Conductive Hearing Loss and the Jugular Bulb

which noted some thinning of bone over superior semi-circular canal and high riding jugular bulb (Fig. 2). However, neither of these findings were considered to be the cause of his conductive hearing loss at the time. Based on the history of repeated effusions/infection, an ossicular affection was suspected and an exploratory tympanotomy was performed. Upon elevation of the tympanomeatal flap, a large bony structure was encountered in the tympanic cavity. It was confirmed to be a high riding jugular bulb and bony adhesions were identified between the bulb and the malleus, the stapes and the tympanic membrane. Additionally the jugular bulb was overlying the round window. In retrospect, these can also be seen on the CT multiplanar reformatted images (Fig. 3 and 4). The bony attachments were freed and the stapes foot plate was noted to be mobile. The jugular bulb however was not moved. The patient healed well from the surgery, but an audiogram following the procedure showed persistent moderate lowand mid-frequency 40 dB conductive loss on the right side.