The n e w e ng l a n d j o u r na l of m e dic i n e

images in clinical medicine

Persistent Stapedial Artery Visualized

through a Perforated Tympanic Membrane
A B

Incus

Kevin W. Lollar, M.D.
Alexander G. Bien, M.D.
University of Missouri School of Medicine
Columbia, MO
kevin.lollar@hrhonline.org
A
29-year-old woman presented with hearing loss and mild inter-
mittent pulsatile tinnitus on the right side. Her medical history was notable
for the placement of several sets of pressure-equalization tubes. Physical
examination revealed a 40% perforation in the posterior quadrant of the right tym-
panic membrane (Panel A) and a mild conductive hearing loss on the right side. On
otomicroscopy, she was noted to have a persistent stapedial artery (Panel B, arrow)
coursing between the posterior crus (arrowhead) and the anterior crus of the sta-
pes, which was well visualized through the perforation (see video). Persistent stape-
dial artery is the most common vascular malformation of the middle ear, with an
incidence ranging from 1 in 5000 to 1 in 10,000. Treatment of persistent stapedial
artery is rarely necessary in an asymptomatic patient. The patient’s tympanic mem-
brane was surgically repaired without complications.
Copyright © 2011 Massachusetts Medical Society.

e42 n engl j med 365;22 nejm.org december 1, 2011

The New England Journal of Medicine

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