Lemierre's syndrome, which affects previously healthy, young adults, is a rare complication secondary to infections in the head and neck that result in septic thrombophlebitis of the internal jugular vein.

This paper reports a case of a young, healthy female with malignant otitis externa, which resulted in the development of Lemierre's syndrome. A review of the relevant literature was also carried out. This involved a search of the Medline database using multiple search terms including ‘Lemierre’, ‘septic thrombophlebitis’, ‘otitis externa’, ‘internal jugular vein thrombosis’ and ‘management’.

The patient presented with fever, left-sided otalgia, otorrhoea, neck swelling and pain. She was subsequently diagnosed with Lemierre's syndrome and managed accordingly.

Lemierre's syndrome is a potentially fatal complication associated with significant morbidity. A high index of suspicion is required for prompt recognition and the early institution of treatment.

We report a rare case of posterior semicircular canal dehiscence caused by a jugular diverticulum, and we describe its surgical treatment using a dehiscence resurfacing manoeuvre.

The clinical findings, surgical procedure and outcomes are presented.

A 66-year-old man presented with disequilibrium, sound-induced vertigo, a reduced ocular vestibular evoked myogenic potential threshold, and pressure-induced vertical and torsional nystagmus. Computed tomography revealed a right posterior semicircular canal dehiscence caused by a diverticulum of the jugular bulb. The defect in the posterior semicircular canal was localised and resurfaced with bone paté, temporalis muscle fascia and conchal cartilage, under direct visualisation. Post-operatively, the patient's symptoms disappeared and his ocular vestibular evoked myogenic potential threshold normalised.

This case illustrates that posterior semicircular canal dehiscence can be surgically managed by resurfacing the defect site via a transmastoid approach.

We report an extremely rare case of an aberrant internal carotid artery in the middle ear, together with a dehiscent high jugular bulb, a combination never previously reported.

Case report with a review of the literature.

A 24-year-old man presented with a five-year history of aural fullness, pulsatile tinnitus and mild hearing impairment in his right ear. Otoscopy revealed a retro-tympanic mass. Computed tomography of the temporal bone revealed protrusion of the right internal carotid artery into the middle-ear cavity, with a dehiscent high jugular bulb. Magnetic resonance angiography showed a reduced diameter and lateralisation of the right internal carotid artery. A diagnosis of an aberrant internal carotid artery with a dehiscent high jugular bulb was made, and the patient was managed with conservative treatment.

The otologist should be aware of the possibility of an aberrant internal carotid artery when the patient presents with a retro-tympanic mass, hearing loss and pulsatile tinnitus. Radiological investigation is required to make the differential diagnosis. When an aberrant internal carotid artery presents with a dehiscent high jugular bulb, the risk of serious bleeding is elevated. We recommend a conservative approach for cases presenting without bleeding complications.

To demonstrate the need for computed tomography imaging of the temporal bone before considering revision stapes surgery in patients with recurrent or residual conductive hearing loss.

We report the case of a high-riding jugular bulb with an associated jugular bulb diverticulum, which was dehiscent towards the vestibular aqueduct, in a patient with confirmed otosclerosis who did not experience hearing improvement after stapedotomy.

This case demonstrates the usefulness of temporal bone computed tomography in the evaluation of patients with otosclerosis in whom stapedotomy has not improved hearing. In such patients, revision surgery to address residual hearing loss would eventually prove unnecessary and avoidable.