Epistaxis is a common nasal symptom seen in all age groups. It often presents as an emergency. An attempt should always be made to find any local or systemic cause for it because epistaxis is a sign and not a disease per se. Objectives: To evaluate the local causes of epistaxis using rigid nasal endoscope for specific treatment planning. Methods: This was a prospective study which included 50 patients with epistaxis who attended the Otolaryngology outpatient department of SUT Academy of Medical Sciences, Trivandrum over a period of one year. Rigid nasal endoscopy under local anesthesia was done for these patients for whom both anterior and posterior rhinoscopy could not reveal any local causes. Results: Nasal endoscopy helped in finding the local causes for epistaxis. Epistaxis was more common in males (66%) and majority was in the age group of 21-30 years (46%). The causes were posterior deviation of nasal septum with spur (24%), bleeding points on the nasal septum (12%), rhinosporidiosis (10%), infected polyp (10%), deviated nasal septum with allergic rhinitis (8%), congested adenoids (8%), deviated nasal septum with sinusitis (4%), nasopharyngeal mass (4%), and miscellaneous conditions (6%). In 6% patients, no significant local cause was detected. All the patients were treated according to the endoscopic findings. Conclusion: Nasal endoscope is an important tool in diagnosis and treatment of local causes of epistaxis.

BACKGROUND Active mucosal chronic otitis media (COM) is a disease of the middle ear cleft associated with inflammation and production of pus. The incidence is high in developing countries. It affects all age groups and both genders. If not properly treated, it can lead to complications. The bacterial isolates and their sensitivity pattern vary from place to place and also over time. Early identification of the microorganisms and their antibiotic sensitivity patterns helps in proper selection of antibiotics and quick recovery in COM patients. METHODS Fifty patients with active mucosal COM were selected for the study. The study was conducted over a period of one year. Ear swab from the deep external auditory canal was collected under strict aseptic precautions from these patients before starting antibiotic treatment. Microorganisms were identified by gram staining, growth on different agar plates, and various biochemical tests. Antibiotic sensitivity was done by the Kirby-Bauer method. RESULTS Majority of the patients were in the age group of 21 - 40 years (42 %) with female preponderance (62 %). All patients had a central perforation in the tympanic membrane (100 %). Bacterial growth was seen in 44 samples (88 %). Two samples (4 %) showed fungal growth. Four samples (8 %) showed no growth even after 48 hours of incubation. Single bacterium was isolated in 41 cases (82 %) whereas 3 samples (6 %) showed more than one bacterial growth. The predominant bacteria were Pseudomonas aeruginosa (50 %) followed by Staphylococcus aureus. The other isolates were coagulase negative staphylococci, enterococci, enterobacter, acinetobacter, and E coli. Pseudomonas showed maximum sensitivity to amikacin, imipenem and piperacillin / tazobactam (100 %). The most effective antibiotics for staphylococcus was vancomycin and linezolid. CONCLUSIONS The most common bacteria isolated in active mucosal COM were pseudomonas followed by Staphylococcus aureus. The most effective antibiotics for pseudomonas was amikacin, imipenem and piperacillin / tazobactam. Staphylococcus showed maximum sensitivity to vancomycin and linezolid. KEYWORDS Chronic Otitis Media (COM), Active Mucosal, Ear Swab, Bacteriology, Sensitivity