It was a treat to read your article “The presenting features of middle ear facial nerve sheath tumors: a clinical review” published in the January 2008 volume of this journal. It was surprising to know the various ways in which facial nerve tumors can present. During my tenure at various tertiary institutions of India—All India Institute of Medical Sciences, New Delhi, and Post-Graduate Institute of Medical education and Research, Chandigarh—I was fortunate enough to see a few of such patients. However, the cases that I saw presented as conductive deafness and/or aural polyp, with progressive facial palsy. None of the cases had any postaural lump. Thus, these varied presentations that you mentioned in your article actually help us in keeping this condition in mind while dealing with such cases.

All the patients that I saw had facial nerve palsy that virtually ruled out otosclerosis. The fact that you have considered otosclerosis in case 1 of your series despite presence of facial palsy is difficult for me to understand.In the same case, the approach that you chose for excision was translabyrinthine. Frankly, I also failed to understand the reason for choosing this approach. If a patient presents with conductive deafness (40 dB in your case), I would like to go ahead with a transmastoid approach to preserve the hearing. This is the same approach that you used in the other 3 cases.

One more thing that perturbed me was the first sentence in the abstract, and I quote “Facial nerve sheath tumors are the most common middle ear benign neoplasms.” I believe that this distinction should be given to glomus tympanicum. Please let me know if there is any reference that indicates that incidence has changed.

I would be obliged if you could answer my queries.