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and TEES may decrease post-operative pain. Hearing outcomes in TORP ossiculoplasty are similar in TEES and PAM surgery, and TEES may decrease post-operative pain.Variable internal jugular vein anatomy is not rare. A high jugular bulb (J is reported in 6 to 34% of cases and, it can be jeopardized during middle ear surgery, especially if dehiscent. Its injury represents a threatening complication of ear surgery. In recent years there has been an increasing trend in the use of endoscopic ear surgery for a wide range of otologic procedures