Beyond the pulse: unusual presentations of Takayasu抯 arteritis

Takayasu抯 arteritis (TA) a.k.a pulseless disease is a chronic inflammatory occlusive thrombo-aortopathy. It is a rare inflammatory disease affecting large arteries, often leading to significant diagnostic challenges, especially when presenting with atypical symptoms. This case report explores a patient, whose primary complaints were chest pain and no neurological or constitutional symptoms, diverging from the common presentations of diminished pulses or limb claudication. Advanced imaging, including CT Aortogram and interventions like cardiac angiography, played a crucial role in detecting vascular inflammation and stenosis, facilitating accurate diagnosis and management. The case underscores the importance of considering Takayasu arteritis in differential diagnoses, even with non-classical presentations. This present case demonstrates rare and unique presentation of TA where patient presents with myocardial infarction and cardiogenic shock and also explains the diagnostic dilemma of TA with such unusual presentation.

Novel contribution to existing knowledge: a focus on emotional intelligence and academic behavior in Northern India

Background: The present study explored the relationship between emotional intelligence (EI) and academic behavior (AB) among undergraduate students in Northern Indian colleges. Understanding these factors is fundamental for enhancing student success and well-being. Methods: Using a cross-sectional methodology, self-report questionnaires were used to gather data from 1000 undergraduate students who were selected through purposive sampling. Data was collected using tools that included the Emotional Intelligence Self-Assessment Questionnaire and the Academic Behavior Assessment Questionnaire. Results: The study's findings indicate that, while emotional intelligence and academic behavior are not substantially associated, students exhibit exceptional academic behavior and high emotional intelligence scores Statistical analyses examined the correlations and impacts of various demographic factors on EI and academic behavior. Participants exhibited high levels of academic behavior (mean=87.26, SD=13.55) and average levels of EI (mean = 48.76, SD = 13.99). A statistically significant positive correlation was found between EI and academic behavior (r = 0.097, p = 0.002). Course of study, presence of physical illness, and socio-economic status significantly influenced academic behavior, while place of residence, religion, and socio-economic status affected EI scores. Conclusions: Despite the positive correlation between EI and academic behavior, the association was not substantial. The study highlights the complex interplay of multiple factors affecting student achievement. Further research is encouraged to investigate additional variables impacting EI and academic behavior among Northern Indian undergraduates. These insights can inform targeted interventions to support student development and academic success.

Vasculitis masquerading as a mass: a case report of Takayasu arteritis in a 28-year-old male

Takayasu arteritis is a chronic vasculitis mainly involving the aorta and its main branches most commonly subclavian and carotid. It induces clinically varied ischaemic symptoms due to stenotic lesions or thrombus formation, including blindness, retinal haemorrhage, pulselessness, aortic regurgitation and congestive heart failure due to dilatation of the ascending aorta. More acute progression causes destruction of arterial wall, leading to the formation of aneurysms and rupture of the involved arteries. Here we present a case of Takayasu’s arteritis in a 28-year-old male who presented with nonspecific symptoms of fever and neck pain with palpitations and feeling of pulsations in right side of neck since last 20 days and was eventually diagnosed as arteritis. This case shows that it can present with many non-specific symptoms and can be diagnosed with proper examination and a high index of suspicion due to its nonspecific overlapping features with many diseases.

A study of detection of diarrhoea associated human rotavirus and co-infection with diarrhoea genic pathogens in childhood stool specimen by using ELISA and RT-PCR in a tertiary care hospital at Indore, Madhya Pradesh

Background: Childhood diarrhoea mainly caused by Group A Rotavirus, is a major global health issue, especially for children under five. In India, RVA-induced diarrhoea causes numerous deaths, hospitalizations, and outpatient visits annually. Vaccination is crucial in preventing RVA, with WHO-approved oral vaccines significantly reducing global mortality and morbidity. However, challenges persist in implementing vaccines in regions like sub-Saharan Africa due to factors like malnutrition and unsanitary conditions. Despite this, since 2009, low-income countries have seen a decline in RVA-related illness. Methods: Over 18 months, from January 2021 to June 2022, a study at the Post Grad Dept. of Microbiology, Index Medical College, Hospital and Research Centre in Indore, MP, involved 250 children under five with acute gastroenteritis. Ethical clearance and parental consent were obtained. Data included demographic, antenatal, diarrhoea l symptoms, feeding, hygiene, physical exams, and stool analysis. Results: 250 children under five were screened for Rotavirus. 60 tested positive, mostly in 6–12-month-olds during cooler months in urban areas. 80% were from low socioeconomic backgrounds. Exclusive breastfeeding linked to lower incidence. Vomiting and severe dehydration more frequent in positive cases. ELISA and ICG methods equally effective. Conclusions: Childhood diarrhoea, primarily caused by Rotavirus, remains a leading cause of under-five deaths, totalling 600,000 annually. Among 250 children studied, 60 tested positive for Rotavirus, especially among males aged 7-12 months, with infections peaking in cooler months. Both ELISA and ICG were equally effective in detection. Treatment primarily involves oral rehydration with low osmolarity ORS. Predominant strains were G1 P (8) and G2 P (4). Global endorsement of rotavirus vaccines like Rotarix and Rotateq, with Rotavac showing promise in India, signals progress in fighting rotavirus, potentially improving public health via inclusion in state immunization programs.

Electronic device use and its adversities among BPH students of Kathmandu valley

Background: Electronic devices here means devices like computer, laptop, smart phones, e-games etc. Recently the ownership, use and time-spent on electronic devices has increased dramatically on all age groups for the purpose of communication, entertainment, education, work, etc. and mostly adults are dependent on these devices. Methods: A descriptive cross sectional was done among 248 BPH students of Kathmandu valley. Four colleges were selected through lottery method and 62 students of 1st, 2nd and 3rd year were conveniently selected from each college by disproportionate stratified sampling. Semi-structured self-administered questionnaire was used to collect data which was analysed in SPSS version 21.0 and interpreted using bivariate test. Results: All the respondents owned at least one electronic device. Smart phones were found to be the mostly used electronic device and entertainment was the main purpose for which the devices were used. 10.5% showed range of health adversities in relation to electronic device use with eye symptoms being the most common adversity. 80% were found to use electronic device before going to bed which was associated with the sleep quality of the respondents. Conclusions: This study concluded that time-spent on electronic device is high and using electronic devices before bed time was significantly associated with the sleep quality. Not just sleep quality but excessive use of these devices for long run had the risk of developing health effects like headache, eye, ear and musculoskeletal symptoms and few had mild health effects.

Vaccine hesitancy amongst the tribal population of India: a comparative scenario between COVID-19 vaccination and routine immunization

Vaccine hesitancy plays a crucial role in slowing down the efforts towards achieving an immunized and healthy society, particularly, children and women. VH is very conspicuous among the economically marginalized tribal and indigenous population. Previous research papers have not presented a comparative scenario between VH for RI and COVID-19 and have not discussed in detail different reasons behind VH from the gender perspective among tribal population. The key research question for this systematic review is whether the vaccine hesitancy for routine child vaccination among the tribal population will reduce or escalate or show no change after COVID-19 vaccination drive. This paper using Google Scholar database identified the research paper and reports, published between 2013 and 2023, and synthesized the factors contributing to vaccine hesitancy among the tribal population. While hesitancy due to reasons such as the safety and trust concerns, related to vaccines and the government; strong dependency on natural remedies; decision making dominated by social and cultural norms prevailing since ages; emerged as the key resistant in case of routine immunization among the tribal population, these were observed to be similar, to a large extent, in case of COVID-19, as well, in spite of two different age groups being the target of the vaccination drive. The paper identified key enablers and barriers of vaccine acceptance, which will be insightful for policy makers, healthcare agencies and professionals working to eliminate VH among tribal and indigenous population.

Significance of evaluating mandibular parameters for the identification of an individual

Background: Estimating the age of death is a crucial step since it narrows the field of probable identities that must be compared to remains after mass tragedies. Morphological changes in the mandible are mostly driven by an individual抯 age and occlusal status. The aim of this study was to determine the association of the dimensions of these parameters with the age and gender of an individual with a larger sample size using orthopantograms in the north Indian population. Methods: A retrospective radio morphometric analysis was performed for panoramic radiographs of 300 (150 males and 150 females). The digital panoramic images were saved in Dicom format and exported to MicroDicom software for linear measurements. The co-relation of study parameters with age was analyzed by one-way ANOVA and assessment of co-relation with sex by applying student抯 t-test. Results: The mean values of the right and left gonial angles were higher in females, while the ramus height and bigonial width dimensions were greater in males. However, only the left gonial angle and ramus height showed statistically significant differences with gender (p<0.05). Conclusions: The present study found substantial changes in gonial angle, ramus height, and bigonial breadth based on gender and age in a larger sample size. As a result, these dimensions can be an accurate predictor of an individual抯 age and sex. Thus, morphometric examination of the mandible can be a useful tool in both identifying individuals and studying growth patterns.

Extreme thrombocytosis in traumatic amputee and role of thromboembolism prophylaxis: a case report

Platelets are the smallest blood component produced in the bone marrow that plays a fundamental role in the blood clotting process. A normal platelet count applicable to all adults is 150 to 400�9/l. Thrombocytosis develops when the platelet count exceeds 450�9/l. Thrombocytosis is classified into primary thrombocytosis and secondary (or extreme) thrombocytosis. Primary thrombocytosis is a chronic myeloproliferative disorder in which sustained megakaryocyte proliferation leads to an increase in the number of circulating platelets. Extreme thrombocytosis or reactive thrombocytosis, is defined as abnormally high platelet count in the absence of chronic myeloproliferative disease, secondary to an underlying events, disease, or the use of certain medications. Causes of reactive thrombocytosis include acute blood loss, acute infection, amputation, iron deficiency, asplenia, cancer, chronic inflammatory or infectious diseases. Secondary thrombocytosis resolves when the underlying event is managed. Extreme thrombocytosis may result in thromboembolic episode such as mesenteric vein thrombosis, pulmonary embolism and acute myocardial infarction. In patients who survive after trauma the platelet count displays a bimodal response with an initial decrease below baseline values, followed by an increase above the normal range after 1 week. We report a similar experience of a trauma patient with reactive thrombocytosis and discussion on importance of thromboprophylaxis.

Hearing assessment in mobile phone users

Background: Mobile phones have become an indispensable part of today's modern world. But with various day-to-day benefits, mobile phones also bring detrimental effects on the health of users. Ear being the closest organ in contact with phones, faces maximum effect of electromagnetic waves generated by them. Chronic exposure to these waves and sounds can result in permanent hearing loss. Hence, the present study was done to assess the association between hearing loss and duration of mobile usage. Methods: This cross-sectional study was conducted on mobile phone users between the age group of 20 and 40 years in the Department of ENT, Rajindra Hospital, Patiala over 6 months (1 August 2022 to 31 January 2023). 600 volunteers were involved and divided into three groups based on the duration of mobile phone usage. Pure tone audiometry and DPOAE were used to assess the hearing loss in these subjects. Results: A variable degree of hearing loss was observed on PTA and DPOAE in all three groups with a significant association between hearing loss and the duration of mobile phone usage. A higher proportion of sensorineural hearing loss was observed in the group with mobile phone usage of more than 1 hour per day for a minimum of 4 years as compared to those who used them for <1 hour per day for a minimum of 4 years and control group (p=0.001) which was significant statistically. Conclusions: People using mobile phones for long hours are at higher risk of developing hearing loss, especially in the dominant ear.

Medicinal plants used for treating infertility and related disorders of women in India: a systematic review

Assessment of plant medicine for treating infertility and related disorders is making headway universally recent couple of decades to bring out new effective and safe substances as an alternative medicine. Present paper reviews the published literature on plant medicine used for female infertility and related disorders. The 53 research papers or reports shortlisted are based studies under taken in India. Total 459 uses of 202 medicinal plants classified under 84 families. Total 62 trees, 55 shrubs, 79 herbs and 3 climbers are reported. Most used plant parts for making medicine are roots in 111 formulations and leaf in 101 formulations. Medicinal plants used for infertility are 84, while for related disorder like leucorrhoea 79 plants, menorrhagia 53, dysmenorrhea 29, amenorrhea 23 and 22 plants used to regulate menstruation. Additional investigations could be helpful to verify the claims reported using a specific formulations or recipes and which will subsequently result in providing possible the alternative medicine for the treatment of female infertility.

Knowledge, attitudes and practice among healthcare workers towards COVID-19 in a tertiary care centre in north India

Background: Coronavirus disease pandemic has affected the entire world and till date, there is no definitive cure for it with prevention of infection and knowledge about the disease being the only proven effective methods to contain it. Healthcare workers (HCWs) are highly susceptible to getting infected and their knowledge about COVID-19 infection has been known to be inversely proportional to the rates of COVID-19 infection. Methods: Cross-sectional questionnaire-based study assessing knowledge, attitude and practices towards COVID-19 preventive measures was carried out amongst HCWs at a tertiary care hospital in North India. Results: Around 95% of HCWs had received training regarding COVID-19 infection and more than 95% HCWs had adequate knowledge about COVID-19 infection. More than 95% HCWs experienced anxiety and fear while monitoring and treating COVID-19 patients. 85% HCWs felt that there is sufficient awareness in the society regarding COVID-19 infection. Most of the respondents followed correct practices for avoidance of COVID-19 infection with around 90% respondents using face masks and practicing frequent hand washing. Social distancing and avoidance of large gatherings was practiced by around 95% respondents. More than 95% respondents had either taken COVID-19 vaccine or wish to take it. Conclusions: The study suggested that the majority of HCWs had good knowledge and positive attitude toward COVID-19 but there are still some lacunae present in the knowledge regarding prevention of COVID 19 infection. Further education and training are required for HCWs so as to fight COVID and prevent its spread in a better way.

Population Dynamics of Mustard Aphid, Lipaphis erysimi (Kaltenbach) on Cauliflower in Relation to Biotic and Abiotic Factors

The field experiment was conducted at Horticulture Farm, S.K.N. College of Agriculture, Jobner during Rabi 2021/22 to know the population dynamics of mustard aphid, Lipaphis erysimi (Kaltenbach). The incidence of aphid started in the first week of December and second week of December remained active throughout the crop season during both years. The population of aphid gradually increased and reached to its peak in the second week of February and first week of February in Rabi, 2021/22, respectively. The correlation studies indicated that the aphid population had non-significant correlation with temperature, relative humidity and sunshine hours in both the years. Both the predators, ladybird beetle and syrphid fly had significant positive relationship with aphid population during both the years.

Effect of Sowing Methods and Nitrogen Levels on Growth, Yield and Economics of Oats (Avena sativa L.) under Mid-Hills of Himachal Pradesh, India

In Himachal Pradesh, farmers typically possess small land holdings where machinery isn't practical for various sowing techniques, limiting them to broadcasting. Regarding nitrogen, it facilitates more vegetative growth by enhancing the photosynthetic rate. The higher the nitrogen content, the greater the vegetative growth potential. Therefore, present investigation titled “Effect of Sowing Methods and Nitrogen Levels on Growth, Yield and Economics of Oats (Avena sativa L.) under Mid-hills of Himachal Pradesh, India” was conducted during rabi season of 2022-23 at Chamelti Agriculture Farm, MS Swaminathan School of Agriculture, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh. The field experiment was laid out in Split Plot Design comprising twelve treatments with three replications. The experiment consists of three sowing methods in main plot i.e., (S1) Broadcasting, (S2) Line sowing and (S3) Crisscross and four levels of nitrogen N0 (0 kg ha-1), N1 (75 kg ha-1), N2 (100 kg ha-1) and N3 (125 kg ha-1) as sub plot. OL 12 variety of oats was used for sowing. Sowing methods and nitrogen levels were done as per treatment. Other crop management practices were followed as per the recommendation of the area. Results indicated that among the sowing methods, (S3) crisscross, recorded significantly higher growth and yield, over line sowing and broadcasting which was on par with (S2) line sowing over the rest of the treatments except for grain, straw and biological yield. In case of nitrogen levels, (N3) application of 125 kg N ha-1 recorded significantly higher growth and yield of oats, over rest of the nitrogen levels and was on par with 100 kg N ha-1. Economically, (S3) crisscross sowing with application of (N3) 125 kg N ha-1 resulted in higher gross returns, net returns and B: C ratio under Mid Hills of Himachal Pradesh.

Medicinal plants used during pregnancy, childbirth and postpartum care in India: a systematic review

Use of plant medicine during pregnancy, childbirth and in postpartum care has grown significantly worldwide and is remarkably well-known in different regions of India. Traditional plant medicine has the potential for treating various diseases/ailments and is evidenced by well-known pharmacopeia of India - Ayurveda. This paper reviews the research papers on plant medicine utilization during pregnancy, childbirth and for postpartum care based on information published from India. Total 206 uses of 146 medicinal plants belong to 69 families, of which 125 are herbs, 39 trees, 26 shrubs and 16 climbers. Plant parts used as medicine for treating various disorders during pregnancy, childbirth and postpartum are 75 leaves, 48 roots, 23 seeds, 19 whole plants, 15 fruits, 11 barks, stem and flower 5 each, gum 2, latex 1, while in 24 cases part used is not specified. The use of plants for treating various disorder/ailments during pregnancy, of these most prevalent use is as a tonic (23 uses) which followed by vomiting (10), abdominal pain (9), to facilitate delivery (6) and so on. Use of plants during childbirth, maximum number of plants used to facilitate deliver (32 uses), for labor pain (15), and to induce labor (12). While use of plants for postpartum care, includes (37 uses) for lactation, (10) for haemorrhage, and 7 for abdominal pain.

Effect of Integrated Nutrient Management on Growth and Yield of Barley (Hordeum vulgare L.)

During the Rabi season of 2018-19, a field experiment was undertaken at Vivekananda Global University's Research Farm in Jaipur to investigate the "Effect of Integrated Nutrient Management on Growth and Yield of Barley (Hordeum vulgare L.)." The experiment followed a randomized block design with three replications. The treatments consisting of nine treatment combinations viz., 100% RDF (T1), 100% RDF + vermicompost 2.5 t ha-1 (T2), 100% RDF + vermicompost 2.5 t ha-1 + Azotobacter (T3), 75% RDF (T4), 75% RDF + vermicompost 2.5 t ha-1 (T5), 75% RDF + vermicompost 2.5 t ha-1 + Azotobacter (T6), 50% RDF (T7), 50% RDF + vermicompost 2.5 t ha-1 (T8) and 50% RDF + vermicompost 2.5 t ha-1 + Azotobacter (T9) were applied to the barley var. RD-2035. The experimental results demonstrated that several integrated nutrient treatments greatly boosted barley growth, yield characteristics and yield, quality, and economics. With the application of 100% RDF + vermicompost 2.5 t ha-1 + Azotobacter (T3), the maximum plant height at 60 DAS and 90 DAS, total number of tillers at 60 DAS and 90 DAS, effective number of tillers, ear length, number of grains ear-1, grain yield, straw yield, biological yield, and nitrogen content in grain and straw of barley were obtained. However, the application of 100% RDF yielded the significantly largest net returns and B: C ratio of barley (T1).

Comparison of various decalcifying agents to evaluate their efficacy

Background: Bone is a biological complex structure primarily comprising collagen and minerals. It is important to demineralize these mineralized tissues to remove their calcium apatite crystals for analysing the sub-cellular, cellular, and fibrillar architecture. Six demineralizing agents’ efficacy was examined by assessing their duration, ease of handling tissue, staining, and histological criteria. The present study aimed to evaluate six commonly used demineralizing agents to identify the best decalcifying agent. Methods: Twenty resected hard tissue specimens (1 cm × 1 cm x 1 cm) from the archives were used in the study. These segments were decalcified by solutions namely 10% nitric acid, 10% formic acid, 14% ethylene di amine tetra acetic acid (EDTA), a mixture of formic acid and hydrochloric acid (formic + HCL) 4% each, and a mixture of formic acid and nitric acid 4% each (formic + HNO3), 10% formal nitric acid further subjected to radiographic endpoint test. Results: The present study confirmed the fact that samples treated with EDTA showed the best overall impression in terms of tissue integrity and histology followed by 10% formal nitric acid which gave fairly good cellular details and was also rapid in the action. Conclusions: Based on the present study findings, we suggest that 10% formal nitric acid is the better decalcifying agent available, considering time and tissue integrity as two main factors.

Hypertrophic pachymeningitis: a rare manifestation of IgG4 related disease

Hypertrophic pachymeningitis (HP) is a rare form of diffuse inflammatory disease that causes thickening of the dura mater. It can involve the cranial or the spinal dura or both. An increasingly well-known symptom of IgG4-related illness, a fibroinflammatory syndrome that may affect almost any organ, is IgG4-related hypertrophic pachymeningitis (IgG4-RHP). It is estimated that IgG4-RHP may account for a high proportion of cases of hypertrophic pachymeningitis once considered idiopathic. Contrast magnetic resonance imaging (MRI) shows pachymeningeal enhancement. Serum IgG4 levels may be elevated but are normal in most patients. However, most patients have elevated cerebrospinal fluid (CSF) IgG4 index. Hence, CSF IgG4 index could serve as a less invasive diagnostic marker of IgG4-RHP. Confirmation of diagnosis is by meningeal biopsy that shows swirling “storiform” fibrosis with lymphocytic infiltrates, obliterate phlebitis and IgG4 positive plasma cells. This case highlights the diagnostic dilemma of IgG4-RHP as gold standard of diagnosis is meningeal biopsy which has many of its own limitations. CSF IgG4 index could be an alternate option for meningeal biopsy when the procedure is contraindicated or uninformative.

Adrenal ganglioneuroma; a rare neurogenic tumor in a 25-year-old female

Ganglioneuromas (GNs) are rare benign tumors originating from the neural crest tissue. They are characteristically located in the posterior mediastinum and retroperitoneum; and are rarely found in the adrenal gland. GNs are usually hormonally inactive, and most of the cases are detected incidentally. We report a case of 25-year-old female who presented with pain abdomen in the right upper quadrant. Imaging studies showed a large well defined hypodense lesion with calcification measuring 14.5×11.5×11cm in the region of right adrenal gland and a possibility of adrenocortical carcinoma was suggested. The patient underwent right adrenalectomy and histopathological examination revealed ganglioneuroma. This report emphasizes that GN can be misdiagnosed preoperatively as the presenting symptoms are nonspecific and imaging characteristics are variable. Histopathological examination is the mainstay of diagnosis.

Prevalence and associated factors of nomophobia amongunder graduate students of AIIMS Patna

Introduction:Nomophobia is the fear of being cut off from one's mobile phone, and it relates to the discomfort, anxiety, tension, uneasiness, and anguish that comes with it. Since the first decade of the twenty-first century , when this social phobia was coined, a growing number of researchers have investigated and reported the prevalence of this technology -related condition. This study aims to assess the prevalence and associated factors of nomophobia and to determine the association of prevalence and associated factors of nomophobia with selected socio-demographic variables among undergraduate students of AIIMS Patna. Material and Methods: Undergraduate students of AIIMS, Patna are taken as the target population in which the minimum required sample size was 210 but it was increased to 230 for this study. Data was collected by sending questionnaires via social media. Data analysis was done by using descriptive and inferential statistics. Results: It shows that out of the taken 230 samples, a total of 229(99.56%) are having nomophobia which 55(23.91 3%) are having mild nomophobia, 128(55.652) are having moderate nomophobia, 46(20%) are having severe nomophobia i.e. most of the students are moderately nomophobia.The findings also reveal that there is an association of prevalence and associated factors of nomophobia with selected socio-demographic variables (Duration of using smartphone per day) with a p-value of 0.000 and the Fisher exact value is 22.169 by using SPSS, the p-value for this study is 0.05.Conclusion:The study shows that 99.56 % of students are having nomophobia and it is an alarming wake-up.

Comparative study of pre-operative high-resolution computed tomography in middle ear cholesteatoma with per-operative findings

Background: Imaging plays an important role in the management of middle ear pathology. Temporal bone imaging is challenging and involves deep understanding of the anatomy, especially in relation to high resolution computed tomography (HRCT) imaging. An HRCT scan can precisely determine the site and extension of cholesteatoma and its sac, assessing the erosion of ossicles, evaluating the facial nerve in its entire course, tegmen and sinus plate, and determining Dural, sigmoid sinus, and jugular bulb positions. Methods: This prospective descriptive study was performed from January 2018 to May 2019 in 60 patients with cholesteatoma who were referred to the Otolaryngology department of the Command Hospital Kolkata. Preoperative high-resolution temporal bone CT scans were carried out and compared with intraoperative findings. Results: Evaluation of 60 patients and their CT scans revealed excellent correlation for presence of soft tissue mass and its extent into the middle ear and mastoid, erosion of scutum, erosion of ossicular chain and tegmen plate, good correlation for facial canal dehiscence, labyrinthine fistula and sinus plate erosions. Conclusions: HRCT temporal bone is essential for anatomical determination of cholesteatoma and its complication. Careful and thorough evaluation is needed for the early diagnosis and treatment of the disease, to prevent complications and preserve hearing. The extent of disease and associated complications like facial nerve paralysis, labyrinthine fistula, and intracranial complications often will determine the aggressiveness of the surgical approach.