After a 10-year interval, we now have a fourth edition of this book, extensively revised to demonstrate a decade's advances in imaging. This text remains more than a simple atlas, although, being lavishly illustrated with over 1500 images, an atlas it undoubtedly is. The content is well updated and, so, we are treated to imaging of superior semi-circular canal dehiscence syndrome, advances in implant technology and, of course, far more attention to magnetic resonance imaging. A single chapter on the inner ear and otodystrophies comprises 100 pages, of which the bibliography (with no fewer than 375 references) takes up 10.

There is a temptation for any author to include curiosities and attractive illustrations irrespective of their clinical relevance. One has to question the indication for computed tomography irradiation in a patient with an earring in the external canal or, elsewhere, several similar images of extruded tympanostomy tubes. Equally, one might quibble over the external canal cholesteatoma which looks like classical keratosis obturans to this reviewer. The challenge for the reviewer is to spot any errors; I failed here!

Thinking I was an expert, I nevertheless learnt so much from this book. For a decade, I have been authoritatively showing what I thought was the cochlear aqueduct in lectures. Now I know how to distinguish it from the canal for the glossopharyngeal nerve. A search through the index for X-linked gusher, cochlear otosclerosis, large vestibular aqueduct and facial neuroma, topics chosen at random, led me to superb coverage on all. A personal favourite, however, was a chapter entitled ‘Temporal bone vascular anatomy, anomalies and disease with an emphasis on pulsatile tinnitus’. Very thought provoking but extremely complex.

This book will obviously appeal to radiologists ‘with an interest’, but is possibly of even greater value to the general otologist, and to all trainees. Imaging should now be far more than a simple diagnostic tool. Indeed, the interventional radiologists have developed therapeutic roles, which may well put many of us out of business. If imaging is ever to truly influence management, then the surgeon, personally, must be able to interpret the findings, and this book will be invaluable. I would see this text as essential in any ENT department aspiring to train; it represents excellent value.