well with clean mastoid cavity and improved healing to the point of epithelialisation, whereas out of the remaining 25 patients treated empirically only 9 patients (36%) responded well with clean mastoid cavity and improved healing and the rest followed up with either discharging cavities or granulation tissue. CONCLUSION Use of ear swab and its role in selection of antibiotics has a positive effect in faster healing of wide mastoid cavity and can prevent the problems of a discharging cavity post-operatively.

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