The aim of the study was to evaluate the factors that act as barriers and delay the process of cochlear implantation in children with congenital profound sensorineural hearing loss. This is a cross sectional observational study in which 154 children with profound sensorineural deafness attending ENT outdoor from Jan 2013 to June 2014 at Sri Aurobindo Institute of Medical College and PG Institute, Indore, were included in the study. Information was taken from the parents of the candidates regarding the reasons for the delay in reporting, the delay in intervention and a detailed history was also taken to evaluate the possible reason for the hearing loss with the help of open ended questions. The most common cause for the delay in reporting was lack of information about the availability of technique and procedure for cochlear implant. Financial constrain was the most common cause for the delay in getting the cochlear implant surgery.

Rhinoplasty has grown and developed over so many years but the choice of the graft material in revision rhinoplasty and rhinoplasty for post-traumatic cases still remains debatable. In such patients, non-availability of adequate autogenous graft, multiple septal fractures and skin fibrosis are a challenge to the rhinologist. To deal with this problem authors have used diced cartilage pieces as a grafting material. Secondary rhinoplasty for correction of the nasal dorsum was done in 32 patients and evaluated. The study, highlights the distinct advantages of using diced cartilage wrapped in fascia for dorsal augmentation. Full length grafts were used in all patients and this was supported on a L-shaped cartilage fixed between the two upper lateral cartilage. Fascial tube was prepared from fascia lata and conchal, rib or septal cartilage was the source of diced cartilage (0.5-1 mm sized pieces). The L-shaped structural support was prepared from the remnant of septal cartilage if any or from the conchal or rib cartilage. Patients were followed for a period of 6 months-3 years. In 30 patients post-op course was uneventful with good reconstruction results.Step-deformity was encountered in one patient and in another patient the tube opened with extrusion of diced cartilage pieces. Both these patients were effectively managed. In conclusion, diced cartilage wrapped in fascial tube has distinct advantages like it is simpler procedure and graft material is adequate and autogenous. Grafts can be prepared as per the desired length, shape and size to fit the specific defect. These being highly malleable can be used without any tension on the already thickened and fibrosed skin and soft tissue. Complications like step deformity and extrusion rarely occur and can be easily managed. Over correction and graft visibility were not met with.

Juvenile nasopharyngeal angiofibroma (JNA) are locally growing highly vascular tumours treated primarily by surgical excision (open approach as wide as a mid facial degloving or endoscopic approach). All our patients underwent exclusive endoscopic tumour excision after a pre-operative embolisation. The tumours were completely resected with acceptable blood loss and no recurrences or residual masses were seen. Post-operative morbidity was minimal without external scar-marks. To conclude endoscopic excision is a very effective method to resect JNA even for extensive tumours.

The authors want to highlight the importance of clinical, radiological and histopathological evaluation in unilateral proptosis. A 17-yearold male presented with left progressive nonpulsatile proptosis, lateral gaze diplopia and decreased visual acuity. It was diagnosed as orbital hydatid cyst on CT scan and MRI. The patient was successfully operated with near total recovery of the vision. Radiological investigation showed a circumscribed cystic lesion lateral to orbit separate from the lacrimal gland. Intraoperative cysts and postoperative histopathology confirmed the primary orbital hydatid cyst. Although rare there is always a possibility of a primary hydatid in patients with unilateral proptosis, restricted eye movements and lateral decreased visual acuity. This is possible even when the Casoni's test is negative. Surgical excision with postoperative albendazole is the effective treatment for the cure of disease.

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