[The management of high jugular bulb and its active bleeding during middle ear surgery]

To study the incidence of high jugular bulb (HJB) in the patients with chronic otitis media and to explore the management of its active bleeding during middle ear surgery.

From January 2005 to August 2006, consecutive 287 patients undergoing surgical intervention for chronic otitis media were retrospectively studied. The high resolution CT (HRCT) scan and the surgical technique for diagnosis and management of bleeding of jugular bulb were also discussed.

Sixty-five patients (22.6%) were diagnosed as HJB by HRCT scan, including 21 men and 44 women (P<0.01), with their ages ranged from 7 to 68 years (mean 41 years). Fourteen cases of them were on the left side, and 31 were on the right side (P<0.05). Twenty cases showed bilateral HJB. Five cases were found dehiscent high jugular bulb by CT scan and were confirmed in operation. Active bleeding was encountered in one case while elevating the pathological eardrum in hypotympanum. It was treated by pressure compression using collagen gelfoam cushion covered by muscle to protect the dehiscent bulb. The patients proceed through the planned surgery without complications.

HJB might cause hemorrhage during middle ear surgery, but preliminary attention, correct treatment and awareness of the pitfalls may lessen the operation risk.