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

  • Y-Y Lin (a1), C-H Wang (a1), S-C Liu (a1) and H-C Chen (a1)

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.


Case report with a review of the literature.


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.


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.

Corresponding author
Address for correspondence: Dr Hsin-Chien Chen, Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Sec 2, Cheng-Kung Rd, Taipei 114, Taiwan, ROC Fax: 886 2 87927193 E-mail:
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3 M Botma , RA Kell , J Bhattacharya , JA Crowther . Aberrant internal carotid artery in the middle-ear space. J Laryngol Otol 2000;114:784–7

4 E Sauvaget , J Paris , S Kici , R Kania , JP Guichard , R Chapot Aberrant internal carotid artery in the temporal bone: imaging findings and management. Arch Otolaryngol Head Neck Surg 2006;132:8691

5 S Koesling , P Kunkel , T Schul . Vascular anomalies, sutures and small canals of the temporal bone on axial CT. Eur J Radiol 2005;54:335–43

6 CH Wang , ZP Shi , DW Liu , HW Wang , BR Huang , HC Chen . High computed tomographic correlations between carotid canal dehiscence and high jugular bulb in the middle ear. Audiol Neurootol 2011;16:106–12

7 RL Ruggles , RC Reed . Treatment of aberrant carotid arteries in the middle ear: a report of two cases. Laryngoscope 1972;82:1199–205

8 BR Huang , CH Wang , YH Young . Dehiscent high jugular bulb: a pitfall in middle ear surgery. Otol Neurotol 2006;27:923–7

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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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