Cervical internal carotid Artery pseudoaneurysm complicating malignant otitis externa: First case report

Malignant Otitis Externa: Unveiling the Hidden Danger of ICA Pseudoaneurysm

Pseudoaneurysm of the internal carotid artery following otogenic infection is rare but leads to catastrophic outcomes. In our case series, we present two patients with ICA pseudoaneurysm complicated by malignant otitis externa, and we emphasise the importance of timely diagnosis and management to prevent fatal outcomes. A pseudoaneurysm should be ruled out in a patient with malignant otitis externa presenting with recurrent epistaxis or ear bleed.

Petrous internal carotid artery aneurysm: A cause of chronic otitis

BACKGROUND

Aneurysm of the petrous segment of the internal carotid artery (pICA) is a rare pathology presenting with extracranial and especially oto-rhinological symptoms that can be misleading and delay diagnosis.

METHODS

We report the case of a giant pICA aneurysm compressing the Eustachian tube (ET), presenting with hearing loss due to chronic serous otitis. A PRISMA review of the literature was performed to find similar cases. In addition, relevant anatomical sources were screened.

RESULTS

Five reports about 7 cases of middle-ear effusion caused by pICA aneurysm compressing the ET were identified. Median age at diagnosis was 18.5 years. After endovascular treatment, overall outcome was favorable, with no mortality, although outcome was sometimes impaired by neurological comorbidities and unclear prognosis of hearing-loss recovery.

DISCUSSION

These reports, though rare, offer relevant insights into the poorly known regional anatomy of the pICA, in the borderland between neurosurgery and ENT. Within the petrous bone, the osseous separation between the ET and the pICA is narrow, when not dehiscent. This leads to a risk of any pathological process in either the pICA or the ET impinging on the other.

CONCLUSION

Giant pICA aneurysm is a rare cause of hearing loss, due to compression of the ET, leading to chronic serous otitis. This co-dependency between pICA and ET should be kept in mind, as it underlines the necessity of multidisciplinary management and could facilitate earlier diagnosis and therapeutic management when facing atypical clinical situations.

Petrous internal carotid artery aneurysm rupture induced by Eustachian tube catheterisation: case report

BACKGROUND

Petrous internal carotid artery aneurysms are very rare vascular lesions, which may present with otalgia and life-threatening massive otorrhoea.

CASE REPORT

An 84-year-old woman presented at a local otolaryngology clinic with progressive otalgia due to an acute exacerbation of chronic otitis media. She was referred with left-sided massive otorrhoea following Eustachian tube catheterisation. She suffered another massive otorrhoea with epistaxis during left-sided ear cleaning at a clinic visit. Contrast-enhanced computed tomography and computed tomography angiography revealed a left-sided aneurysm and adjacent stenosis at the left internal carotid artery. Coil embolisation of the petrous internal carotid artery aneurysm was performed with percutaneous transluminal angioplasty followed by dilatation of the stenosis.

CONCLUSION

Computed tomography angiography should be performed immediately when a patient reports massive otorrhoea. Endovascular occlusion is a treatment option as it avoids complications of open surgical ligation procedures.

Malignant otitis externa presenting cerebral infarction from pseudoaneurysm: A case report and a review of the literature

Chronic renal failure and diabetes mellitus could also be risk factors of pseudoaneurysm of the internal carotid artery (ICA) due to malignant otitis externa (MOE). Although pseudoaneurysm of the ICA is a rarely encountered disease, it should always be taken into consideration when treating patients of MOE.