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[An aberrant course of the internal carotid artery through the middle ear]
F Heimlich1, A Dörfler, F Wallner
1Universitäts-HNO-Klinik Heidelberg.
Insights
A rare vascular anomaly, internal carotid artery in the middle ear, presents with specific symptoms. Diagnosis involves advanced imaging, with treatment reserved for severe cases due to side effects.
Area of Science:
- Vascular Surgery
- Otolaryngology
- Radiology
Background:
- The internal carotid artery (ICA) is typically absent from the middle ear.
- A rare vascular anomaly involves the aberrant presence of the ICA within the middle ear space.
Observation:
- Clinical presentation often includes a blue-reddish mass behind the tympanic membrane.
- Key symptoms are hearing loss and pulsatile tinnitus (tinnitus synchronous with the pulse).
Findings:
- High-resolution computed tomography (CT) scans, with or without contrast, or magnetic resonance imaging (MRI) are crucial for diagnosis.
- These imaging modalities allow for detailed visualization of the anomalous vascular structure.
Implications:
- Therapeutic options like embolization, stent implantation, or balloon occlusion exist but are rarely indicated due to significant side effects.
- Regular follow-up examinations are essential for monitoring patients with this condition.
Abstract:
The presence of the internal carotid artery in the middle ear is a rare but known vascular anomaly. A blue-reddish mass behind the tympanic membrane, hearing loss and a tinnitus that is synchronous with the pulse are the typical symptoms and should lead to a correct diagnosis. The diagnostic procedure includes high resolution CT scans with or without contrast or MRI. Possible methods of therapy include embolization, stent implantation or balloon occlusion of the internal carotid artery but are seldom indicated clinically because of the high rate of side-effects. However, regular followup examinations must be performed.