Experience With Transcanal Endoscopic Ear Surgery and Preoperative Imaging in the Case of Persistent Stapedial Artery

The persistent stapedial artery (PSA) is an exceedingly vascular anomaly that can lead to hearing loss or pulsatile tinnitus, yet its preoperative diagnosis is often challenging. We report the case of a 24-year-old woman with bilateral PSA and stapes ankylosis who presented with progressive bilateral mixed hearing loss. The patient was initially diagnosed with bilateral congenital stapes ankylosis and stapes surgery was performed on the left side using transcanal endoscopic ear surgery (TEES). Intraoperative observation of the tympanic cavity revealed the presence of a persistent stapedial artery. The stapes surgery was completed successfully while preserving the stapedial artery, resulting in postoperative hearing improvement. Subsequently, surgery was planned for the right ear. Suspecting the possibility of PSA, we performed a contrast CT scan; additionally, we prepared subtraction images and CT angiography. These images strongly suggested the presence of the PSA on the right side as well. This case highlights the superior surgical visualization provided by TEES and underscores the effectiveness of advanced imaging techniques in diagnosing PSA.