{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T21:05:03Z","timestamp":1786309503141,"version":"build-2736575974"},"reference-count":19,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,3,30]]},"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:p>High-riding jugular bulb (HRJB), although rare, may pose a challenge as it may be mistaken for other non-alarming condition, such as middle ear effusion. Patients with HRJB classically present with pulsatile tinnitus. We report a unique case of a 26-year-old patient with underlying beta thalassaemia who presented with a 2-month history of intermittent epistaxis and rhinorrhoea. Otoscopic examinations revealed a pulsatile bluish mass behind the right tympanic membrane and a dull left tympanic membrane. Imaging performed revealed a finding of dual retrotympanic pathology, which consisted of a right dehiscent HRJB and left cholesterol granuloma. We highlight a rare case of dual retrotympanic mass as well as its management.<\/jats:p>","DOI":"10.1136\/bcr-2021-241591","type":"journal-article","created":{"date-parts":[[2021,4,12]],"date-time":"2021-04-12T11:53:50Z","timestamp":1618228430000},"page":"e241591","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Dual retrotympanic aural mass"],"prefix":"10.1136","volume":"14","author":[{"given":"Nurul Asma","family":"Che Ab Rahim","sequence":"first","affiliation":[{"name":"Otorhinolaryngology, University of Malaya, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1974-4379","authenticated-orcid":false,"given":"Jeyasakthy","family":"Saniasiaya","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology, University of Malaya, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeyanthi","family":"Kulasegarah","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology, University of Malaya, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,4,12]]},"reference":[{"key":"2025082709330496000_14.4.e241591.1","doi-asserted-by":"crossref","first-page":"129","DOI":"10.4103\/0971-7749.136863","article-title":"High-riding jugular bulb: a rare entity","volume":"20","author":"Sasindran","year":"2014","journal-title":"Indian J Otol"},{"key":"2025082709330496000_14.4.e241591.2","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1017\/S0022215100128087","article-title":"The high jugular bulb in ear surgery: three case reports and a review of the literature","volume":"108","author":"Moore","year":"1994","journal-title":"J Laryngol Otol"},{"key":"2025082709330496000_14.4.e241591.3","doi-asserted-by":"publisher","DOI":"10.1016\/0720-048X(95)00619-2"},{"key":"2025082709330496000_14.4.e241591.4","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1017\/S0022215109992349","article-title":"Beware the silent presentation of a high and dehiscent jugular bulb in the external ear canal","volume":"124","author":"Ball","year":"2010","journal-title":"J Laryngol Otol"},{"key":"2025082709330496000_14.4.e241591.5","doi-asserted-by":"publisher","DOI":"10.3171\/2018.5.FOCUS18106"},{"key":"2025082709330496000_14.4.e241591.6","first-page":"157","article-title":"[The management of high jugular bulb and its active bleeding during middle ear surgery]","volume":"21","author":"Chen","year":"2007","journal-title":"Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi"},{"key":"2025082709330496000_14.4.e241591.7","doi-asserted-by":"publisher","DOI":"10.1097\/01.mao.0000226310.97316.99"},{"key":"2025082709330496000_14.4.e241591.8","doi-asserted-by":"publisher","DOI":"10.1067\/mva.1987.avs0060248"},{"key":"2025082709330496000_14.4.e241591.9","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2011.231"},{"key":"2025082709330496000_14.4.e241591.10","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s00062-015-0436-5","article-title":"Conductive hearing loss and the jugular bulb","volume":"26","author":"Toman","year":"2016","journal-title":"Clin Neuroradiol"},{"key":"2025082709330496000_14.4.e241591.11","doi-asserted-by":"publisher","DOI":"10.1097\/01.rct.0000175499.34213.5d"},{"key":"2025082709330496000_14.4.e241591.12","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000011067"},{"key":"2025082709330496000_14.4.e241591.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2004.09.003"},{"key":"2025082709330496000_14.4.e241591.14","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1017\/S0022215116009166","article-title":"Radiological and audiometric evaluation of high jugular bulb and dehiscent high jugular bulb","volume":"130","author":"Sayit","year":"2016","journal-title":"J Laryngol Otol"},{"key":"2025082709330496000_14.4.e241591.15","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.1097\/MAO.0000000000001346","article-title":"Conductive hearing loss from a jugular bulb anomaly","volume":"38","author":"Moore","year":"2017","journal-title":"Otol Neurotol"},{"key":"2025082709330496000_14.4.e241591.16","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-199703000-00008"},{"key":"2025082709330496000_14.4.e241591.17","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1097\/00129492-200405000-00005","article-title":"Invasive middle ear cholesterol granuloma involving the basal turn of the cochlea with profound sensorineural hearing loss","volume":"25","author":"Murugasu","year":"2004","journal-title":"Otol Neurotol"},{"key":"2025082709330496000_14.4.e241591.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2009.12.007"},{"key":"2025082709330496000_14.4.e241591.19","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1002\/lary.23891","article-title":"A novel approach for surgical repair of dehiscent high jugular bulb","volume":"123","author":"Shaikh","year":"2013","journal-title":"Laryngoscope"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-241591","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:33:14Z","timestamp":1756312394000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-241591"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4]]},"references-count":19,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,12]]},"published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1136\/bcr-2021-241591"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-241591","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4]]}}}