“…In the presence of otologic symptoms only, recalcitrant cephalal gia may be a leading symptom [4], In radical mastoid cavities, endaural brain hernia may be suspected by otoscopy with palpation evidencing a ses sile or pedunculated mass [4. 13, 14], and pulsation and increase under Valsalva's maneuver are almost pathogno monic [4,12,14], Any mass protruding from above into a surgical mastoid cavity 'must be considered brain tissue until proved otherwise' [3]. Differential diagnosis in cludes inflammatory tissue, inclusion cholesteatoma and blue-domed cyst [3.…”