Summary
Introduction. The jugular bulb is a crucial component of the venous circulatory system in the head and neck region, serving as a connection between the sigmoid sinus and the internal jugular vein. Positioned at the inferior pole of the tympanic cavity, the jugular bulb is separated from it by a thin bony lamina. Anatomical variations, such as a high-placed jugular bulb or bony dehiscence of the jugular bulb, significantly increase the risk of injury and hemorrhage during surgical procedures. Early detection of these variations is essential to prevent complications. Although computed tomography imaging of the temporal bone is useful in detecting jugular bulb anatomical variations, it is not routinely performed prior to tympanic membrane reconstructive surgery.
Clinical case. A 34-year-old male presented to our clinic with complaints of hearing loss in his right ear and intermittent purulent discharge. Examination revealed a central perforation of the tympanic membrane in the right ear, and audiological assessment confirmed mixed hearing loss. A decision was made to perform tympanic membrane reconstruction. During the surgery, the surgeons encountered significant venous bleeding in the tympanic cavity after elevating the tympanomeatal flap. This bleeding was successfully controlled using hemostatic agents. Postoperative imaging, performed via computed tomography, revealed a high-placed jugular bulb with bony dehiscence.
Discussion. The jugular bulb can exhibit several anatomical variations, including a high-placed jugular bulb, hypoplasia, hyperplasia, bony dehiscence, and diverticulum. Among these, the high-placed jugular bulb is the most common, occurring in 10–15% of cases. While typically asymptomatic, variations may present with symptoms such as pulsatile tinnitus, vertigo, headache, or hearing loss, suggesting an atypical jugular bulb anatomy. These anatomical changes increase the risk of complications during surgical procedures. Although imaging studies are crucial for detecting such variations, they are not routinely conducted before tympanic membrane reconstruction surgery.
Conclusions. The jugular bulb can present with diverse anatomical variations, which may increase the risk of complications during surgery. Since patients with these variations are often asymptomatic, diagnosing such variants can be challenging. This challenge is compounded by the fact that imaging studies are not typically conducted before minor ear surgeries.
