A Rare and Fatal Complication of Ear Syringing: Rupture of Pseudoaneurysm at Petrous Internal Carotid Artery


1 Departments of Otorhinolaryngology, IMS and SUM Hospital, Siksha “O” Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India

2 Departments of Radiodiagnosis, IMS and SUM Hospital, Siksha “O” Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India



Ear syringing is a common procedure done for cleaning wax from the ear canal. Rupture of the pseudoaneurysm at the petrous part of the internal carotid artery (ICA) due to ear syringing is an extremely rare incidence in clinical practice. Sudden and profuse bleeding from the ear is the clinical presentation in case of ruptured pseudoaneurysm of ICA at the petrous part. Presence of the cholesteatoma at the middle ear cleft may be an etiology causing rupture of the pseudoaneurysm at the petrous part of the ICA, but the forceful ear syringing is an uncommon cause for the rupture of pseudoaneurysm. Radiological imaging is an important tool for the diagnosis. Endovascular technique is often used for the treatment of pseudoaneurysm of the ICA. Here, we are reporting an uncommon complication of forceful ear syringing making rupture of the pseudoaneurysm of petrous ICA leading to fatal spontaneous and profuse bleeding from the ear.


1. Yu LB, Zhang D, Yang SH, Zhao JZ. Surgical management of giant intrapetrous internal carotid aneurysm presenting with coil exposure after endovascular treatment. Neurosurg Rev 2018;41:891‑4.
2. Lim LY, Mohamad I, Lau JH, Tang IP. A rare complication of middle ear cholesteatoma – Pseudoaneurysm of petrous internal carotid artery. Egypt J Ear Nose Throat Allied Sci 2017;18:199‑201.
3. Gross BA, Moon K, Ducruet AF, Albuquerque FC. A rare but morbid neurosurgical target: Petrous aneurysms and their endovascular management in the stent/flow diverter era. J Neurointerv Surg 2017;9:381‑3.
4. Oyama H, Hattori K, Tanahashi S, Kito A, Maki H, Tanahashi K, et al. Ruptured pseudoaneurysm of the petrous internal carotid artery caused by chronic otitis media. Neurol Med Chir (Tokyo) 2010;50:578‑80.
5. Hamamoto Filho PT, Machado VC, Macedo‑de‑Freitas CC. A giant aneurysm from the petrous carotid presenting with isolated peripheral facial palsy. Rev Assoc Med Bras (1992) 2013;59:531‑3.
6. Graziano F, Ganau M, Russo VM, Iacopino DG, Ulm AJ. Emergency endovascular treatment of petrous carotid artery false aneurysm. Interdiscip Neurosurg 2015;2:21‑5.
7. Palacios E, Gómez J, Alvernia JE, Jacob C. Aneurysm of the petrous portion of the internal carotid artery at the foramen lacerum: Anatomic, imaging, and otologic findings. Ear Nose Throat J 2010;89:303‑5.
8. Leonetti JP, Smith PG, Linthicum FH. The petrous carotid artery: Anatomic relationships in skull base surgery. Otolaryngol Head Neck Surg 1990;102:3‑12.
9. Seibert B, Tummala RP, Chow R, Faridar A, Mousavi SA, Divani AA, et al. Intracranial aneurysms: Review of current treatment options and outcomes. Front Neurol 2011;2:45.
10. Liu JK, Gottfried ON, Amini A, Couldwell WT. Aneurysms of the petrous internal carotid artery: Anatomy, origins, and treatment. Neurosurg Focus 2004;17:E13.
11. Malikov S, Thomassin JM, Magnan PE, Keshelava G, Bartoli M, BranchereauA, et al. Open surgical reconstruction of the internal carotid artery aneurysm at the base of the skull. J Vasc Surg 2010;51:323‑9.
12. ParkEK, AhnJS, KwonDH, KwunBD. Result of extracranial‑intracranial bypass surgery in the treatment of complex intracranial aneurysms: Outcomes in 15 cases. J Korean Neurosurg Soc 2008;44:228‑33.
13. Borha A, Patron V, Huet H, Emery E, Barbier C. Endovascular management of a giant petrous internal carotid artery aneurysm in a child. Case report and literature review. Childs Nerv Syst 2019;35:183‑6.