Global prevalence of high jugular bulb and jugular bulb dehiscence: a systematic review and meta-analysis

High jugular bulb (HJB) and jugular bulb dehiscence (JBD) are anatomical variants with significant clinical implications; however, reported prevalence varies widely due to heterogeneous definitions and imaging protocols. We conducted a systematic review and meta-analysis of 49 studies, encompassing more than 43,000 temporal bones and 17,000 patients, to estimate pooled HJB and JBD prevalence. Observational studies reporting extractable prevalence data were synthesized using random-effects generalized linear mixed models with cluster-robust variance estimation. HJB definitions were harmonized into landmark-based families (internal acoustic meatus, round window/basal turn, tympanic annulus, tympanic protrusion), and separate analyses were performed for per-patient and per-ear denominators. Pooled HJB prevalence was 24.4% per patient (95% CI 16.7-34.3; prediction interval 3.8-72.4) and 16.2% per ear (10.7-23.8; PI 1.6-69.7), with extreme between-study heterogeneity (I² > 97%). Definition-specific estimates differed systematically, with round-window/basal-turn criteria yielding approximately 22% compared with 15% for internal acoustic meatus-based definitions. JBD prevalence was 6.1% per patient (3.4-9.5) and 3.2% per ear (2.1-4.7). Meta-regression indicated that definition choice accounted for less than 10% of between-study variance, with imaging protocols, measurement planes, and clinical populations accounting for most of the remaining heterogeneity. Both variants are sufficiently common to warrant routine preoperative imaging before otologic and skull-base procedures. Given wide prediction intervals, single pooled prevalence values are not directly transportable; reporting should emphasize definition-specific estimates and imaging parameters to inform surgical planning and risk stratification.