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The vertical open MRI (Signa SP, 0, 5 Tesla) is ideal for interventional diagnosis and therapy. From our point of view indications in Otorhinolaryngology are biopsies of tumours which are difficult to access such as the petrous apex and the petroclival region, the parapharyngeal space and neck and the orbit. Furthermore the open MRI is useful in the surgery of paranasal sinuses, in the evaluation of tissue-resection and helpful in detection of the anatomy of delicate structures as the internal carotid artery, the skull-base and the orbit. Also navigation in open MRI is possible for example with a flash-point-system. The advantage to conventional navigation systems is the possibility of real-time-imaging, which allows detection of tissue shift occurring during the procedure. We report about our experience with ten biopsies of the petrous apex and the petroclival junction and two biopsy of the parapharyngeal space and the neck. Further experience was gained with MR guided placement of afterloading tubes into large neck metastases in three cases and microscopic surgery of paranasal sinuses in five cases. In all operative procedures an excellent resolution was found especially for soft tissue structures as for example blood vessels. With the aid of special pointer systems or artefacts by surgical instruments all relevant anatomical structures could be detected intraoperatively, concerning normal and pathologic tissue. Thus open MRI proved to be a helpful instrument in these operative procedures.