Abstract: Objective This report delves into the clinical manifestation, diagnosis, and treatment of cholesteatoma accompanied by a dehiscent high jugular bulb. We conducted a retrospective study on a patient with this condition and supplemented our findings with a literature review. Methods Our patient exhibited signs of a dehiscent high jugular bulb reaching the mesotympanum, as observed through otoscopy and CT scans. To address the cholesteatoma, we utilized underwater otoscopy, successfully removing the cholesteatoma, rectifying the retraction pocket involving pars flaccida and the posterosuperior aspect of pars tensa, and extracting the partially eroded malleus and incus. The arches of stapes were absent, but the footplate functioned well. During tympanoplasty with ossiculoplasty, we carefully navigated around the protruding jugular bulb while raising the tympanomeatal flap. A 2.5 mm total ossicular replacement prosthesis and preserved tragal cartilage perichondrium were used. Results In addition to pre-operative assessments of the mastoid, antrum, and ossicular chain, evaluating the jugular bulb is crucial to prevent severe complications like profuse hemorrhage. The underwater otoscopy technique demonstrated unique advantages in managing acquired cholesteatoma with a dehiscent high jugular bulb. Conclusion This case highlights the importance of thorough evaluation, including the jugular bulb, in cholesteatoma cases. The underwater otoscopy technique proved effective in our management approach.

Key words: High jugular bulb, Cholesteatoma, Underwater otoscopy technique