I was quite surprised by this textbook. Firstly, it is on its fourth edition, and I seemed to have missed the previous three editions, and secondly, it is very good. At first glance, you may be forgiven for thinking that it is an incomplete work. There are certainly bigger and more thorough reference texts available, and there are some topics which appear underdone when leafing through casually. But the reality is that this book is a highly refined work, and you can tell the American authors have really thought about the content and listened to feedback from their students. The authors have picked out the concepts that trainees find difficult and taken great care to explain them fully. For example, the anatomy section is excellent, utilising histological, radiographic and anatomical diagrams to emphasise important points.

The diagrams are generally very well done, and typically provide a unique but informative viewpoint in order to illustrate difficult anatomical points. For instance, the diagram showing the tympanic plexus and its relationship with the eustachian tube and lesser petrosal and greater petrosal nerves was a perspective I hadn't appreciated before. The chapter on otosclerosis is another good example. The diagrams clearly show with great detail how to create a laser rosette and develop a fenestration. This level of detail is normally omitted from other textbooks, but this is the point in the operation that trainees find most difficult to grasp. It therefore makes complete sense to focus on this part of the operation.

The writing is concise and repeatedly delivers snippets of terrifically useful information. These relevant ‘pearls’ are what makes this book so useful. The information is provided in a sensible and consistent way. For example, classifications and differential diagnoses are clearly illustrated in textboxes. I know that this is done in other books, but it is done better here.

I wouldn't say this book is aimed at the junior ranks, nor is it for those in the higher echelons of our profession. It is based on the middle tier, and is not solely for those hoping to pass exams either. My impression of this book is that it hopes to capture the attention of those who just want to be better clinicians. This may be a dwindling population with the current emphasis on examination success, but I would wholeheartedly recommend this book to anyone interested in otology.