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Updated: Dec 1, 2025
Discovering Middle Ear Anatomy by Transcanal Endoscopic Ear Surgery: A Dissection Manual
Published on: January 11, 2018
Endoscopic Intervention of Aberrant Carotid Artery in the Middle Ear
Noor Dina Hashim1,2, Seung H Jang2, In Seok Moon2
1Department of Otorhinolaryngology, U niversiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
Objective:
To describe surgical management for transcanal endoscopic ear surgery (TEES) in two patients with aberrant internal carotid artery (ICA) in the middle ear.
Patients:
A young girl who complained of pulsatile tinnitus and an elderly man who presented with ear bleeding. Otoendoscopy examination revealed a pulsatile reddish mass protruding through the tympanic membrane in both patients.
Interventions:
A combination of clinical assessments and imaging supported the diagnosis of aberrant ICA in the middle ear. Transcanal endoscopic reinforcement of the artery was performed; tragal cartilage was used as a shield to strengthen the carotid canal defect.
Results:
Assisted by fine endoscopic instruments, the protruding arteries were separated without damage to the surrounding structures and reinforced using tragal cartilage. Both patients' symptoms improved postoperatively; they reported tinnitus relief and hearing improvement.
Conclusion:
To prevent catastrophic events, diagnosis of aberrant ICA is important before any surgical intervention. With appropriate management, surgical intervention using transcanal endoscopic ear surgery offers a clear view of the surgical field and is an excellent choice for management of aberrant ICA.
