The jugular bulb is a supreme position of the internal jugular vein. If the level of dome of jugular bulb is superior to a round window niche or inferior annulus of the tympanic membrane, we call it a high jugular bulb. The average width and height of jugular bulb is 15mm and 20mm respectively. The incidence of high jugular bulb is rare, but it is clinically important because of severe intraoperative bleeding when injured. Recently we experienced a high jugular bulb case in a patient with cholesteatomatous otitis media during middle ear operation. This was confirmed by postoperative temporal bone CT scan. We report this case with review of the literatures. The results of this paper that we should pay attention to high jugular bulb about accidental intraoperative bleeding during middle ear operation and the importance of preoperative CT check for prevention of accidental bleeding.