Aberrant Internal Carotid Artery: A Rare Cause of Unfitness Revealed During Admission Audiometry.
Tess Marseille-Boningre, Robin Baudouin, Rayan Fawaz et al.
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Case in brief
A 23-year-old woman undergoing medical assessment for army enlistment was found on audiometry to have unilateral conductive hearing loss. Otoscopy showed a pale red, pulsatile middle-ear mass anterior to the umbo. Temporal-bone CT and MRI confirmed an aberrant tympanic segment of the internal carotid artery. The team recommended conservative management with regular follow-up; because military duty could expose her to ear trauma, she was deemed unfit for service.
What made this case unusual
The vascular anomaly was identified during routine enlistment screening in a candidate whose presentation was limited to unilateral conductive hearing loss, rather than through a reported vascular or otologic complication.
Diagnostic / clinical pearl
A pulsatile middle-ear mass warrants imaging to identify an aberrant internal carotid artery before otologic procedures, given the risk of catastrophic hemorrhage.
Why it matters
Systematic otoscopy and audiometry during military screening can reveal an anomaly relevant both to service fitness and to preventing injury-related or iatrogenic complications.