Tympanoplasty is the standard and well established procedure for closure of tympanic membrane perforations. Traditionally each ear drum is taken up for grafting sequentially in two different sittings, which leads to huge increase in operation cost, time and discomfort to the patient. Since, simultaneous bilateral tympanic membrane grafting could be quite safe and helpful to the patients, we performed the same in 32 patients with bilateral (64) ear drum perforations due to chronic suppurative otitis media. All patients had a conductive hearing loss corresponding to the size and site of the perforation, without evidence of ossicular chain defect or any other middle or inner ear pathology. The post-aural route was approached for the grafting in 27 ears, endaural in 22 perforations and the remaining 15 small perforations were done via endomeatal approach. All the ears were operated using the Underlay technique. The majority of the grafts were harvested from temporalis fascia (59 grafts), remaining five were obtained from tragal perichondrium. All the patients were subjected to regular follow-up evaluation and audiometry for up to 1 year after the surgery. Six ears showed incomplete recovery with residual perforation, although in two of them the tissue regeneration over next few weeks led to entire shutting down of the defect. Thus, the graft take rate was 93.75 % without any retraction pockets or displaced grafts. We did not encounter any iatrogenic sensorineural hearing loss. Thus the results from our study reinforce the safety of the single-step procedure and question the traditional apprehension regarding theoretical risk of iatrogenic sensorineural hearing loss making the ENT surgeon reluctant to perform this readily acceptable minor surgery in one sitting.

Endonasal dacryocystorhinostomy is widely accepted and effective treatment option for nasolacrimal duct obstruction. It can be done with or without the use of stents. This study was carried out to evaluate the results of endonasal DCR surgery and to access efficacy of this procedure without stenting. This is a prospective clinical study conducted in Departments of ENT and Ophthalmology, L.N. Medical College and J.K. Hospital, Bhopal from October 2008 to April 2012. A total of 90 patients with epiphora as evidenced by nasolacrimal duct blockage on syringing were included in the study. These patients underwent endoscopic DCR without stenting. The cases were followed up to 18 months postoperative. Surgical success was defined as anatomical patency and symptomatic relief at the end of the follow up period. Failure was defined as no symptomatic relief, and/or acute dacryocystitis, and/or non patent lacrimal drainage system. Surgical success was observed in 80 of 90 (88.89 %) patients. Incidence of complication was low as only 6 patients had minor complication of bleeding, synechie and granulation tissue formation. It was concluded that high success rates could be achieved in case of nasolacrimal duct obstruction by endoscopic DCR. Thus, we can minimize complications, discomfort, the cost of stenting and follow up visits after endonasal DCR surgery.

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This prospective double blind randomized study evaluated the effect of clonidine when used as an adjuvant to local anaesthetic agents for infiltration block and measured its impact on the quality of anaesthesia, intraoperative bleeding and post-operative pain. We recruited 60 patients needing tympanoplasty, which were randomized them into two groups; group A patients received local infiltration of 12 ml 2 % xylocaine with adrenaline (1:200,000 dilution), while group B received 12 ml 2 % xylocaine with adrenaline with 30 lg of clonidine. Duration of block was significantly prolonged in group B (group A 53.66 ± 7.7 vs. group B 177.13 ± 48.9, p \ 0.005). Mean pain scores were significantly lower in group B during the first hour following the block (3.43 in group A vs. 1.2 in group B, p \ 0.005). Total number of analgesic doses over 24 h showed no significant difference (3.1 in group B vs. 3.26 in group A, p [ 0.05). 93.3 % patients in group A required sedation with midazolam, compared to 10 % in group B. Grade of bleeding was significantly lower in group B. Patient and surgeon satisfaction scores were better in group B. It could be concluded that 30 lg clonidine added to lidocaine 2 % has a significant impact in decreasing the bleeding in the operative field and improving the quality of intraoperative anesthesia as well as prolonging the duration of postoperative analgesia without significant side effects.

Introduction Sore throat (acute tonsillitis/pharyngitis) is one of the most common clinical diagnosis encountered in ENT practice. It is a common practice to advice antibiotics in patients of sore throat not only in otolaryngology practice but also in pediatricians, GP's and internists. This is now becoming a matter of concern for two reasons, for the side effects of antibiotics and bacterial drug resistance. Methods To analyse patients on their symptoms and rapid streptococcal test for group A Stretococcus and determine antibiotic use. A prospective study was done in 600 patients who were clinically diagnosed as acute tonsillitis or acute pharyngitis and results analysed. Discussion Results showed that 24 % patients needed antibiotics while the rest did well without antibiotics. Results Rapid streptococcal test is a useful test in determining whether the patient needs antibiotic and help is reducing irrational use of antibiotics.