Aberrant internal carotid artery in the middle ear with dehiscent high jugular bulb

AbstractObjective:We report an extremely rare case of an aberrant internal carotid artery in the middle ear, together with a dehiscent high jugular bulb, a combination never previously reported.Methods:Case report with a review of the literature.Results:A 24-year-old man presented with a five-year history of aural fullness, pulsatile tinnitus and mild hearing impairment in his right ear. Otoscopy revealed a retro-tympanic mass. Computed tomography of the temporal bone revealed protrusion of the right internal carotid artery into the middle-ear cavity, with a dehiscent high jugular bulb. Magnetic resonance angiography showed a reduced diameter and lateralisation of the right internal carotid artery. A diagnosis of an aberrant internal carotid artery with a dehiscent high jugular bulb was made, and the patient was managed with conservative treatment.Conclusion:The otologist should be aware of the possibility of an aberrant internal carotid artery when the patient presents with a retro-tympanic mass, hearing loss and pulsatile tinnitus. Radiological investigation is required to make the differential diagnosis. When an aberrant internal carotid artery presents with a dehiscent high jugular bulb, the risk of serious bleeding is elevated. We recommend a conservative approach for cases presenting without bleeding complications.

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Nonneoplastic Vascular Lesions of the Middle Ear

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949310200918 ◽

1993 ◽

Vol 102 (9) ◽

pp. 738-740 ◽

Cited By ~ 2

Author(s):

Patricia A. Suarez ◽

John G. Batsakis

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Jugular Bulb ◽

Vascular Lesions ◽

High Jugular Bulb

Nonneoplastic vascular lesions in the middle ear may be arterial or venous. For the former, ectopic location of the internal carotid artery is the most common; a high jugular bulb is the most common venous abnormality. Both may be clinically misdiagnosed without radiographic studies and, in the event, lead to disaster.

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Surgical treatment for the aberrant internal carotid artery in the middle ear with pulsatile tinnitus

Auris Nasus Larynx ◽

10.1016/j.anl.2013.10.002 ◽

2014 ◽

Vol 41 (2) ◽

pp. 215-218 ◽

Cited By ~ 9

Author(s):

Yohei Honkura ◽

Hiroshi Hidaka ◽

Jun Ohta ◽

Shigeki Gorai ◽

Yukio Katori ◽

...

Keyword(s):

Surgical Treatment ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Pulsatile Tinnitus ◽

Aberrant Internal Carotid Artery

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Aberrant ectatic internal carotid artery in the middle ear

Ear Nose & Throat Journal ◽

10.1177/014556130808700413 ◽

2008 ◽

Vol 87 (4) ◽

pp. 214-216 ◽

Cited By ~ 3

Author(s):

Adnan Safdar ◽

Joseph P. Hughes ◽

Rory McConn Walsh

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Physical Examination ◽

Middle Ear ◽

Internal Carotid ◽

Imaging Techniques ◽

Pulsatile Tinnitus ◽

Modern Imaging ◽

Aberrant Internal Carotid Artery

We report the case of a 34-year-old man with pulsatile tinnitus and a reddish mass in the anteroinferior quadrant of the middle ear. Physical examination and imaging were unable to establish a diagnosis, so an exploratory tympanotomy was performed. Exploration revealed the presence of an ectatic aberrant internal carotid artery in the middle ear. Aberrations of the internal carotid artery in the middle ear are rare. Even so, our case is unusual in that all initial investigations had failed to establish the diagnosis. This case highlights the limitations of modern imaging techniques in certain situations.

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Aberrant internal carotid artery in the middle-ear space

The Journal of Laryngology & Otology ◽

10.1258/0022215001903924 ◽

2000 ◽

Vol 114 (10) ◽

pp. 784-787 ◽

Cited By ~ 38

Author(s):

Marissa Botma ◽

Robin A. Kell ◽

Jo Bhattacharya ◽

John A. Crowther

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Clinical Presentation ◽

Pulsatile Tinnitus ◽

Aberrant Internal Carotid Artery

The incidence of an aberrant internal carotid artery in the middle ear is approximately one per cent and most patients are asymptomatic. We present two patients with an aberrant internal carotid artery who presented with pulsatile tinnitus and an intra-tympanic mass. Here we discuss the clinical presentation, relevant radiographic investigations and further management of these patients.

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An aberrant internal carotid artery in the temporal bone presenting as a middle-ear mass: a case report

The Journal of Laryngology & Otology ◽

10.1017/s0022215107000199 ◽

2007 ◽

Vol 122 (9) ◽

pp. 983-985 ◽

Cited By ~ 10

Author(s):

A Eryilmaz ◽

M Dagli ◽

M Cayonu ◽

E Dursun ◽

C Gocer

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Temporal Bone ◽

Middle Ear ◽

Internal Carotid ◽

Middle Ear Surgery ◽

Computed Tomography Scan ◽

Ear Surgery ◽

Aberrant Internal Carotid Artery ◽

Tomography Scan

AbstractObjective:To draw attention to the possibility of an aberrant internal carotid artery behind an intact tympanic membrane presenting as a middle-ear mass.Case:A 48-year-old female patient presented with a hearing impairment in her right ear that had started 10 years ago. Otoscopic examination revealed a retro-tympanic mass. A high resolution computed tomography scan of the temporal bone was performed that showed protrusion of the internal carotid artery into the middle ear. Magnetic resonance angiography provided excellent visualisation of the internal carotid artery. Finally, a diagnosis of an aberrant internal carotid artery was made and the patient was evaluated with a conservative approach.Conclusion:All retro-tympanic masses should ideally be visualised with a computed tomography scan of the temporal bone before any middle-ear surgery, such as tympanotomy and biopsy, and it is essential for every otologist who undertakes myringotomy and middle-ear surgery to know about this rare entity.

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Aberrant internal carotid artery lying within the middle ear

Neuroradiology ◽

10.1007/bf00339565 ◽

1985 ◽

Vol 27 (4) ◽

pp. 322-326 ◽

Cited By ~ 18

Author(s):

J. D. Swartz ◽

Margaret L. Bazarnic ◽

T. P. Naidich ◽

L. D. Lowry ◽

H. T. Doan

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Aberrant Internal Carotid Artery

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Aberrant Internal Carotid Artery in the Middle Ear

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948109000117 ◽

1981 ◽

Vol 90 (1) ◽

pp. 67-69 ◽

Cited By ~ 24

Author(s):

Roy S. Goodman ◽

Noel L. Cohen

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Stapedial Artery ◽

Rare Anomaly ◽

Bony Canal ◽

Aberrant Internal Carotid Artery ◽

Ear Symptoms

Aberrant internal carotid artery in the middle ear is a rare anomaly. Myringotomy in a patient with this anomaly caused violent hemorrhage, requiring immediate packing and eventual ligation of the artery. The anomaly may represent the artery bulging through a dehiscent bony canal, or it may be due to traction on the developing carotid by a persistent stapedial artery. Various middle ear symptoms have been reported in earlier cases. Diagnosis is by angiography, and therapy is surgical.

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Otorrhagia from the “Aberrant Internal Carotid” Artery in the Middle Ear

Interventional Neuroradiology ◽

10.1177/159101999700300305 ◽

1997 ◽

Vol 3 (3) ◽

pp. 231-238 ◽

Cited By ~ 3

Author(s):

M. Söderman ◽

M. Moersdorf ◽

M. Lysdahl ◽

L. Mendel

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Large Artery ◽

Arterial Aneurysm ◽

Anatomical Variant ◽

Cervical Portion ◽

Aberrant Internal Carotid Artery ◽

The Brain

Agenesis of the cervical portion of the internal carotid artery (ICA) may result in blood supply to the ipsilateral cerebral hemisphere being provided by an enlarged inferior tympanic branch of the ascending pharyngeal artery. This enlarged vessel, passing through Jacobson's canal and anastomosing with the likewise enlarged caroticotympanic branch of the ICA in front of the promontorium, may simulate a middle ear mass. We present five patients with this unusual anatomical variant, three of which underwent biopsy of what was believed to be a middle ear tumour. One patient experienced rupture of an arterial aneurysm in the middle ear successfully treated with endovascular application of detachable platinum coils. It is mandatory for ENT-surgeons and radiologists who perform head-and-neck examinations to recognize this anatomical variant, not mistaking it for a tumour, since biopsy of a large artery supplying the brain may have disastrous consequences. In patients with otorrhagia, an arterial aneurysm must be considered as a possible source of bleeding, in some cases amenable for treatment with an endovascular technique. The diagnosis of “aberrant internal carotid artery” is usually made with CT of the temporal bone or MR of the skull base. Cerebral angiography is in most cases not necessary, unless an endovascular procedure is planned.

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