Abstract
Intratympanically aberrant internal carotid artery(ICA) is a rarely seen vascular abnormality. We present here the combination of aberration and prominent hypoplasia of the ICA in a case. Intratympanic aberrant ICA, which is rarely cited as a cause of tinnitus and hearing loss, should be known as a reason to be kept in mind as it may lead to life-threatening complications. Generally, it has been defined upon massive bleeding during myringotomy, ear surgery or biopsy procedure. In this article, the audiological and radiological studies confirmed with CT and MR angiography conducted on an aberrant and hypoplastic internal carotid artery that was identified under the manubrium mallei in a 28-year-old, young male patient who presented with complaints about hearing loss and fullness in the left ear were presented along with a literature review.
1
Introduction
In cases of tinnitus that is accompanied by fullness in the ear and hearing loss, infective conditions involving the drum and tympanum are the first to be considered, but vascular and mass-related reasons that are seen less frequently should also be considered. Aberrant internal carotid artery is a rare condition where the internal carotid artery aberrantly extends in a more lateral direction inside the temporal bone and passes through the cavity of the tympanum . It is generally considered to be due to the formation of collateral routes related to the agenesis of the first embryonic segment of the internal carotid artery . It may generally be observed in the clinical setting as a vascular mass in white or red color behind the tympanic membrane. It was frequently seen in the past with abundant bleeding during ear surgeries or biopsy procedures. Aberrant internal carotid artery should definitely be differentiated from other vascular reasons such as glomus tumor, other vascular temporal bone lesions, dehiscent jugular bulb, cholesterol granuloma and petrous carotid aneurysm .
In this paper, an aberrant and hypoplastic internal carotid artery case that could be seen from beneath the umbo of the malleus in intratympanic view and caused loss of hearing, pulsatile tinnitus and fullness in the ear and literature review will be provided.
2
Case report
A 28-year-old male patient presented with complaints about limited hearing and fullness in the left ear and pulsatile tinnitus for the last 2 years. A round, halo-like white area around the umbo mallei in the left ear and an opaque appearance in the tympanic membrane were identified in otologic examination ( Fig. 1 ). The audiological studies revealed 25 dB conductive hearing loss in the pure tone audiogram and flat A-type curve in tympanogram ( Fig. 2 ). Temporal CT revealed an aberrant internal carotid artery set on the promontorium beneath the manubrium mallei which had invaded the cavity of the tympanum ( Fig. 3 ,C–H). At the MRA view 50%–60% hypoplasia and volume reduction of the left internal carotid artery than the right counterpart were seen ( Fig. 3 , A–B).
2
Case report
A 28-year-old male patient presented with complaints about limited hearing and fullness in the left ear and pulsatile tinnitus for the last 2 years. A round, halo-like white area around the umbo mallei in the left ear and an opaque appearance in the tympanic membrane were identified in otologic examination ( Fig. 1 ). The audiological studies revealed 25 dB conductive hearing loss in the pure tone audiogram and flat A-type curve in tympanogram ( Fig. 2 ). Temporal CT revealed an aberrant internal carotid artery set on the promontorium beneath the manubrium mallei which had invaded the cavity of the tympanum ( Fig. 3 ,C–H). At the MRA view 50%–60% hypoplasia and volume reduction of the left internal carotid artery than the right counterpart were seen ( Fig. 3 , A–B).
