This paper reports a case series of three elderly patients who were regularly attending ENT clinic every four to six weeks for ear canal care to address chronic otitis externa. All three patients had been taking bisphosphonate alendronic acid for years, and it is suspected that this drug was partly to blame for the progression of their chronic ear conditions.

Some improvements were noted when the bisphosphonate was discontinued. The regular microsuctioning, and application of topical antibiotics with steroids, provided temporary relief of symptoms. The present pandemic shut down the routine clinic and the patients were not seen for four to five months. On latest review, it was a surprise to see that their ears seemed to have significantly improved, with healthy re-epithelialisation.

It is thus believed that excessive and repeated microsuctioning in bisphosphonate-induced osteonecrosis of that external ear canal can delay re-epithelialisation, and gradually prolonging the intervals between microsuctioning could help in overall resolution of the disease.

The choice of surgical approach for a petrous apex lesion depends on its relationship with the internal carotid artery, degree of medial expansion and pathology. The correct identification of patients who will benefit from this approach is necessary.

Two adult patients presented with a lesion in the left petrous apex. Computed tomography showed a homogeneous mass extending anteromedially, and abutting the internal carotid artery and the sphenoid sinus in both patients. Using magnetic resonance imaging, a third recurrence of cholesterol granuloma in case one and cholesteatoma in case two were diagnosed. Both patients underwent trans-sphenoid excision, as the sphenoid sinus was well pneumatised and the lesion was medial to the internal carotid artery.

Nasal endoscopic access to the petrous apex via the trans-sphenoid corridor should be preferred for benign lesions extending anteromedially in cases where lateral access is impeded by the internal carotid artery, the labyrinth and the facial nerve, and anterior trans-sphenoidal access offers a low-morbidity alternative.