山东大学耳鼻喉眼学报 ›› 2026, Vol. 40 ›› Issue (2): 95-101.doi: 10.6040/j.issn.1673-3770.0.2024.082

• 综述 • 上一篇    下一篇

搏动性耳鸣的治疗研究进展

高奇歌1,张华2   

  1. 1.河南中医药大学第一临床医学院, 河南 郑州 450000;
    2.河南中医药大学第一附属医院 耳鼻喉科, 河南 郑州 450000
  • 发布日期:2026-03-26
  • 通讯作者: 张华. E-mail:sq2006fcctbt@sina.com

Treatment of pulsatile tinnitus: a literature review

GAO Qige1, ZHANG Hua2   

  1. 1.The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou 450000, Henan, China2.Department of Otolaryngology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, Henan, China
  • Published:2026-03-26

摘要: 搏动性耳鸣(pulsatile tinnitus, PT)是一种具有节律性的耳鸣,其发生机制尚不明确,病因涉及血管性病变或畸形、乙状窦壁缺损及憩室、副神经节瘤、上半规管裂综合征、腭肌及中耳肌阵挛等多种头颈部疾病。PT的治疗以外科治疗为主,内科治疗适用范围相对较小,临床常用的治疗方法包括以支架置入术、弹簧圈栓塞术等的血管内治疗与以表面重建术为代表的外科手术治疗,大部分PT经治症状均能明显减轻或完全消除,且长期疗效理想、不良事件率低,但由于发病机制不明确,目前尚无PT治疗方面的统一意见,如何分辨PT的具体病因并给予对应治疗以及部分治疗方法是否适用于PT等问题仍需进一步研究与讨论。本文通过查阅近年与PT治疗相关的中、外文文献,总结与分析了目前临床常见的PT病因与对应治疗研究进展,以期为PT的临床诊疗工作提供参考。

关键词: 耳鸣, 搏动性耳鸣, 乙状窦壁缺损, 表面重建术

Abstract: Pulsatile tinnitus(PT)is a type of rhythmic tinnitus symptom. The pathological mechanism of PT is still unclear, its causes include various diseases such as vascular malformation, sigmoid sinus wall dehiscence/diverticulum, paraganglioma, superior canal dehiscence syndrome, and palatal/middle ear myoclonus, etc. Surgical treatment is the main method of PT, the scope of medical treatment is smaller in comparison. Endovascular stenting, coil embolization and surgical treatment represented by surface reconstruction have been widely used in clinical management. Most of PAD can be significantly reduced or eliminated after treatment, with ideal long-term efficacy and low adverse event rate. However, because the pathogenesis of PT is still unclear, there is no unified opinion for the management of PT, how to clarify the specific cause and choose the corresponding treatment, and whether some treatment methods are suitable for PT still require further research and discussion. This article reviews the literatures related to the treatment of PT in recent years, summarizes the common clinical causes of PT and the research progress of corresponding treatments, aiming to provide reference for the clinical diagnosis and treatment of PT.

Key words: Tinnitus, Pulsatile tinnitus, Sigmoid sinus wall anomalies, Reconstruction

中图分类号: 

  • R764
[1] 龚树生, 曾嵘, 王国鹏. 重视乙状窦相关病变致搏动性耳鸣的诊治[J]. 临床耳鼻咽喉头颈外科杂志, 2015, 29(8): 677-680. doi:10.13201/j.issn.1001-1781.2015.08.001 GONG Shusheng, ZENG Rong, WANG Guopeng. Diagnosis and treatment of pulsatile tinnitus caused by the sigmoid sinus anomalies[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2015, 29(8): 677-680. doi:10.13201/j.issn.1001-1781.2015.08.001
[2] Bhatt JM, Lin HW, Bhattacharyya N. Prevalence, severity, exposures, and treatment patterns of tinnitus in the United States[J]. JAMA Otolaryngol Head Neck Surg, 2016, 142(10): 959-965. doi:10.1001/jamaoto.2016.1700
[3] Liyanage SH, Singh A, Savundra P, et al. Pulsatile tinnitus[J]. J Laryngol Otol, 2006, 120(2): 93-97. doi:10.1017/s0022215105001714
[4] 陈倬诣, 郑亿庆, 杨海弟. 慢性主观性耳鸣分类、发生发展机制及治疗新进展[J]. 山东大学耳鼻喉眼学报, 2023, 9(4): 1-12. doi: 10.6040/j.issn.1673-3770.0.2023.137 CHEN Zhuoyi, ZHENG Yiqing, YANG Haidi. Classification, pathogenesis, and treatment advances of chronic subjective tinnitus[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 9(4): 1-12. doi: 10.6040/j.issn.1673-3770.0.2023.137
[5] 中国医学影像技术研究会放射学分会, 北京市医学影像质量控制和改进中心. 耳鸣患者影像学检查临床适用性评价共识(2022版)[J]. 中华医学杂志, 2022, 102(27): 2067-2073. doi:10.3760/cma.j.cn112137-20220304-00456
[6] Cummins DD, Caton MT, Hemphill K, et al. Cerebrovascular pulsatile tinnitus: causes, treatments, and outcomes in 164 patients with neuroangiographic correlation[J]. J Neurointerv Surg, 2023, 15(10): 1014-1020. doi:10.1136/jnis-2022-019259
[7] Narsinh KH, Hui F, Saloner D, et al. Diagnostic approach to pulsatile tinnitus: a narrative review[J]. JAMA Otolaryngol Head Neck Surg, 2022, 148(5): 476-483. doi:10.1001/jamaoto.2021.4470
[8] Dai CH, Zhao PF, Ding HY, et al. CT evaluation of unilateral pulsatile tinnitus with jugular bulb wall dehiscence[J]. Eur Radiol, 2023, 33(6): 4464-4471. doi:10.1007/s00330-022-09352-8
[9] Li X, Qiu X, Ding H, et al. Effects of different morphologic abnormalities on hemodynamics in patients with venous pulsatile tinnitus: a four-dimensional flow magnetic resonance imaging study[J]. J Magn Reson Imaging, 2021, 53(6): 1744-1751. doi:10.1002/jmri.27503
[10] Pereira VM, Cancelliere NM, Najafi M, et al. Torrents of torment: turbulence as a mechanism of pulsatile tinnitus secondary to venous stenosis revealed by high-fidelity computational fluid dynamics[J]. J Neurointerv Surg, 2021, 13(8): 732-737. doi:10.1136/neurintsurg-2020-016636
[11] Wang X, Hsieh YL, Xu X, et al. Influence of sigmoid plate and dura mater on vascular wall displacement, vibroacoustic/hydroacoustic sources characteristics, and frequency-loudness assessments of venous pulsatile tinnitus: a coupled-computational fluid dynamics study combining transcanal recording investigation[J]. Front Bioeng Biotechnol, 2022, 10: 948230. doi:10.3389/fbioe.2022.948230
[12] Labeyrie MA, Fantoni M, Vever U, et al. Intracranial venous sinus stenting for the treatment of lateral sinus stenoses: an analysis of 200 patients[J]. Diagn Interv Imaging, 2021, 102(10): 619-627. doi:10.1016/j.diii.2021.05.008
[13] Dinkin MJ, Patsalides A. Idiopathic intracranial venous hypertension: toward a better understanding of venous stenosis and the role of stenting in idiopathic intracranial hypertension[J]. J Neuroophthalmol, 2023, 43(4): 451-463. doi:10.1097/wno.0000000000001898
[14] Farid M, Alawamry A, Zaitoun MMA, et al. Relentless pulsatile tinnitus secondary to dural sinovenous stenosis: is endovascular sinus stenting the answer?[J]. Clin Radiol, 2021, 76(7): 526-531. doi:10.1016/j.crad.2021.02.022
[15] Zhao PF, Ding HY, Lv H, et al. CT venography correlate of transverse sinus stenosis and venous transstenotic pressure gradient in unilateral pulsatile tinnitus patients with sigmoid sinus wall anomalies[J]. Eur Radiol, 2021, 31(5): 2896-2902. doi:10.1007/s00330-020-07415-2
[16] Liu GS, Boursiquot BC, Blevins NH, et al. Systematic review of temporal bone-resurfacing techniques for pulsatile tinnitus associated with vascular wall anomalies[J]. Otolaryngol Head Neck Surg, 2019, 160(5): 749-761. doi:10.1177/0194599818823205
[17] Liu L, Mu ZX, Kang YZ, et al. Hemodynamic mechanism of pulsatile tinnitus caused by venous diverticulum treated with coil embolization[J]. Comput Meth Programs Biomed, 2022, 215: 106617. doi:10.1016/j.cmpb.2022.106617
[18] 张欣, 潘宇澄, 沙勇芳, 等. 女性横窦狭窄与乙状窦前壁骨质缺损发生风险的病例对照研究[J]. 复旦学报(医学版), 2023, 50(1): 64-70. doi:10.3969/j.issn.1672-8467.2023.01.009 ZHANG Xin, PAN Yucheng, SHA Yongfang, et al. Transverse sinus stenosis and the risk of sigmoid sinus anterior wall dehiscence of females: a case-control study[J]. Fudan University Journal of Medical Sciences, 2023, 50(1): 64-70. doi:10.3969/j.issn.1672-8467.2023.01.00
[19] Li D, Wang G, Zeng R, et al. Analysis of revision surgery following surgical reconstruction of the sigmoid sinus wall in patients with pulsatile tinnitus[J]. J Int Adv Otol, 2022, 18(4): 358-364. doi:10.5152/iao.2022.21471
[20] Han YJ, Xia J, Jin L, et al. Computational fluid dynamics study of the effect of transverse sinus stenosis on the blood flow pattern in the ipsilateral superior curve of the sigmoid sinus[J]. Eur Radiol, 2021, 31(8): 6286-6294. doi:10.1007/s00330-020-07630-x
[21] Qiu XY, Zhao PF, Ding HY, et al. Bone remodeling in sigmoid sinus diverticulum after stenting for transverse sinus stenosis in pulsatile tinnitus: a case report[J]. World J Clin Cases, 2021, 9(10): 2320-2325. doi:10.12998/wjcc.v9.i10.2320
[22] Scullen T, Mathkour M, Tubbs RS, et al. Characteristics and management of dilated mastoid emissary veins: a case report and literature review[J]. World Neurosurg, 2022, 165: 100-105. doi:10.1016/j.wneu.2022.06.106
[23] Eliezer M, Freitas RK, Fantoni M, et al. Selective embolization of the mastoid emissary vein for pulsatile tinnitus treatment: when is it indicated?[J]. J Neurointerv Surg, 2020, 12(10): 999-1001. doi:10.1136/neurintsurg-2020-015855
[24] Bai C, Wang Z, Stone C, et al. Pathogenesis and management in cerebrovenous outflow disorders[J]. Aging Dis, 2021, 12(1): 203-222. doi:10.14336/ad.2020.0404
[25] Pang S, Kolarich AR, Brinjikji W, et al. Interventional and surgical management of internal jugular venous stenosis: a narrative review[J]. J Neurointerv Surg, 2022, 14(5): neurintsurg-2021-017937. doi:10.1136/neurintsurg-2021-017937
[26] Bai C, Chen Z, Ding Y, et al. Long-term safety and efficacy of stenting on correcting internal jugular vein and cerebral venous sinus stenosis [J]. Ann Clin Transl Neurol, 2023.doi:10.1002/acn3.51822
[27] Guniganti R, Giordan E, Chen CJ, et al. Consortium for dural arteriovenous fistula outcomes research(CONDOR): rationale, design, and initial characterization of patient cohort[J]. J Neurosurg, 2022, 136(4): 951-961. doi:10.3171/2021.1.jns202790
[28] Gross BA, Albuquerque FC, Moon K, et al. Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas[J]. J Neurosurg, 2017, 126(6): 1884-1893. doi:10.3171/2016.5.jns16331
[29] Kim MJ, Hong SW, Kim DJ, et al. Efficacy and safety of stereotactic radiosurgery versus endovascular treatment for symptomatic cavernous sinus dural arteriovenous fistula without ophthalmological emergency: a single-center 10-year experience[J]. J Neurosurg, 2023, 139(1): 139-149. doi:10.3171/2022.10.jns221770
[30] Hasegawa H, Shin M, Kawagishi J, et al. A practical grading scale for predicting outcomes of radiosurgery for dural arteriovenous fistulas: JLGK 1802 study[J]. J Stroke, 2022, 24(2): 278-287. doi:10.5853/jos.2021.03594
[31] Honkura Y, Hidaka H, Ohta J, et al. Surgical treatment for the aberrant internal carotid artery in the middle ear with pulsatile tinnitus[J]. Auris Nasus Larynx, 2014, 41(2): 215-218. doi:10.1016/j.anl.2013.10.002
[32] Chen L, Chen L, Jiang Y, et al. Pulsatile tinnitus was the only manifestation of internal carotid artery dissection[J]. Neurol Sci, 2021, 42(3): 1221-1222. doi:10.1007/s10072-020-04803-w
[33] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国颈部动脉夹层诊治指南2015[J]. 中华神经科杂志, 2015, 48(8): 644-651. doi:10.3760/cma.j.issn.1006-7876.2015.08.004
[34] Janquli M, Selvarajah L, Moloney MA, et al. Long-term outcome of cervical artery dissection[J]. J Vasc Surg, 2023, 78(1): 158-165. doi:10.1016/j.jvs.2023.03.020
[35] CADISS trial investigators, Markus HS, Hayter E, et al. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection(CADISS): a randomised trial[J]. Lancet Neurol, 2015, 14(4): 361-367. doi:10.1016/s1474-4422(15)70018-9
[36] Cozart Ashley C, Kennedy John T, Seidman Michael D. A basis for standardizing superior semicircular canal dehiscence management[J]. Ear Nose Throat J, 2020, 100(10): 145561320927941
[37] Eberhard KE, Chari DA, Nakajima HH, et al. Current trends, controversies, and future directions in the evaluation and management of superior canal dehiscence syndrome[J]. Front Neurol, 2021, 12: 638574. doi:10.3389/fneur.2021.638574
[38] Xie Y, Sharon JD, Pross SE, et al. Surgical complications from superior canal dehiscence syndrome repair: two decades of experience[J]. Otolaryngol Head Neck Surg, 2017, 157(2): 273-280. doi:10.1177/0194599817706491
[39] Vlastarakos PV, Proikas K, Tavoulari E, et al. Efficacy assessment and complications of surgical management for superior semicircular canal dehiscence: a meta-analysis of published interventional studies[J]. Eur Arch Otorhinolaryngol, 2009, 266(2): 177-186. doi:10.1007/s00405-008-0840-4
[40] Suresh K, Garcia A, Bartholomew RA, et al. Auditory and vestibular symptom improvement with surgery for superior canal dehiscence syndrome [J]. Otolaryngol Head Neck, 2023. doi:10.1002/ohn.359
[41] Bunne M, Andersson H, Myhrum M. Long-term outcomes of round window reinforcement for superior semicircular canal dehiscence syndrome[J]. Otol Neurotol, 2022, 43(6): 709-716. doi:10.1097/mao.0000000000003561
[42] Douse DM, Dornhoffer JR, Benson JC, et al. Natural history of facial paraganglioma with 2 decades of follow-up: a case report and literature review[J]. Am J Otolaryngol, 2023, 44(5): 103952. doi:10.1016/j.amjoto.2023.103952
[43] Carlson ML, Sweeney AD, Wanna GB, et al. Natural history of glomus jugulare: a review of 16 tumors managed with primary observation[J]. Otolaryngol Head Neck Surg, 2015, 152(1): 98-105. doi:10.1177/0194599814555839
[44] Yildiz E, Dahm V, Gstoettner W, et al. Long-term outcome and comparison of treatment modalities of temporal bone paragangliomas[J]. Cancers(Basel), 2021, 13(20): 5083. doi:10.3390/cancers13205083
[45] Park SN, Bae SC, Lee GH, et al. Clinical characteristics and therapeutic response of objective tinnitus due to middle ear myoclonus: a large case series[J]. Laryngoscope, 2013, 123(10): 2516-2520. doi:10.1002/lary.23854
[46] Wong WK, Lee MF. Middle ear myoclonus: Systematic review of results and complications for various treatment approaches[J]. Am J Otolaryngol, 2022, 43(1): 103228. doi:10.1016/j.amjoto.2021.103228
[47] Kim DK, Park JM, Han JJ, et al. Long-term effects of middle ear tendon resection on middle ear myoclonic tinnitus, hearing, and hyperacusis[J]. Audiol Neurootol, 2017, 22(6): 343-349. doi:10.1159/000487260
[48] Salehi PP, Kasle D, Torabi SJ, et al. The etiology, pathogeneses, and treatment of objective tinnitus: Unique case series and literature review[J]. Am J Otolaryngol, 2019, 40(4): 594-597. doi:10.1016/j.amjoto.2019.03.017
[49] Markey KA, Mollan SP, Jensen RH, et al. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions[J]. Lancet Neurol, 2016, 15(1): 78-91. doi:10.1016/s1474-4422(15)00298-7
[50] Widmeyer JR, Sismanis A, Felton W, et al. Magnetic resonance imaging findings in idiopathic intracranial hypertension with and without pulsatile tinnitus: an age-matched cohort study[J]. Otol Neurotol, 2023, 44(5): 525-528. doi:10.1097/mao.0000000000003847
[51] 余力生,杨仕明,王秋菊, 等. 耳鸣的诊断与治疗[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(5): 325-334. doi:10.13201/j.issn.2096-7993.2022.05.001 YU Lisheng, YANG Shiming, WANG Qiuju, et al. Diagnosis and treatment of tinnitus[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2022, 36(5): 325-334. doi:10.13201/j.issn.2096-7993.2022.05.001
[1] 凌雯琛,陈佳旭,徐智辉,郑伟,刘广宇,赵鑫宇,黄平. 基于R语言数据挖掘技术对黄平教授治疗耳鸣用药规律及诊疗特色[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 8-19.
[2] 王莹,蔡燕文. 以听力减退为主要表现的中枢神经系统表面铁沉积症1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 89-96.
[3] 董雪林,张治军. 掩蔽声治疗慢性主观性耳鸣的焦虑抑郁状态分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 18-24.
[4] 郭振平,李雪冰. 慢性主观性耳鸣患者心理特征、睡眠质量调查及与临床效果相关性[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 1-7.
[5] 卜苓南,李茂才,宫丽丽. 以搏动性耳鸣就诊的外伤性颞浅动静脉瘘1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 101-104.
[6] 陈倬诣,郑亿庆,杨海弟. 慢性主观性耳鸣分类、发生发展机制及治疗新进展[J]. 山东大学耳鼻喉眼学报, 2023, 37(4): 1-12.
[7] 罗伊雯,肖永涛,高敏倩,杨嘉仪,杨海弟. 慢性主观性耳鸣的声治疗研究进展[J]. 山东大学耳鼻喉眼学报, 2023, 37(4): 13-23.
[8] 张红,李欣. 中枢神经系统活动异常在耳鸣发生中的作用与机制[J]. 山东大学耳鼻喉眼学报, 2023, 37(4): 24-29.
[9] 董洪松,王春丽,俞艳萍,陈涛,聂国辉. 声音疗法联合药物治疗慢性主观性耳鸣的临床随机对照研究[J]. 山东大学耳鼻喉眼学报, 2023, 37(4): 30-37.
[10] 许海艳,曹卫,范大川. 多元复合声治疗对突聋患者耳鸣的疗效分析[J]. 山东大学耳鼻喉眼学报, 2023, 37(4): 38-45.
[11] 吴波,黄天德,闫斌,陈伊,汤勇. 焦虑抑郁状态与特发性耳鸣预后的相关性研究[J]. 山东大学耳鼻喉眼学报, 2023, 37(4): 46-52.
[12] 刘广宇,谭君颖,霍岩,张剑宁,李明. “治鸣六穴”治疗脾胃虚弱型耳鸣患者的临床疗效观察及脑效应机制研究[J]. 山东大学耳鼻喉眼学报, 2023, 37(4): 53-61.
[13] 熊彬彬,卢子昂,杨晶,徐文强,周潞茹,孙平原,袁丁,朱佳浩. 纯音听阈值正常的中青年耳鸣群体耳蜗功能分析[J]. 山东大学耳鼻喉眼学报, 2023, 37(4): 62-67.
[14] 王楠,黄晶,彭涛,冯勃. OSAHS与耳鸣的相关性研究现状[J]. 山东大学耳鼻喉眼学报, 2023, 37(2): 122-127.
[15] 王欣怡,杨文杰,余文兴,徐艳红,胡纯红,母晓松,蒲晓兵,任建君,赵宇. 家庭化个体多元复合声治疗对耳鸣伴听力损失患者的疗效及影响因素分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(6): 70-76.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 万俐佳,鲁海涛,姜义道,刘 辉,李 琴,佘腊枝 . 改良腭咽成形术治疗阻塞性睡眠呼吸暂停综合征41例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 204 -205 .
[2] 于青青 ,王跃建 . 硬质耳内镜的临床应用进展[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 222 -224 .
[3] 吉晓滨,邓家德,臧林泉,王 磊,谢 军 . 豚鼠变应性鼻炎模型血清组胺的测定[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 228 -230 .
[4] 向登,卢永田,孙焕吉 . 鼻内镜下修补脑脊液鼻漏19例并文献复习[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 234 -236 .
[5] 殷国华,钟 笑 . 激光减容术治疗舌扁桃体肥大的远期疗效[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 280 -282 .
[6] 刘联合 . 刎颈伤21例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 283 -284 .
[7] 蔡 谦,苏振忠,文卫平,柴丽萍,叶 辉,滕以书,吴 旋 . 成人打鼾与口咽腔狭窄评分的相关性[J]. 山东大学耳鼻喉眼学报, 2008, 22(4): 289 -292 .
[8] 储九圣,黄永久,鲍学礼,田为中 . 甲状舌管癌1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2008, 22(4): 322 -324 .
[9] 张吉仲,李大建 . 鼻内镜下鼻中隔软骨或筛骨修补鼻中隔穿孔[J]. 山东大学耳鼻喉眼学报, 2008, 22(4): 336 -337 .
[10] 张端和,陈建平,马政旺,王 成,王护国 . 游离、旋转全层皮瓣移植治疗鼻、面部皮肤缺损[J]. 山东大学耳鼻喉眼学报, 2008, 22(4): 338 -339 .