Endoscopic ear surgery is increasingly becoming commonplace in otological practice.Reference Mitchell and Coulson ¹ Advantages include the panoramic views obtained with the use of the otoendoscope outside of the microscope's line of sight and higher magnification. One of the drawbacks is only having a single hand available for dissection. In addition, endoscopic ear surgery limits the ability to use standard drills because of the risk of damage to the endoscope and the limited workspace in the external auditory canal.

In this month's issue of The Journal of Laryngology & Otology, Gardner et al. describe the feasibility and safety of using an ultrasonic bone aspirator in transcanal endoscopic ear surgery.Reference Gardner, Sappington, Arriaga and Kanotra ² Although the study was only performed on cadaveric temporal bones, it is a landmark study in that it illustrates the potential for powered instrumentation in endoscopic ear surgery, much like how functional endoscopic sinus surgery started out in its early days. The authors demonstrate the ease of bone removal with the ultrasonic aspirator (as demonstrated by the supplementary video material, available online at The Journal website ³ ), with no additional complications and a significant reduction in the time taken to perform an atticoantrostomy, compared with standard bone curettage.

The efficacy, tolerability and safety of subcutaneous and sublingual immunotherapy for allergic rhinitis is hotly debated, and is the subject of the recently published European Academy of Allergy and Clinical Immunology guidelines on allergen immunotherapy.Reference Durham and Penagos ^{4 ,} Reference Roberts, Pfaar, Akdis, Ansotegui, Durham and van Wijk ⁵ An article by Sahin et al. in this month's issue investigated the long-term effects of subcutaneous immunotherapy for house dust mite induced allergic rhinitis, based on a 10-year follow up.Reference Sahin, Dizdar, Dinc and Cirik ⁶ The authors conclude that subcutaneous immunotherapy is effective for house dust mite induced allergy, even 10 years after treatment. This study follows previous research which demonstrated that sublingual immunotherapy with house dust mite extracts is also efficacious for patients with house dust mite allergic rhinitis.Reference Soh, Thalayasingam, Ong, Loo, Shek and Chao ⁷

Finally, an article by Luu et al.Reference Luu, Straatman, Nakku, Westerberg, Clark and Carter ⁸ in this month's issue continues the theme of surgical simulation,Reference Clark, Westerberg and Mitchell ^{9 ,} Reference Avnstorp, Jensen, Dzongodza, Matinhira, Chidziva and Melchiors ¹⁰ and evaluates a low-fidelity ear surgery simulator for developing otological microsurgical skills in low-resource settings. Simulation has become increasingly popular as a method of training surgeons in low-resource settings, with no risk to patient safety. Such a tool may be highly valuable in helping to train future surgeons to manage middle-ear disease.