title: Surgical treatment for the aberrant internal carotid artery in the middle ear with pulsatile tinnitus.
abstract: Many previous reports have indicated that pulsatile tinnitus caused by an aberrant internal carotid artery (ICA) should not be treated surgically because of the risk of infection or aneurysm formation. We herein describe a case of aberrant ICA treated by middle ear surgery for which we introduced a novel approach. An 84-year-old man was presented with a one-year history of tinnitus in his right ear. Otoscopic examination demonstrated a whitish mass in the antero-inferior quadrant of the tympanic membrane associated with rhythmic pulsation. Images obtained by CT, MRI and MRA revealed protrusion of the ICA into the tympanic cavity, making contact with the tympanic membrane. Surgery to separate the tympanic membrane from the ICA was performed in order to relieve the pulsatile tinnitus. After the operation, the patient's aural activity was preserved and the tinnitus did not recur within a follow-up period of one year. In the present case, delicate middle ear surgery was effective for relief of the tinnitus. When treating patients with aberrant IAC showing features similar to the present case, the surgical approach we have described is worth attempting.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Honkura
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hidaka
authors.affiliation: Division of Otorhinolaryngology, Iwaki Kyoritsu Hospital, Iwaki, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Ohta
authors.affiliation: Division of Otorhinolaryngology, Iwaki Kyoritsu Hospital, Iwaki, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Gorai
authors.affiliation: Division of Otolaryngology, Sendai Municipal Hospital, Sendai, Japan. Electronic address: entsendai@yahoo.co.jp.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Katori
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Kobayashi
mesh_terms: D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D004432:Ear, Middle / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D014012:Tinnitus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Aberrant internal carotid artery; Middle ear surgery; Pulsatile tinnitus; Tympanic membrane