Unilateral conductive hearing loss secondary to an ipsilateral high jugular bulb with contralateral agenesis of the lateral dural sinuses in a pediatric patient

We present a case of a 7-year-old boy with a left sided conductive hearing loss accompanied by pulsating tinnitus. Otomicroscopic examination of the left ear revealed a bluish, non-pulsating mass behind the posterior inferior quadrant of the tympanic membrane. The audiogram demonstrated a left conductive hearing loss and a type B tympanogram. A myringotomy with insertion of a pressure equalizing (PE) tube was performed with no change in symptoms and hearing. CT demonstrated a high jugular bulb (HJB) on the left side, intruding the middle ear space, in contact with the ossicular chain. Venous stage of magnetic resonance demonstrated a complete dominance of the dural sinuses on the left side, with a huge internal jugular vein diverticulum. In addition, a complete agenesis of the lateral dural sinuses was demonstrated on the contralateral side. The combination of pulsatile tinnitus and unilateral conductive hearing loss with a red or blue to purple mass behind the tympanic membrane should alert the physician. Assessment of the anatomy and blood flow by CT scan and MRI of the ear and head are advised to delineate the finding, before considering any type of intervention.