Thirty‐seven cases of ceruminous gland tumors of the external auditory‐canal are presented. These are rare tumors, each of which has different clinical characteristics. Six adenomas are reported which are benign and require only local excision for long‐term cure. Two muco‐epidermoid carcinomas, a type not previously reported, are presented. The muco‐epidermoid carcinoma tends to iecur locally and radical excision is necessary for control. The most common glandular tumor of the external auditory canal is the adenoid cystic carcinoma. Twenty‐four are reported. Pain is the hallmark of this tumor. The long clinical course ultimately results in death if the tumor is not radically removed at the earliest possible time. Radiation is ineffective. Treatment recommended is (1) wide excision of the external auditory canal, (2) extensive radical mastoidec‐tomy, and (3) total parotidectomy and mandibular condylectomy.Five cases of adenocarcinoma are presented. Four were dead from local invasion and distant metastasis within four years, and the fifth was lost to follow‐up.Careful histologie evaluation and classification of the type of tumor is necessary to predict the natural history and select the proper treatment. Local excision is curative for the benign adenoma. For the three types of carcinoma described, the surgeon must not hesitate to do the radical operation for the early lesion, because it is in the early stages that the opportunity to produce the cure exists.

The epithelium basement membrane of cholesteatomas in cases of chronic otitis media often extends into the sinus tympani. In the majority of cases it can be safely and completely removed by dissection through the ear canal and tympanum. In 2% of cases, not all squamous epithelium basement membrane can be removed because the sinus tympani extends more than 3 or 4 mm posterior to the anterior edge of the facial nerve and because the membrane is adherent to the irregular bony surface. Surgical exposure of the sinus tympani through the mastoid posterior and medial to the facial nerve allows complete removal of all basement membrane with a direct view. The technique using a retrofacial approach to expose this obscure sinus is described and a series of 48 cases treated successfully by this method are reported.

Facial nerve neuromas are uncommon, slow-growing neoplasms that may occur anywhere along the course of the facial nerve from the brainstem to the facial muscles. The signs and symptoms are characteristic and vary with the anatomic site of origin. Surgery should not be attempted until a complete and thorough diagnostic examination has been completed. The surgeon should be prepared to perform a middle-cranial fossa or translabyrinthine approach in all cases, and must expect to do a nerve graft. The results of 37 patients treated by the author reveal that, under optimal conditions, patients who have had a facial nerve graft, can be expected to regain an average of 80 % facial nerve strength in almost every case. All patients who have had a facial nerve graft will have some degree of synkinesis. No graft was required in 3 patients, and a hypoglossal facial anastomosis was used for one. Facial function was completely normal in 2 patients, 16 had 80 – 90 % return, 5 patients had 50 – 80 % return, 4 had 20 – 50% return, one had no recovery at all and 9 recent patients have not reached the time for their expected recovery. Early diagnosis, prompt surgical removal and VII - VII Nerve graft for facial paralysis of ten or fewer years duration offers patients the best opportunity to avoid a permanent facial palsy.

Facial nerve neuromas are uncommon, slow growing, and readily treatable when detected. Fourteen patients with facial nerve neuromas are reported here. These tumors can occur within any part of the intratemporal course of the facial nerve. Occurrence and progression of the symptoms depend on the site of origin of the tumor and are those of facial nerve paralysis, hearing loss, or vertigo; occasionally there may be no symptoms at all. Initial facial paralysis may recover leading to a mistaken diagnosis of Bell's palsy. All patients with facial paralysis should be seen by an otologist whose examination would include audiogram for pure tones and speech, positional and caloric vestibular examination and roentgenogram of the temporal bone. If the possibility of intracranial extension exists, a pre‐operative myelogram of the posterior fossa should be made. Early diagnosis, prompt surgical removal, and graft or end to end anastomosis of the facial nerve would be the goal in the treatment of facial nerve neuromas.

A rare cause of otalgia is geniculate neuralgia. In its most typical f orm, it is charac terized by seve re paroxysmal neuralgic pain centered directly in the ear. The pain can be ofa gradual onset and ofa dull, persistent nature, but occasionally it is sharp and stabbing. When the pain becomes illtractabl e, all operation to surgically excise the nervus intermedius and geniculate ganglion via the middle cranial fossa approa ch is indicated. The pu rpose of this article is to review the long-term outcom es in 64 patients who were treated ill this manner. Findings indicate that excision of the nervus intermedius and geniculate ganglion call be routinely performed without causing fac ial paralysis and that it is an effective defi nitive treatmentfor intracta ble geniculate neuralgia.