CASE STUDY 1: A man in mid-life developed acute left facial paralysis. He was treated by casualty staff and by a Senior House Officer in neurology for Bell’s palsy. His left ear was not examined despite a history of chronic discharge. The paralysis did not recover. Many months later he was referred to an otologist and found at operation to have extensive cholesteatoma compressing the facial nerve. Unfortunately, it was too late for recovery of facial function to occur. Expert opinion indicated that the failure to consider chronic ear disease at the time of development of the facial paralysis was unacceptable, and that early diagnosis and intervention would have been followed by recovery of facial movements.