A 66-year-old woman presented with right-sided hearing loss, insidious in onset. Otoscopic examination showed pulsation of the tympanic membrane in a seated position (Video 1) which diminished on lying down. A CT venogram of the auditory canal showed a dehiscent right jugular bulb along the hypotympanic surface (Figures 1 and 2). A dehiscent jugular bulb develops because of the absence of sigmoid plate separating the bulb from the middle ear. It appears as blue mass behind the tympanic membrane which may distend with Valsalva or internal jugular vein compression. Affected individuals, while often asymptomatic, can experience conductive/sensorineural hearing loss, tinnitus, or vestibular dysfunction.¹ The patient is followed with imaging periodically for disease progression. Over 10 years, her hearing has been stable. Neurologists should be familiar with the otoscopic appearance of auditory canal dehiscence as tinnitus, and vestibular dysfunction is a common presentation. Treatment involves reassurance and follow-up with serial imaging. Surgical or endovascular intervention is reserved for intolerable symptoms.²

一名 66 岁的女性出现右侧听力损失，起病隐匿。耳镜检查显示坐姿时鼓膜搏动（视频 1），躺下时减弱。耳道 CT 静脉造影显示右颈静脉球沿下鼓室表面裂开（图 1 和 2）。由于缺乏将球与中耳分开的乙状结肠板，因此会出现开裂的颈静脉球。它表现为鼓膜后面的蓝色肿块，可能因 Valsalva 或颈内静脉受压而膨胀。受影响的个体虽然通常无症状，但可能会出现传导性/感觉神经性听力损失、耳鸣或前庭功能障碍。¹定期对患者进行影像学检查以了解疾病进展。10多年来，她的听力一直很稳定。神经科医生应该熟悉耳镜下的耳道裂开表现为耳鸣，前庭功能障碍是常见的表现。治疗包括安慰和后续的连续成像。手术或血管内干预仅用于无法忍受的症状。²