Conductive Hearing Loss From a Jugular Bulb Anomaly.

Copyright © Address correspondenc M.D., Department of O University of Texas Sout Blvd, Dallas, TX 75390-9 E-mail: Brandon.Isaacson Funding: None. IRB: This is a single exemption at University o The authors disclose n DOI: 10.1097/MAO.0 presented with right-sided hearing dehiscence, protrusion, or diverticulu A 9 year-old male loss first detected at a school hearing screen. Audiogram revealed a right mild conductive hearing loss (CHL) with pure-tone average (PTA) of 33 dB, 100% speech discrimination, an air-bone gap (ABG) of 17 dB, as well as a 2000 Hz notch in bone conduction. The patient had normal hearing on the left, bilateral type A tympanograms, and no significant otologic history. He reported right pulsatile tinnitus. Otologic examination demonstrated a faint blue middle ear mass in the posteriorinferior mesotympanum. The differential diagnosis included juvenile otosclerosis, congenital stapes footplate fixation, lateral ossicular chain fixation, ossicular discontinuity/malformation, middle ear paraganglioma, enlarged vestibular aqueduct, and other third window conditions. A high-resolution computed tomography (CT) of the temporal bone with and without contrast was obtained. Contrasted images were obtained to rule out a vascular neoplasm given the otoscopy findings. Axial and coronal images demonstrated a right high-riding and dehiscent jugular bulb (Fig. 1). The jugular bulb protrudes into the posterior mesotympanum and obstructs the round window niche, thus meeting criteria for highriding. Additionally, this protrusion is not covered by bone and is, therefore, classified as dehiscent. It approached, but did not clearly contact, the incudostapedial joint. There were no other abnormal radiographic findings. Management options of observation, a hearing aid, or surgical intervention were discussed. The family agreed to the primary recommendation of observation. The jugular bulb is located below the hypotympanum of the middle ear (1). The size, location, and configuration of the jugular bulb is variable. Jugular bulb abnormalities (JBA) represent congenital venous malformations with variants that include a high-riding jugular bulb (HRJB),