Aberrant ectatic internal carotid artery in the middle ear

Area of Science:

• Otolaryngology
• Vascular Surgery
• Diagnostic Imaging

Background:

• Pulsatile tinnitus can be caused by vascular anomalies, necessitating accurate diagnosis.
• Aberrant internal carotid artery (ICA) in the middle ear is a rare vascular malformation.
• Diagnostic challenges exist for identifying rare vascular anomalies in the middle ear.

Observation:

• A 34-year-old male presented with pulsatile tinnitus and a reddish middle ear mass.
• Initial physical examination and imaging studies failed to diagnose the underlying cause.
• Exploratory tympanotomy was performed due to persistent diagnostic uncertainty.

Findings:

• Surgical exploration revealed an ectatic aberrant internal carotid artery within the middle ear space.
• The aberrant ICA was identified as the cause of the patient's pulsatile tinnitus.
• This case underscores the limitations of non-invasive imaging in diagnosing certain vascular anomalies.

Implications:

• Highlights the importance of considering rare vascular pathologies in middle ear diagnostics.
• Suggests a need for heightened awareness among clinicians regarding aberrant ICA presentations.
• Emphasizes the role of surgical exploration when diagnostic imaging is inconclusive for pulsatile tinnitus.