Research on the Incidence of High Jugular Bulb in the Lateral Position among Otitis Media Patients

Abstract

Objective: This study aims to analyze the incidence of high jugular bulb (HJB), an anatomical variation, in patients with otitis media using high-resolution CT imaging in the lateral position.
Methods: A retrospective analysis was performed on high-resolution CT scans of the middle ear from 965 patients clinically diagnosed with otitis media between October 2018 and October 2023. The age range was 6 to 81 years, with a mean age of 47.11 years. The cohort included 387 male and 578 female patients. HJB was defined as the superior border of the jugular bulb extending beyond the inferior border of the basal turn of the cochlea. Using the lateral wall of the cochlear basal turn as the reference line, HJB was classified into medial and lateral types. In the lateral type, the jugular bulb was in proximity to the tympanic membrane, ossicular chain, or round window; in the medial type, it was adjacent to the cochlear aqueduct, vestibular aqueduct, or internal auditory canal. The presence of HJB was recorded, and gender and side distribution were analyzed.
Results: Among the 965 patients with chronic otitis media, 176 cases exhibited HJB, representing an incidence rate of 18.23%. Of these, 103 were female (58.52%) and 73 were male (41.48%), indicating a higher prevalence in females. Right-sided HJB occurred in 115 cases (65.34%), compared to 61 cases on the left (34.66%), suggesting a predominance on the right side. Lateral HJB was observed in 125 cases (71.02%), including five cases with direct exposure, whereas medial HJB was found in 51 cases (28.98%), demonstrating a significantly higher frequency of the lateral variant.
Conclusions: The findings indicate that HJB is more prevalent in females than males and more common on the right side than the left. Additionally, the lateral type occurs more frequently than the medial type. Given its anatomical significance, lateral HJB must be carefully evaluated during otoscopic tympanic surgery to prevent potentially serious complications. Special attention should be paid to identifying this variation preoperatively.