The tympanic membranes are unusually horizontally oriented. The middle ear cavities are clear. The long processes of the incus anomalously articulate with what appears to be dysmorphic stapes, which are acutely bent. The oval window fossae appear dysmorphic, being malrotated, and abnormally thickened and narrowed (worse on the left than the right). The right carotid artery has an atypical course, but appears to remain covered by a thin plate of bone where it approaches the middle ear cavity.