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Objective: To depict various temporal bone abnormalities on high-resolution computed tomography in congenital aural atresia patients, and correlate these findings with auditory function test results and microtia subgroup., Methods: Forty patients (56 ears) with congenital malformation of the auricle and/or external auditory canal were evaluated. Auricles were graded according to Marx's classification, divided into subgroups of minor (grades I and II) and major (III and IV) microtia. Other associated anomalies of the external auditory canal, tympanic cavity, ossicular status, oval and round windows, facial nerve, and inner ear were evaluated., Results: Minor and major microtia were observed in 53.6 and 46.4 per cent of ears respectively. Mean hearing levels were 62.47 and 62.37 dB respectively (p = 0.98). The malleus was the most commonly dysplastic ossicle (73.3 vs 80.8 per cent of ears respectively, p = 0.53). Facial nerve (mastoid segment) abnormalities were associated (p = 0.04) with microtia subgroup (80 vs 100 per cent in minor vs major subgroups)., Conclusion: Microtia grade was not significantly associated with mean hearing levels or other ear malformations, except for external auditory canal and facial nerve (mastoid segment) anomalies. High-resolution computed tomography is essential in congenital aural atresia, before management strategy is decided.

Objective: To assess the association between the habitual head position during bedrest and the affected ear in benign paroxysmal positional vertigo (BPPV)., Study Design: Prospective trial of patients with active BPPV of the posterior semicircular canal, confirmed on physical examination., Methods: Seventy-five patients were asked to explain the head position and lying side they were accustomed to before falling asleep in bed., Results: Fifty patients (67 per cent) habitually adopted a lateral head position during bedrest. The ear affected by BPPV was found to be consistent with the head-lying side during bedrest in 43 cases (86 per cent) (29 cases for the right ear and 14 cases for the left ear)., Conclusion: Habitual lateral head-positioning during bedrest can be a major factor leading to the development of BPPV in the ipsilateral ear.

Conservative shunting procedures, i.e. ESS, ultrasonic irradiation and cryosurgery, are based on the assumption that there is increased volume and/or pressure of endolymph in Menière's disease. Since there is no reliable clinical test to detect endolymphatic hydrops, shunting procedures on cases without hydrops are doomed to failure. Surgery on the endolymphatic sac was not associated with fibrosis or obliteration of its lumen. Silastic shunt tubes were well tolerated by the body, and the shunt between the sac and the subarachnoid space seemed to remain open. The results of experimental surgery on the endolymphatic sac and its applicability to humans should be revised. Temporary improvement of Menière's symptom-complex may be expected from any surgical procedure on the membranous labyrinth, even in cases without endolymphatic hydrops. Post-operative serous labyrinthitis with associated biochemical changes is the cause of this improvement. The success of shunting procedures cannot be judged histologically by the position of Reissner's membrane. This membrane acts like varicose veins: once dilated, always dilated. Ultrasonic irradiation and cryosurgery of the labyrinth result in limited degenerative changes close to the site of probe application. Degenerated intact membranous walls may act as an internal otic-perotic shunt and may result in symptomatic improvement in Menière's disease. The idea of selective vestibular neurectomy and internal shunting procedures, i.e. without drainage of endolymph to the outside (mastoid) or to the inside (CSF), should be developed further. Recurrence of symptoms following shunting procedures may be due to failure of the shunt, or to the presence of endolymphatic hydrops in the non-operated ear. MF vestibular neurectomy results in complete denervation of the vestibular end-organs, without effect on the cochlea or facial nerve. Excision of Scarpa's ganglion causes retrograde degeneration in the proximal stump of the vestibular nerve, most probably to the level of the brain-stem. Recurrence of dizziness following TC labyrinthectomy is most commonly due to inadequate removal of the vestibular end-organs. The high regenerative capacity of the vestibular nerve is evidenced by the formation of traumatic neuromas in the vestibule following TC labyrinthectomy. Whether these neuromas produce symptoms is unknown. Persistent cochlear hydrops occurs following TC labyrinthectomy and TL vestibular neurectomy owing to obstruction in the hook region of the cochlea and in the ductus reuniens. This may result in persistent tinnitus and feeling of pressure in the ear.

Otoscopic examination of the ears of Egyptian mummy PUM II with the operating microscope revealed a small oval perforation of the right tympanic membrane in the posteroinferior quadrant. The smooth and concise margins suggested an etiology of middle ear infection. A method which allows decalcification of ancient specimens without disintegration of the eardrum and other soft tissues within the temporal bone was described. There was evidence of histological repair at the margins of the perforation consistent with sequela of otitis media. No other abnormalities were observed in the temporal bones of this individual. There was no evidence of otosclerosis bilaterally. To our knowledge, this is the first time that a pathological tympanic membrane perforation has been histologically documented in an ancient temporal bone.