Introduction  Indolent or chronic mucormycosis is a rare entity that affects both immunosuppressed and immunocompetent individuals. Additionally, its clinical evolution is nonspecific and there is no standardized treatment for this condition. Objective  To describe the clinical characteristics and management of patients with indolent mucormycosis. Methods  In the project of study with chart review in the Interinstitutional secondary care centers, patients with evidence of indolent mucormycosis, defined as pathological confirmation of nasal/paranasal sinus mucormycosis for more than 1 month, were included. All patients underwent complete laboratory workup, imaging studies, surgical treatment and adequate follow-up. No evidence of disease status was defined when patient had subsequent biopsies with no evidence of mucormycosis. Results  We included seven patients, three female and four male subjects. The mean age was 53.14 years. Four patients were immunosuppressed and three immunocompetent. Among the immunosuppressed patients three had diabetes and one had dermatomyositis. The symptoms were nonspecific: facial pain/headache, mucoid discharge and cacosmia were the ones most frequently reported. Maxillary sinus involvement was present in all patients. Two immunosuppressed subjects received amphotericin. Posaconazole was the only treatment in one immunosuppressed patient. All immunocompetent patients had single paranasal sinus disease and received only surgical treatment. All patients are alive and free of disease. Conclusion  Indolent mucormycosis is a new and emerging clinical entity in immunosuppressed and immunocompetent patients. Single paranasal sinus disease is a frequent presentation and should not be overlooked as a differential diagnosis in these patients. Immunocompetent patients should only be treated surgically.

| CONCLUSIONWith respect to loudness level, MCL was more normalised using VSB than HA. Patients with moderate and moderate-tosevere SNHL could tolerate VSB fitting with sufficient amplification at 1 and 2 kHz frequencies, which is critical for normalising MCL.

Objective: To evaluate the efficacy of on demand and low dose intratympanic gentamicin (ITG) in patients with intractable Meniere's disease (MD). Study Design: Clinical chart review. Setting: Secondary care center. Patients: Subjects with MD who failed conventional treatment and underwent on demand ITG infiltration from June 2013 to December 2018. Intervention: 0.4 to 0.5 ml of buffered gentamicin were administered through an intratympanic route. A total of 5 mg in case of low dose and 20 mg as a standard dose. Main Outcome Measures: Vertigo control, Meniere's Disease Functional Level Scale (MDFLS), Dizziness Handicap Inventory (DHI), and pure tone audiometry pre and posttreatment. Results: Thirty-one patients, 16 women and 15 men with a mean age of 52.81 (22–79) years were included. The number of ITG injections ranged from 1 to 7, with a mean of 2.52 applications per patient. Mean interval between doses was 212.15 (21–1442) days. Average follow-up was 24.03 months. An improvement on MDFLS was seen on 77.4% (n = 24) patients. DHI score improved after gentamicin treatment (mean 55.23 versus 24.06, p ≤ 0.001). Thirty patients (96.8%) reached complete or substantial vertigo control. Only one patient did not achieve control. Hearing was preserved in 43.5% (n = 10) of analyzed audiograms, whereas 17.4% (n = 4) developed hearing loss greater than 20 dB, which was not statistically significant (p = 0.099). Conclusions: In our study, on demand and low dose ITG was effective for vertigo control in patients with intractable MD. Individualized therapy is recommended in all patients to minimize vestibular and cochlear toxicity.

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Objective: To analyze the efficacy of endoscopic dacryocystorhinostomy (DCR) with marsupialization of the lacrimal sac compared with other techniques of endoscopic dacryocystorhinostomy. Material and methods: Clinical chart review. Patients with lacrimal sac pathologies and endoscopic DCR with or without marsupialization of the lacrimal sac were included from 2011 to 2015. The outcome measurements were absence of ocular symptoms and permeability of the lacrimal sac. Results: A total of 24 patients were evaluated, 17 women and 7 men, average age was 47 years.  Seven patients underwent DCR with marsupialization, 17 patients underwent other endoscopic techniques. Average follow-up was 18 months. The efficacy (absence of symptoms and permeability of the lacrimal sac) of the DCR technique with marsupialization was 71%, without significant difference compared to other techniques (p = 0.686). Conclusion: Similar results were found in the different types of endoscopic DCR techniques. More studies are needed to corroborate our results.