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Aberrant carotid artery in the middle ear
Archives of Oto-Rhino-Laryngology
|January 1, 1975
Summary
Aberrant internal carotid arteries in the middle ear can cause severe ear bleeding during myringotomy. Early recognition of this vascular anomaly, often indicated by ear pain and reddish tympanic membrane swelling, is crucial for safe surgical procedures.
Area of Science:
- Otolaryngology
- Vascular Anatomy
- Pediatric Surgery
Background:
- Aberrant internal carotid arteries (AICA) are rare vascular anomalies where the internal carotid artery enters the middle ear instead of its normal petrous course.
- AICA in the middle ear can present with pulsatile tinnitus, hearing loss, or otorrhagia, and may be mistaken for vascular tumors or other middle ear pathologies.
- Misidentification of AICA can lead to catastrophic hemorrhage during otologic procedures such as myringotomy.
Purpose of the Study:
- To highlight the potential for severe intraoperative hemorrhage during myringotomy in the presence of aberrant internal carotid arteries in the middle ear.
- To emphasize the importance of recognizing the clinical signs suggestive of AICA in the middle ear to prevent surgical complications.
- To review the diagnostic and management considerations for AICA in the pediatric population.
Main Methods:
- Case report of a 2-year-old girl experiencing profuse, recurrent aural hemorrhage post-myringotomy.
- Diagnostic imaging using carotid angiography to identify the vascular anomaly.
- Review of existing literature on aberrant internal carotid arteries in the middle ear.
Main Results:
- Carotid angiography confirmed bilateral aberrant internal carotid arteries in the middle ears.
- The patient experienced significant aural hemorrhage during and after the myringotomy procedure.
- Otalgia was identified as a common initial symptom in both this case and previously reported cases of AICA.
Conclusions:
- Aberrant internal carotid arteries in the middle ear pose a significant risk of severe hemorrhage during otologic surgery.
- Clinical suspicion should be raised in cases of reddish swelling in the inferior quadrant of the tympanic membrane, especially when accompanied by otalgia.
- Preoperative identification of AICA through appropriate imaging is essential to avoid misdiagnosis and ensure patient safety during myringotomy and other middle ear procedures.