Aberrant ICA in the middle ear
- 1Division of Anatomy, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, Bucharest, 020021 Romania
Abstract
An aberrant internal carotid artery (a-ICA) in the middle ear is rare, but it may be injured during routine otological procedures. This review examines 48 publications on its embryological basis, clinical presentation, imaging diagnosis, and management. The a-ICA results from agenesis of the first embryonic segment of the internal carotid artery, with collateralisation through the inferior tympanic artery. Presentation is often non-specific; hearing loss (47.7%) and pulsatile tinnitus (30.0%) are the most frequent symptoms. Otoscopy may show a pulsatile retrotympanic mass in the anteroinferior quadrant. High-resolution computed tomography is central to diagnosis; relevant features include absence of the normal vertical carotid canal and its exocranial opening, and enlargement of the inferior tympanic canaliculus. The a-ICA must be distinguished from the more common lateralised petrous ICA variant, which retains a normal proximal calibre and enters the anterior mesotympanum without involving the inferior tympanic canaliculus. In iatrogenic injury, immediate packing is followed by definitive treatment in most reported cases; endovascular approaches have fewer complications than surgical ligation. Preoperative recognition remains one of the main safeguards against severe haemorrhage and neurological sequelae.
Related
- Aberrant Gamma Oscillations in Parkinson’s Disease
- Overestimated Volatility Underpins Aberrant Decision Making in Bipolar I Disorder
- The Shared Pathological Niche in Pulmonary Fibrosis: From Aberrant Epithelial Repair to ECM Remodeling
- Distal cholangiocarcinoma in a patient with portal annular pancreas and aberrant common hepatic artery: a case report
- Extracavitary Primary Effusion Lymphoma in an HIV-Negative Patient With Aberrant Immunophenotypic Features.
BibTeX
@article{rusu2026aberrant,
title = {{Aberrant ICA in the middle ear}},
author = {Mugurel Constantin Rusu},
journal = {European Archives of Oto-Rhino-Laryngology},
year = {2026},
month = aug,
doi = {10.1007/s00405-026-10500-9},
url = {https://doi.org/10.1007/s00405-026-10500-9},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Aberrant ICA in the middle ear
AU - Mugurel Constantin Rusu
PY - 2026
DA - 2026/08/03
JO - European Archives of Oto-Rhino-Laryngology
DO - 10.1007/s00405-026-10500-9
UR - https://doi.org/10.1007/s00405-026-10500-9
AB - An aberrant internal carotid artery (a-ICA) in the middle ear is rare, but it may be injured during routine otological procedures. This review examines 48 publications on its embryological basis, clinical presentation, imaging diagnosis, and management. The a-ICA results from agenesis of the first embryonic segment of the internal carotid artery, with collateralisation through the inferior tympanic artery. Presentation is often non-specific; hearing loss (47.7%) and pulsatile tinnitus (30.0%) are the most frequent symptoms. Otoscopy may show a pulsatile retrotympanic mass in the anteroinferior quadrant. High-resolution computed tomography is central to diagnosis; relevant features include absence of the normal vertical carotid canal and its exocranial opening, and enlargement of the inferior tympanic canaliculus. The a-ICA must be distinguished from the more common lateralised petrous ICA variant, which retains a normal proximal calibre and enters the anterior mesotympanum without involving the inferior tympanic canaliculus. In iatrogenic injury, immediate packing is followed by definitive treatment in most reported cases; endovascular approaches have fewer complications than surgical ligation. Preoperative recognition remains one of the main safeguards against severe haemorrhage and neurological sequelae.
SN - 0937-4477
SN - 1434-4726
ER -