Carotid Artery Aneurysm: A Rare Cause of Hemotympanum

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.

Unusual case of bilateral haemotympanum after endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUS-TBNA)

We present a case of bilateral haemotympanum (HT) during endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUS-TBNA). A 64 year-old-man underwent EBUS-TBNA for mediastinal lymph nodes (LN) staging. Medical history included emphysema and angina. Medication included aspirin until the day before procedure. Full blood count and clotting screen were normal. He received sedation (5 mg midazolam, 1000 mcg alfentanil) and topical anaesthesia (16 mL 1% lignocaine) but coughed excessively throughout the procedure. Left hilar LN was the only area sampled. Spontaneous bleeding ensued from both ears towards the end of the procedure. Patient remained haemodynamically stable. The procedure was aborted and otolaryngology consult sought. Otoscopy showed bilateral haematoma from anterior ear canal with normal tympanic membranes and no hearing loss. Nasendoscopy revealed erythematous ostium of both Eustachian tubes. Bleeding stopped spontaneously and patient required no further imaging or treatment. We report this case to increase awareness of this very rare complication resulting from excessive coughing during EBUS-TBNA.