The rational treatment for the cholesteatoma should be based on the factors related with the pathogenesis, behaviors, localization of the cholesteatoma as well as the anatomic and functional factors and the ossicular chain involvement.
1. Retraction pockets are known to be the precursors of cholesteatoma formation so the retraction pockets in earlier stages have to be strategically treated.
2. The impairment of ventilation between the Eustachian tube and the aditus is very important in the pathogenesis of retraction pocket formation so, maintaining or re-creating the pathways again will serve for better success.
3. The surgical plans should be based on the locations of the cholesteatoma in order to have a beater exposition of the cholesteatoma and to remove it completely.
4. It is important to establish the most efficient way of reaching to the cholesteatoma even if it is located in tympanic sinus or anterior epitympanic recess. May be the endoscopes can serve us for better control in these cases.
5. One of the most important factors on determining for the type of surgery is the presence of mastoid air cells. The sclerotic mastoids as being the evidence of impaired ventilation should force us for creating small cavities in common with the middle ear and external auditory canal. But the most important is preserving he mucosa which is known as the lungs for the middle ear.
In regard to the factors mentioned above, the strategies of performing open and closed techniques will be discussed as well as the preventive measures of residual and recurrent cholesteatoma.

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Introduction
Glomus tumors are rare benign neoplasms in the head and neck. Glomus tympanicum and glomus jugulare lesions are associated with the temporal bone. The usual presenting symptom is pulsatile tinnitus followed by hearing loss. There is no controversy with the management of glomus tympanicums as they are mainly treated with surgical removal. Controversy occurs in the management of glomus jugulare tumors because of the lower cranial morbidity associated with the surgical removal.
Materials and Methods
Glomus tympanicum and jugulare cases will be discussed. Work up and therapeutic management will be reviewed. In glomus jugulare cases, conventional surgery verses gamma knife stereotactic radiation will be discussed. Outcomes and complications will be reviewed.
Results
Glomus tympanicums respond well to surgical excision. Glomus jugulare surgery is commonly associated with dysphonia and dysphagia. Patients commonly require a short term feeding tube because of the risk of aspiration. While stereotactic radiation does prevent further growth of the lesion, it does not correct the pulsatile tinnitus or conductive hearing loss as well as surgical excision.
Conclusion
There appears to be significantly higher morbidity with surgery verses stereotactic radiation. Patients should be counseled appropriately, especially about the cranial nerve deficits. Also, they should express realistic expectations of the results particularly the resolution of the tinnitus and hearing loss.

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Objects :
The cause of unilateral profound hearing loss has been attributed to postnatal viral infection, sudden deafness, or embryogenic abnormalities. However, an absence or hypoplasia of the cochlear nerve has emerged as the etiology of childhood congenital sensory neural hearing loss due to advances in magnetic resonance (MR) imaging, since the high resolution of MR imaging allows the visualization of individual neurons even in the internal auditory canal. We studied the relationship between the morphology of the internal auditory canal (IAC) and the etiology / clinical picture of congenital unilateral hearing loss.
Methods :
In 14 cases of cryptogenic unilateral hearing loss, the caliber of the internal auditory canal was measured using MRI and temporal bone high resolution computed tomography (HRCT) scan. Auditory function was evaluated by pure tone hearing test, distortion product of otoacoustic emission (DPOAE), Auditory brainstem response (ABR), and vestibular evoked myogenic potential (VEMP).
Results :
Eight and 2 of 14 cases showed cochlear nerve aplasia and hypoplasia respectively on the impaired side on MRI. The caliber of the IAC was more than 2 mm in all 10 cases demonstrating aplastic / hypoplastic cochlear nerve, and 5 of 10 cases showed a slightly narrower IAC on the impaired side compared to that on the healthy side. All 5 cases showing aplastic / hypoplastic cochlear nerve that also underwent HRCT scan showed no cochlear nerve canal (CNC) or the caliber of the CNC measured <1.5 mm.
Audiometry and ABR showed elevated hearing threshold on the impaired side for all 10 cases of cochlear nerve deficiency, while 5 of those 10 cases showed normal response on the DPOAE test indicating that cochlear function of the 5 cases remained intact. Vestibular Evoked Myogenic Potentials (VEMPs) of 4 cases with cochlear nerve aplasia showed evoked potentials, but decresed P-N amplitude was seen in 2 of the 4 cases. Choroid plexus cyst was seen in 2 of the 8 cases demonstrating cochlear nerve aplasia.
Conclusion :
Cochlear nerve aplasia was the predominant cause of congenital unilateral hearing loss in this series. Half of the cases showing cochlear nerve aplasia showed electrophysiological evidence of unilateral auditory neuropathy.
MRI and HRCT studies of the inner ear should be performed for all children with unilateral hearing loss.

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The inspection of cochlear nerve integrity may be important for diagnosis and managements of patients with profound sensorineural hearing loss (SNHL). Recent studies have described that the high-resolution T2-weighted MRI may be efficient to identify cochlear nerve deficiency (CND) in children with profound SNHL. We report 2 cases with unilateral unexplained progressive sensorineural hearing loss associated with the CND. A 20-year-old woman showed a profound SNHL in audiogram and no response in auditory brainstem response (ABR) in her right ear, however she showed almost normal responses in both ears using distortion product otoacoustic emissions (DPOAE). Another case was a 12-year-old boy, who showed a SNHL in high frequency and no response in ABR and poor response at high frequency in DPOAE. In affected side of these patients with high-resolution T2-weighted MRI, the CND was observed, and high resolution CT showed the hypoplasia of bony cochlear nerve canal (BCNC). Therefore, we suggest that the high resolution T2-weighted MRI is essential to detect the CND associated with unexplained sensorineural hearing loss.

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A case of rare middle ear anomaly is presented. Five year old boy had a congenital hearing impairment of the left ear. His audiogram was 68 dB in an average of the left air conduction hearing and the right ear was normal. He had normal ear drum with a relatively narrow external acoustic meatus and small pinna. He was diagnosed as middle ear anomaly and operated on September 2006.
Three dimensional (3D) CT before the surgery showed a bony bridge along the chorda tympani in the left ear and normal structure in the right. Operative findings was identical with 3D CT. A bone bridge fixed the malleus and ossicular mobility became smooth after drilling the bone. Other anomaly was not seen in the middle ear cleft. His left hearing has improved up to 30 dB. 3D CT after the surgery showed normal ossicular chain and disappearance of the abnormal bone.
Middle ear anomaly has a variety of findings and no typical common pattern. This kind of bone anomaly has rarely been reported and so it was an unexpected operative finding. However, 3D CT is very useful to detect such a rare anomaly and its imaging information can help ear surgeon to perform a safe operation.

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We present a rare case of isolated congenital fixation between the stapes superstructure and the facial canal. A 65-year-old woman was found a left hearing loss of 86. 7dB on pure tone audiogram. CT showed abnormal calcification at the left stapes superstructure. Her stapes was an immature bone and the stapes superstructure appeared to be fixed to the facial canal ; the footplate was normal, with good mobility. The stapes superstructure was separated from the stapes footplate. The stapedius muscle was absent. We believe that this is the first reported case of this abnormality.
In this case, this abnormality was thought induced by abnormality of the second branchial arch. We considered that the development of stapes superstructure was disturbed at about 5 weeks gestation.
In regard to fixation of the stapes superstructure, we recognized the low risk of inner ear damage during the surgical operation.

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Granulocytic sarcoma (chloroma) is a rare extramedullary tumor associated with acute or chronic leukemia. Most reported cases have occurred in patients with obvious acute or chronic leukemia or other myeloproliferative disorders. Granulocytic sarcoma occurs in a variety of body, including mediastinal space, skin, bone, testis and breast. We present a 62-year-old-female patient with right tinnitus and autophonia. On CT and MRI examination, a mass lesion in the aditus ad antrum was detected and fluid retention was identified in her right mastoid cavity. At first, she was treated as a cholesterol granuloma, but no response was observed. We performed right mastoidectomy and histologic examination of the surgical specimen demonstrated a granulocytic sarcoma. The pathologic lesion disappeared after induction chemotheraphy and there was no recurrence for 16 months. Recognition of this rare entity is important because early aggressive chemotheraphy can cause regression of the tumor and thus improve patient longevity.

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We reported two cases with the foreign body findings on CT in the external auditory canal.
The first patient was a 45-year-old man who treated for otitis externa with Burow's solution. Preoperative CT showed the metal foreign body like findings in his external auditory canal. The second patient was a 14-year-old boy who treated for intractable otitis externa using Bismuth iodoform paraffin paste. MRSA was detected in his otorrhea. His CT scan revealed the metal foreign body like findings in the external auditory canal. These images of metal foreign body were thought to due to the solution or paste which contains light metal. Recently, Burow's solution and Bismuth iodoform paraffin paste are more often used for treatment of intractable otitis externa. Therefore, the auditory canal should be cleaned carefully before CT scanning in the patients who was treated with these materials.

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