Unilateral Aberrant Internal Carotid Artery in the Middle Ear: A Case Report Presenting with Pulsatile Tinnitus

The prevalence of aberrant internal carotid artery (ICA) in the middle ear is very low. It represents a potentially life-threatening anatomical variation that requires an accurate diagnosis to prevent catastrophic complications such as massive hemorrhage during otologic procedures. Tomography and magnetic resonance could be very useful to identify this rare entity and to avoid its complications. We report the case of a 42-year-old woman who presented to our Ear, Nose and Throat department with persistent unilateral pulsatile tinnitus. An aberrant ICA in the tympanic cavity is a rare and particularly dangerous condition. Otolaryngologists must always consider the possibility of severe or fatal hemorrhage, so accurate pre- operative radiologic investigations are recommended before each middle-ear surgical intervention.