Dehiscent high jugular bulb: a pitfall in middle ear surgery.

OBJECTIVE

The aim of this study was to present our experience on facing the dehiscent high jugular bulb (HJB) during middle ear surgery in the past 2 decades.

STUDY

DESIGN

Retrospective review.

SETTING

Secondary referral hospital.

PATIENTS: From January 1982 to June 2002, consecutive 1,657 patients underwent surgical intervention for middle ear cleft diseases, a total of 1,857 operations. Of them, 10 ears (0.5%) in nine patients were proven to have dehiscent HJB during operation for adhesive otitis media in four ears and for chronic otitis media with cholesteatoma in six ears.

MAIN OUTCOME MEASURES: Each patient underwent otoscopic examination, radiographic examination, and audiometry before and 6 months after operation.

RESULTS

Otoscopic examination revealed atrophic changes in the pars tensa with adhering to the promontory in two ears, attic retraction in one ear, and both findings in seven ears. All lesions were located beneath the basal turn of the cochlea and the round window niche at anteroinferior and/or posteroinferior quadrants. Active bleeding was encountered in two ears (20%) while elevating the tympanomeatal flap, which was treated by pressure compression associated with gelfoam sheet, then covered with an autologous cartilage to protect the dehiscent bulb. For the remaining eight ears, the bulbs were reinforced with fascia, perichondrium, or autologous cartilage. All 10 ears were allowed completion of the planned surgery without complications.

CONCLUSION

HJB is not a contraindication for middle ear surgery. Awareness of this pitfall may lessen the operation risk.