Otorrhagia as the initial presentation of an internal carotid artery aneurysm in the middle ear. Case presentation

Abstract

Middle ear aneurysms are rare and difficult to treat. The case of a 50-year-old female who presented with left otorrhagia caused by an internal carotid aneurysm is reported. She had no medical history of tinnitus, vertigo, otalgia or otorrhea. Middle ear surgery was effective in resolving bleeding and did not cause any permanent neurological deficit. High resolution computed tomography angiography is the technique of choice and, in some cases, can be complemented with a magnetic resonance angiography. Misdiagnosis of the internal carotid artery aneurysm may lead to serious morbidity because of bleeding or vascular occlusion. The use of modern imaging techniques explain the current relative increase in frequency.

Management of life‐threatening post‐traumatic otorrhagia

“…2 There are several documented cases of otorrhagia due to nontraumatic internal carotid artery pathology, namely, aneurysms, in the middle ear space. 3,4 However, to our knowledge, there are no documented cases of trauma to the temporal bone presenting with life-threatening otorrhagia. In addition, due to the rarity of severe otorrhagia in general, there is no existing literature on its management.…”

“…Most temporal bone fractures are due to blunt trauma, but penetrating injuries may also occur 2 . There are several documented cases of otorrhagia due to nontraumatic internal carotid artery pathology, namely, aneurysms, in the middle ear space 3,4 . However, to our knowledge, there are no documented cases of trauma to the temporal bone presenting with life‐threatening otorrhagia.…”