Aberrant Internal Carotid Artery: A Rare Cause of Unfitness Revealed During Admission Audiometry

An aberrant tympanic segment of the internal carotid artery is a rare vascular anomaly. Clinical manifestations are variable and nonspecific, including hearing loss, tinnitus, vertigo, headache, and aural fullness. In military settings, it may remain undiagnosed, particularly when candidates are asymptomatic or do not report minor symptoms. This condition can render a candidate unfit for enlistment because of the risk of ear trauma during training or procedures. The French Armed Forces require comprehensive medical evaluations before enlistment, including audiometric testing and otoscopic examination. Detecting rare anomalies such as an aberrant carotid artery is critical to ensure candidates' safety.

We present the case of a 23-year-old female candidate who attended a military medical selection center for army enlistment. Audiometric testing revealed unilateral conductive hearing loss, otoscopic examination demonstrated a pale red pulsatile mass in the middle ear anterior to the umbo, and computed tomography (CT) and magnetic resonance imaging (MRI) of the temporal bone confirmed an aberrant internal carotid artery.

The medical team recommended conservative management with regular follow-up. Because military duty increases the risk of ear trauma, the candidate was classified as unfit for service.

This case illustrates a rare vascular cause of military unfitness and underscores the importance of systematic otoscopic examination and audiometric testing during initial medical screening. Beyond military qualification considerations, early recognition of an aberrant internal carotid artery is critical to prevent catastrophic iatrogenic complications, including massive hemorrhage during otologic procedures or head trauma. Raising awareness of this entity among military clinicians enhances patient safety and helps prevent future complications.