Background In the ongoing COVID-19 pandemic, an increased incidence of ROCM was noted in India among those infected with COVID. We determined risk factors for rhino-orbito-cerebral mucormycosis (ROCM) post Coronavirus disease 2019 (COVID-19) among those never and ever hospitalized for COVID-19 separately through a multicentric, hospital-based, unmatched case-control study across India. Methods We defined cases and controls as those with and without post-COVID ROCM, respectively. We compared their socio-demographics, co-morbidities, steroid use, glycaemic status, and practices. We calculated crude and adjusted odds ratio (AOR) with 95% confidence intervals (CI) through logistic regression. The covariates with a p-value for crude OR of less than 0·20 were considered for the regression model. Results Among hospitalised, we recruited 267 cases and 256 controls and 116 cases and 231 controls among never hospitalised. Risk factors (AOR; 95% CI) for post-COVID ROCM among the hospitalised were age 45–59 years (2·1; 1·4 to 3·1), having diabetes mellitus (4·9; 3·4 to 7·1), elevated plasma glucose (6·4; 2·4 to 17·2), steroid use (3·2; 2 to 5·2) and frequent nasal washing (4·8; 1·4 to 17). Among those never hospitalised, age ≥ 60 years (6·6; 3·3 to 13·3), having diabetes mellitus (6·7; 3·8 to 11·6), elevated plasma glucose (13·7; 2·2 to 84), steroid use (9·8; 5·8 to 16·6), and cloth facemask use (2·6; 1·5 to 4·5) were associated with increased risk of post-COVID ROCM. Conclusions Hyperglycemia, irrespective of having diabetes mellitus and steroid use, was associated with an increased risk of ROCM independent of COVID-19 hospitalisation. Rational steroid usage and glucose monitoring may reduce the risk of post-COVID.

Objective: To review the literature about Malignant Otitis Externa. Methodology:A comprehensive review of existing knowledge that is available in literature has been summarised in this article.Results: There is a rising incidence of Malignant Otitis Externa in the developing countries, predominantly seen in elderly diabetics. The common organism isolated is Pseudomonas aeruginosa though other microbials have been described as a causative agent. Radioimaging such as Technitium 99m MDP Scintigraphy, Gallium 67 Single Photon Emission CT and Tc99m Sulesomab scan has been recently used to asses and monitor therapy. The treatment protocol involves initial management with intravenous antimicrobials, regular aural toileting with adjunctive Hyperbaric Oxygen therapy. Unresponsive patients require either a trial with antifungals or a tissue diagnosis to rule out other differentials. Surgery is no longer found to be a first line treatment of MOE. Conclusion:Malignant Otitis Externa is a highly fatal, necrotizing condition of the external auditory canal and temporal bone which is seen in elderly immunocompromised individuals. It is a highly aggressive skull base infection that is associated with high morbidity/mortality and cranial nerve complications. Although a variety of organisms such as Proteus mirabilis, Staphylococci, Klebsiella species and Aspergillus fumigatus have been implicated in the pathogenesis of MOE, Pseudomonas aeruginosa has been a predominant organism closely associated with MOE. With the advent of present day radiological imaging and effective antimicrobials coupled with a high index of suspicion, the mortality rate has been reduced from an alarming 50% to 20% over the past few decades.

BACKGROUND: Mucocele is a true cystic expansile mass filled with mucus resulting from obstruction of the sinus ostia. Prompt diagnosis and management are needed to avoid complications due to the intracranial or intra-orbital extension. OBJECTIVES: To audit data of mucocele of the paranasal sinuses in a tertiary center, to review the literature regarding the clinical features and the management of mucocele in the paranasal sinus and to emphasize the iatrogenic causes of mucocele after the development of Endoscopic Skull Base Surgeries. MATERIALS AND METHODS: A retrospective analysis of etiology, clinical presentation, sinuses involved, operative technique, complication, recurrence were interpreted. RESULTS: The mean age of 16 patients managed is 49. Location:37% frontal,19% ethmoidal,19% frontoethmoidal,19% sphenoidal,6% maxillary. The iatrogenic cause was 44%. Symptoms included proptosis, external swelling, nasal block, and discharge, and vision loss. Complications were orbital abscess and skull base defect. 14 patients underwent endoscopic procedures-excision or marsupialization. One patient underwent craniotomy; one patient combined approach was performed. One patient had a recurrence. CONCLUSION: Mucocele of the paranasal sinuses is still a rare clinical scenario and it is imperative to note that any delay in diagnosis and management can lead to expansion and erosion of the bony wall of the sinuses and causing complications.

ABSTRACT:Glomangiopericytoma is an uncommon sinonasal neoplasm, originating from pericytes of capillaries constituting less than 1% of all sinonasal mass. It is a borderline low malignant tumor. We report the case of a 25 year old female with history of progressive nasal obstruction on the left side, bleeding from the left nasal cavity, anterior rhinoscopy showed a mass in the left middle meatus. This was successfully excised in toto by trans-nasal endoscopic approach. Histopathology was inconclusive and Immuno-histochemistry was required to confirm the diagnosis. The clinical presentation, histopathology, management and prognosis are discussed.

ABSTRACT:BACKGROUND:Juvenile nasopharyngeal angiofibroma (JNA) is an uncommon lesion which exclusively occurs in an adolescent male. They comprise about 0.05% to 0.5% of all head and neck tumors. The surgical management of this lesion is challenging. This tumor being highly vascular has the potential to bleed torrentially during surgery. The advent of endoscopic sinus surgery has significantly modified the way in which the tumors of the nose and paranasal sinus have been managed.AIM AND OBJECTIVES OF THE STUDY:Audit the clinical and operative data, to ascertain the role of preoperative embolization and autologous blood transfusion.STUDY DESIGN: Retrospective study.SUBJECTS AND METHODS:Clinical and operative data of all patients of JNA during the period 2008 to 2011were included in this study.RESULTS: Complete tumor removal was obtained in all the eight cases. Seven of these cases had Stage II b and 1 had stage III b (Radkowski classification). Six cases were managed by endonasal endoscopic approach. Two cases were treated by external approach. All patients underwent super selective embolisation preoperatively 24 hour prior to surgery. The average blood loss during surgery was 362ml+/-176.2ml. All but one had received autologous blood transfusion during surgery. CONCLUSION: Pre-operativeembolization minimizes the intra operative blood loss. Autologous blood transfusion needs to be planned in advance and reduces the morbidity associated with transfusion. Endonasal endoscopic surgery has tremendously reduced the morbidity and facial morphological deformity in surgical management of Juvenile nasopharyngeal angiofibroma.