Two cases of high jugular bulb with attic cholesteatoma are reported. In one case, a pulsating vein was seen through the right tympanic membrane, and in the other, a exposed right jugular bulb was demonstrated by computerized tomography scan.
Both patients had a right acellular mastoid and an enlarged and anterior-lying sigmoid sinus. It was thought that hypoplasia of pneumatization was affected by the anatomical variation in the sinus. Also, judging from the clinical courses of the cases, it seems that the attic wall defects resulted from hypoplasia of the attic, and cholestesteatomas were formed when skin desquamation accumulated in a deep portion of the attic cavity.