A Rare Case of Anatomical Variation in the Middle Ear: Aberrant Internal Carotid Artery

English (OpenAlex)

Although variations in middle ear vascular anatomy are rare, they pose significant risks during otologic procedures. An aberrant internal carotid artery (ICA) is one such anomaly that may remain asymptomatic and undetected without the aid of imaging. A 14-year-old female presented with a one-month history of left ear pain, fullness, conductive hearing loss, and tinnitus. Initially misdiagnosed and treated for serous otitis media, she did not respond to therapy. Otomicroscopy revealed a non-pulsatile retrotympanic vascular mass. Audiometry confirmed conductive hearing loss. Temporal bone CT and MRI demonstrated a left-sided aberrant ICA protruding into the middle ear without bone erosion. The patient was managed conservatively. Aberrant ICA is typically incidental, usually occurring in adults, with a right-sided, pulsatile presentation. This pediatric case with left-sided, non-pulsatile findings highlights the risk of misdiagnosis and potential iatrogenic injury. Imaging was critical for accurate diagnosis. Imaging should be considered for persistent middle ear symptoms to avoid life-threatening surgical complications.