The carotid artery is separated from the middle ear cavity by the tympanic plate. This 0.5-mm-thick plate may be disrupted in basilar skull fractures, displacing the carotid artery into the middle ear. The artery may also pass through the middle ear because of congenital anomalies in its course. Such a vessel may be seen through the tympanic membrane, where it may be mistaken for hemorrhage behind the drum or a tumor. The vessel may be injured during myringotomy; attempts to perform a biopsy of the 'mass' may be disastrous. The authors recently treated a child who experienced massive hemorrhage from his ear after biopsy of a 'mass' at myringotomy. Innovative use of a balloon catheter obviated the need for craniotomy.
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