An aberrant internal carotid artery (ICA) in the middle ear is rare. If unrecognized, it may lead to massive hemorrhage or other catastrophic results during even a minor surgical procedure of the tympanic membrane or middle ear. Recognition of this entity is particularly significant to the primary care or emergency department physician who performs tympanocentesis as a routine part of clinical practice. We present the management and radiographic findings of a case of aberrant ICA referred because of persistent bleeding following a minor surgical procedure. The possibility of an anomalous artery in the middle ear had been recognized during surgery. The procedure was aborted and the patient referred for definitive care.