Migrainous vertigo is a common cause of dizziness presenting to an otorhinolaryngology/otoneurology clinic. Although it causes a substantial burden to the individual and society there are no randomized controlled trails on prophylactic medication for this condition. Flunarizine, a calcium channel blocker has been used effectively in both migraine and vestibular conditions. This randomized control trial was undertaken in a tertiary academic referral center to evaluate the efficacy of flunarizine in patients with migrainous vertigo when compared to non-specific vestibular treatment of betahistine and vestibular exercises. The effect of flunarizine on two particularly disabling symptoms of vertigo and headache was studied. A total of 48 patients who were diagnosed with definitive migrainous vertigo completed the study of 12 weeks duration. Patients in arm A received 10-mg flunarizine daily along with betahistine 16 mg and paracetamol 1 gm during episodes, and arm B received only betahistine and paracetamol during episodes. Symptom scores were noted at the start of the study and at the end of 12 weeks. Analysis of the frequency of vertiginous episodes showed a significant difference between arm A and arm B (p = 0.010) and improvement in severity of vertigo between the two groups (p = 0.046). Headache frequency and severity did not improve to a significant degree in arm A as compared to arm B. The main side effects were weight gain and somnolence and this was not significantly different between the two groups. Flunarizine (10 mg) is effective in patients with migrainous vertigo who suffer from considerable vestibular symptoms.

The aim of the present study was to identify preoperative clinical predictors for difficult laryngeal exposure (DLE) and to define a simple grading system for laryngeal exposure. This is a prospective descriptive study carried out in a tertiary teaching hospital in South India. Patients above 18 years undergoing microlaryngoscopy had presurgical evaluation of 11 physical parameters. Grading of Modified Cormack-Lehane Score (MCLS) and rigid laryngoscopy were done during procedure. On logistic regression analysis, with a 95 % confidence interval (CI) MCLS was found to be a statistically significant predictor (odds ratio 12). With 90 % CI, neck circumference, atlanto-occipital extension and MCLS were significant (odds ratio of 4, 4, 12 respectively). Neck circumference of more than 34.25 cm and limited atlanto-occipital extension of less than 19.50, predicts difficult laryngeal exposure. A simple grading system for laryngeal exposure during microlaryngoscopy is being proposed. MCLS grade more than 2a done intra operatively correlates well with difficult intubation.

<p class="abstract">COVID-19 infections is known to have a multitude of clinical presentations, and newer clinical complications continue to be reported from all over the world. It is now widely known that the diabetic patients with poor glycemic control are associated with a higher risk of developing severe COVID-19 infection. They are also at a high risk for developing secondary bacterial or fungal, co infections because of the complex interplay of multiple risk factors , necessitating an intensive medical care and monitoring in them. We are presenting a case of mucormycosis in a diabetic patient with moderate COVID pneumonia that presented to us as orbital cellulitis and the events that followed. There have been very few documented cases of mucormycosis in COVID infected diabetic patients so far during this pandemic and we also present a literature review of the same.</p>

This study demonstrated the presence of oxidative stress in ascitic fluid from patients with SBP, and showed that ascitic fluid nitrate may be a marker for diagnosing SBP and a useful index in determining therapeutic response to antibiotic treatment.

Background External auditory canal (EAC) masses can arise secondary to a multitude of ear pathologies like congenital, inflammatory, infective, or malignancy. The most common causes of external auditory canal masses are due to otitis media—squamous and mucosal types, tubercular otitis media, malignant otitis externa, and benign tumors like osteomas, exostosis, pleomorphic adenoma, tumors from the ceruminous and sebaceous glands; and malignant tumors like squamous cell carcinoma and rhabdomyosarcoma. The management of an external auditory canal mass will vary in each case, depending upon the underlying pathology and the extent of the involvement of the surrounding structures. Case presentation In our case report, we report a neglected foreign body in the external auditory canal that presented as an EAC mass and its management. Conclusion Hence, we suggest that we need to consider an underlying neglected foreign body as a cause, whenever masses of EAC do not respond to appropriate medical treatment with antibiotics.