Aberrant internal carotid artery in the middle ear

This study was undertaken to evaluate the incidence, typical clinical signs, and proper management of patients with an aberrant internal carotid artery in the middle ear as presented in a case report and review of the relevant literature. A total of 86 cases were reviewed concerning gender, affected side, presenting symptoms, findings on clinical and radiologic examination, and further treatment. About two thirds of the patients (68.6%) were female. The right side was affected in 40 patients, and both sides were affected in 13 patients. Hearing loss (41 patients) and pulsatile tinnitus (26 patients) were the most common symptoms. Preponderances of affected side and gender seem to be reduced by the increasing number of reports. Bilateral findings are not unusual, indicating meticulous examination of both sides. Glomus tumors often mimic an aberrant internal carotid artery. If vascular malformations in the middle ear are suspected, high-resolution computed tomography or magnetic resonance angiography is required before any surgical intervention to exclude vascular malformations. Brisk bleeding, hemiparesis, aphasia, deafness, Horner's syndrome, and intractable vertigo may result if the lesion is injured unintentionally. Once the disorder is correctly diagnosed, yearly follow-up is advisable.