The high jugular bulb in ear surgery: three case reports and a review of the literature.

Encounters with the jugular bulb in ear surgery are uncommon. This communication relates three cases where the author was confronted with the bulb in middle ear surgery--one in relation to the external auditory canal when raising a tympanomeatal flap and two in the hypotympanum when entering the middle ear. The anatomy of the jugular bulb is considered, particularly in regard to its quite variable placement within the temporal bone. The manner of clinical presentation of the high jugular bulb and previous cases in the literature where the jugular bulb has been discovered in juxtaposition to the surgical approach are discussed. Implications of surgical management are considered.