Aberrant internal carotid artery in the middle ear is a rare disease which, if unrecognized on radiologicalstudies, can lead to serious complications during tissue biopsy. We report the imaging features of a case withaberrant internal carotid artery in the middle ear. A 60-year-old woman visited our hospital because of hearingdifficulty on the right side. Temporal bone CT showed a well-defined mass of the right middle ear and lateral bonydefect in the carotid canal adjacent to the mass. After arterial phase temporal bone CT with spiral CT andangiography, the mass could be diagnosed as aberrant internal carotid artery in the middle ear.