Aberrant Carotid Artery Injured at Myringotomy-Reply

In Reply.—We appreciate Dr Ehni and Dr Sugar's comments regarding our report. During our research, we found references describing aberrant passage of the carotid artery through the middle ear dating back some 15 years. This anomaly is now readily detected via tomography or angiography or both. Biopsy of such a "mass" beneath the tympanic membrane should certainly be deferred until such studies have excluded this anomaly.We cannot state categorically that simple carotid artery ligation would have failed to control hemorrhage in our patient. The issue, of course, is retrograde flow. We disagree with Dr Sugar regarding such flow in the internal carotid artery. We have observed retrograde flow below the ophthalmic artery in several patients. His suggestion that, after internal carotid artery ligation, the carotid artery below the ophthalmic artery would become a "blind" segment may be true, but not in this instance. In our patient, this portion