Direct access to the whole length of the cochlear turns via endaural middle ear approach for the placement of extracochlear electrodes is severely restricted. Approximately 10 mm. of the cochlear turns are accessible, being less than a third of their length. The middle cranial fossa, the facial nerve, the internal carotid artery and the temporomandibular joint restrict the access. A further restriction is caused by the position of the cochlea and the direction of its axis. The anterior part of the cochlea lies anterior to the tympanic membrane and medial to the temporomandibular joint, thus limiting an endaural approach to a posterolateral direction. Despite this limitation small sections of the basal, middle and apical turns of the cochlea can be reached.

We report a case in which a defective portable headphone caused ablation of the malleus and removal of the drum.

In addition to the warnings already given against the risk of noise-induced hearing loss, a warning should be given against the use of headphones of poor quality.

Alternatively, headphones consisting of ear-plugs and electric wire without a metal holder should be recommended.

Clivus meningioma is an uncommon tumour arising from the region of the synchondrosis between the basal portions of the sphenoid and occipital bones. We report a case of a patient with a large meningioma of the clivus whose presenting symptom was auditory change. Alteration of hearing is a rare mode of presentation for such a tumour although it may present at a later stage in about 50 per cent of cases. The discrepancy between the size of the tumour and the paucity of physical findings, the value of a multiple test auditory screening strategy, and the surgical approach in this case are discussed.