Aberrant internal carotid artery presenting with chronic suppurative otitis media and moderate conductive hearing loss

• Author Details:   
• Deepanshu Mishra ^*
• Parag Bhayal
• Dhaval Bhojani
• Sudhakar Vaidya

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Aberrant internal carotid artery (ICA) is a rare congenital vascular anomaly where the artery takes an atypical course through the temporal bone and middle ear cavity. Its co-existence with chronic suppurative otitis media (CSOM), a persistent inflammatory disease of the middle ear and mastoid cavity, creates complex diagnostic and therapeutic challenges. This case report presents a 37-year-old female with a 14-year history of CSOM accompanied by pulsatile tinnitus and progressive conductive hearing loss. High-resolution CT and MRI confirmed the presence of an aberrant ICA traversing the tympanic cavity, closely related to the ossicular chain and tympanic membrane.

The clinical examination included tuning fork tests which indicated right-sided conductive hearing loss, supported by audiometric findings revealing moderate conductive hearing loss in both ears. The right ear audiogram showed consistent thresholds around 60 dB HL, with absent responses at high frequencies, necessitating careful interpretation to rule out mixed hearing pathology. A multidisciplinary team including otolaryngologists, radiologists, and an audiologist collaborated to manage this case conservatively to avoid catastrophic intraoperative bleeding.

This case underscores the critical role of comprehensive imaging, detailed audiological evaluation, and collaborative planning in managing such complex otologic conditions. Early identification of vascular anomalies like an aberrant ICA can dramatically alter surgical decisions and outcomes.