title: Beware the silent presentation of a high and dehiscent jugular bulb in the external ear canal.
abstract: OBJECTIVE
  We report two rare cases of high and dehiscent jugular bulbs protruding into the external ear canal; one case was silent, the other symptomatic.
  
  
  METHODS
  The cases are presented and the relevant literature reviewed and discussed.
  
  
  RESULTS
  A 52-year-old woman underwent mastoid exploration for suspected cholesteatoma. On raising the tympanomeatal flap, while still lateral to the annulus, brisk venous bleeding occurred from a high, dehiscent jugular bulb in the external ear canal. The second patient, a 42-year-old man, underwent imaging for suspected glomus tumour. A high, dehiscent jugular bulb was found protruding into the external ear canal and hypotympanum.
  
  
  CONCLUSIONS
  High jugular bulbs in the middle ear have been reported many times. To our knowledge, there has only been one previous report of a high jugular bulb in the external ear. These cases illustrate the importance of full, accurate assessment of high resolution computed tomography images, and of appropriate, immediate management of bleeding.
authors.affiliation: Department of Otolaryngology, Leicester Royal Infirmary, UK. maryball@doctors.org.uk
authors.forename: M
authors.initials: M
authors.lastname: Ball
authors.forename: M
authors.initials: M
authors.lastname: Elloy
authors.forename: R
authors.initials: R
authors.lastname: Vaidhyanath
authors.forename: H
authors.initials: H
authors.lastname: Pau
mesh_terms: D000328:Adult; D004424:Ear Canal / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007601:Jugular Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed