Primary cholesteatoma has been described in a number of sites within the temporal bone. We report an unusual case of primary cholesteatoma, confined to the mastoid, presenting with a Bezold's abscess of the anterior cervical triangle, in an otherwise asymptomatic elderly man with normal hearing.

A case is described in which a transpalatal, transpharyngeal approach was used for access to a cyst of the petrous apex.

Although its indications are limited, in selected patients this conservative procedure has advantages over the more invasive lateral routes.

CSF otorrhoea is not uncommon following head injury but late presentation is rare. In the case described an unsuspected temporal bone fracture presented after an interval of ten years with a conductive deafness due to fluid in the middle ear simulating serous otitis media.

A 53-year-old female patient who presented with recurrent meningitis as a result of a meningioma, is reported. The meningioma was found to be wholly contained within the left mastoid antrum. To our knowledge this is the first reported case of a meningioma localised to the mastoid antrum. The patient had been assessed in the ENT department on two separate occasions, 17 years and 19 years previously for nebulous symptoms related to the left ear which had cleared spontaneously. Following a second episode of pyogenic meningitis, both of which were associated with aural symptoms, radiological examination suggested an intramastoid pathology which prompted mastoid exploration. Histological examination of the mass confined to the mastoid antum provided the diagnosis of meningioma. There was no clinical or radiological evidence of extratemporal spread of tumour.

Variability in the size of the dural sinuses and jugular bulb is not uncommon and usually manifests as a high jugular bulb encroaching upon the floor of the middle ear. A rarer entity is the superior and medial extension of the jugular bulb into the bone of the posterior wall of the internal auditory meatus. We report a case where this anomaly was encountered during acoustic neuroma surgery making exposure of the fundus of the internal auditory meatus technically impossible. The possibility of a communication with the superior petrosal sinus is discussed.

A case of a mycotic aneurysm of the petrous portion of the internal carotid artery is presented. This entity is extremely rare and the problems associated with the diagnosis and clinical management are discussed.

A patient presented with mild upper airway obstruction after being shot from behind through the neck and soft palate. Two days later he developed palsies of the IXth to XIIth cranial nerves inclusive on the traumatised side. These palsies resolved spontaneously after three weeks. Further investigation revealed the presence of a saccular aneurysm of the internal carotid artery. The internal carotid artery was ligated after gradual closure for three days using a Preston clamp.

Facial nerve paralysis is a common otolaryngological diagnosis. Recurrent unilateral peripheral facial palsy is found in about 7 per cent of the cases. Simultaneous bilateral facial palsy is relatively uncommon and occurs in 0.3–2.0 per cent of cases of facial palsy. Recurrent. simultaneous, bilateral, idiopathic facial palsy to the best of our knowledge has never been reported. A case of recurrent, simultaneous, bilateral, idiopathic facial palsy is presented. No evidence of systemic or local disease was found in both attacks of peripheral facial palsies. The association with states of stress is the only common finding between the two attacks.