Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2019, Vol. 33 ›› Issue (5): 26-31.doi: 10.6040/j.issn.1673-3770.1.2019.049

• Clinical Report • Previous Articles     Next Articles

Effects of surgery in patients with venous pulsatile tinnitus

Yongbo ZHENG,Yu ZHAO(),Lin LOU,Yao SONG,Yijun DONG,Jianjun REN,Jing WANG,Yang XU,Lei LEI   

  1. Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
  • Received:2019-07-25 Revised:2019-07-29 Online:2019-09-20 Published:2019-10-15
  • Contact: Yu ZHAO E-mail:yutzhao@163.com

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Abstract: Objective

To summarize the clinical characteristics of patients with venous pulsatile tinnitus and provide reference data for clinical diagnosis and treatment of this disease.

Methods

Clinical data of 25 patients with venous pulsatile tinnitus were analyzed. During surgery, a small incision was made in the posterior auricular region under local anesthesia, and mastoid exploration plus sigmoid sinus constriction or sigmoid sinus retraction were performed. The tinnitus evaluation questionnaire (TEQ) was used to quantify improvement in tinnitus after the operation (1st, 3rd, and 6th months). The preoperative hearing test results were compared with those obtained in the 1st month postoperatively to determine whether the surgery had adverse effects on hearing.

 Results

As reported by the patients, pulsatile tinnitus had disappeared during the follow-up period in 21 patients. Four patients had mild pulsatile tinnitus in the 6th month postoperatively; however, this conscious tinnitus did not affect the patients’daily lives. The preoperative TEQ score of the patients was 10.44±3.08. The postoperative TEQ scores in the 1st, 3rd, and 6th months were 3.68±1.75, 2.76±1.23, and 2.72±1.17, respectively, which were significantly lower than the preoperative TEQ score. The postoperative TEQ scores in the 3rd and 6th months were lower than that in the 1st month postoperatively, but there was no statistical difference between the TEQ scores in the 3rd and 6th months postoperatively. It was observed that the improvement in postoperative tinnitus stabilized gradually. There was no significant difference between the preoperative and postoperative hearing test results.

 Conclusion

Venous pulsatile tinnitus can be diagnosed by careful medical history taking, physical examination, and imaging. Surgery under local anesthesia is convenient for the surgeon to observe real-time improvement in tinnitus, which aids in accurate evaluation of the shape of the sigmoid sinus and reducing the incidence of complications. Therefore, its clinical application is recommended.

Key words: Pulsatile tinnitus, Surgery, Therapeutic effect

CLC Number: 

  • R764.65

Fig. 1

Right sigmoid sinus and jugular bulb abnormalities A-C: Right sigmoid sinus expansion; D-F: right sigmoid sinus expansion and right high jugular bulb expansion."

Fig. 3

Right jugular bulb and bilateral mastoid emissary vein abnormalities A: Right high jugular bulb; B: left mastoid emissary vein showing abnormal position and expansion; C: right mastoid emissary vein malformation."

Fig. 2

Right sigmoid sinus and mastoid emissary vein abnormalities A: Right sigmoid sinus diverticulum; B: right mastoid emissary vein expansion; C-D: right sigmoid sinus and jugular bulb expansion."

Fig.4

Example of a posterior auricular incision"

Fig.5

Intraoperative exposure and tamponade of abnormal sigmoid sinus A-B: Exposure of the abnormal sigmoid sinus; C-D: Use of the temporalis muscle flap to fill the sigmoid sinus."

1 Baguley D , McFerran D , Hall D . Tinnitus[J]. Lancet, 2013, 382(9904): 1600-1607. doi:10.1016/s0140-6736(13)60142-7 .
doi: 10.1016/s0140-6736(13)60142-7
2 Stouffer JL , Tyler RS . Characterization of tinnitus by tinnitus patients[J]. J Speech Hear Disord, 1990, 55(3): 439-453.
3 曾嵘, 王国鹏, 龚树生 . 搏动性耳鸣研究进展[J]. 中华耳鼻咽喉头颈外科杂志, 2011, 46(11): 957-961. doi:10. 3760/cma.j.issn.1673-0860.2011.11.024 .
doi: 10. 3760/cma.j.issn.1673-0860.2011.11.024
4 刘蓬, 徐桂丽, 李明, 等 . 耳鸣评价量表的信度与效度研究[J]. 中华耳鼻咽喉头颈外科杂志, 2012, 47(9): 716-719. doi:10.3760/cma.j.issn.1673-0860.2012.09.004 .
doi: 10.3760/cma.j.issn.1673-0860.2012.09.004
LIU Peng , XU Guili , LI Ming , et al . Study on reliability and validity of the Tinnitus Evaluation Questionnaire[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2012, 47(9): 716-719. doi:10.3760/cma.j.issn.1673-0860.2012.09.004 .
doi: 10.3760/cma.j.issn.1673-0860.2012.09.004
5 陈知己, 郑芸, 钟萍, 等 . 耳鸣评价量表的临床应用价值研究[J]. 听力学及言语疾病杂志, 2017, 25(3): 242-246. doi:10.3969/j.issn.1006-7299.2017.03.006 .
doi: 10.3969/j.issn.1006-7299.2017.03.006
CHEN Zhiji , ZHENG Yun , ZHONG Ping , et al . The investigation of clinical value of tinnitus evaluation questionnaire[J]. Journal of Audiology and Speech Pathology, 2017, 25(3): 242-246. doi:10.3969/j.issn.1006-7299.2017.03.006 .
doi: 10.3969/j.issn.1006-7299.2017.03.006
6 侯志强 . 静脉源性搏动性耳鸣[J]. 听力学及言语疾病杂志, 2011, 19(6): 573-575. doi:10.3969/j.issn.1006-7299.2011.06.029 .
doi: 10.3969/j.issn.1006-7299.2011.06.029
7 Amans MR , Haraldsson H , Kao E , et al . MR venous flow in sigmoid sinus diverticulum[J]. AJNR Am J Neuroradiol, 2018, 39(11): 2108-2113. doi:10.3174/ajnr.a5833 .
doi: 10.3174/ajnr.a5833
8 Li YD , Chen HJ , He L , et al . Hemodynamic assessments of venous pulsatile tinnitus using 4D-flow MRI[J]. Neurology, 2018, 91(6): e586-e593. doi:10.1212/WNL.0000000000005948 .
doi: 10.1212/WNL.0000000000005948
9 Lansley JA , Tucker W , Eriksen MR , et al . Sigmoid sinus diverticulum, dehiscence, and venous sinus stenosis: potential causes of pulsatile tinnitus in patients with idiopathic intracranial hypertension?[J]. AJNR Am J Neuroradiol, 2017, 38(9): 1783-1788. doi:10.3174/ajnr.A5277 .
doi: 10.3174/ajnr.A5277
10 Wang AC , Nelson AN, Pino C , et al . Management of sigmoid sinus associated pulsatile tinnitus: A systematic review of the literature[J]. And, 2017, 38(10): 1390-1396. doi:10.1097/MAO.0000000000001612 .
doi: 10.1097/MAO.0000000000001612
11 梁熙虹, 王振常, 龚树生, 等 . 乙状窦沟异常致搏动性耳鸣的影像分析[J]. 中华放射学杂志, 2010, 44(4): 361-364.doi:10.3760/cma.j.issn.1005-1201.2010.04. 006 .
doi: 10.3760/cma.j.issn.1005-1201.2010.04.006
LIANG Xihong , WANG Zhenchang , GONG Shusheng , et al . Imaging findings of pulsatile tinnitus caused by sigmoid sinus abnormalities[J]. Chinese Journal of Radiology, 2010, 44(4): 361-364. doi:10.3760/cma.j.issn.1005-1201.2010.04.006 .
doi: 10.3760/cma.j.issn.1005-1201.2010.04.006
12 Eisenman DJ , Raghavan P , Hertzano R , et al . Evaluation and treatment of pulsatile tinnitus associated with sigmoid sinus wall anomalies[J]. Laryngoscope, 2018, 128: S1-S13. doi:10.1002/lary.27218 .
doi: 10.1002/lary.27218
13 Houdart E , Chapot R , Merland JJ . Aneurysm of a dural sigmoid sinus: a novel vascular cause of pulsatile tinnitus[J]. Ann Neurol, 2000, 48(4): 669-671.doi:10.1002/1531-8249(200010)48:4<669::aid-ana16>3.3.co;2-y .
doi: 10.1002/1531-8249(200010)48:4<669::aid-ana16>3.3.co;2-y
14 Sanchez TG , Murao M , de Medeiros IR , et al . A new therapeutic procedure for treatment of objective venous pulsatile tinnitus[J]. Int Tinnitus J, 2002, 8(1): 54-57.
15 Otto KJ , Hudgins PA , Abdelkafy W , et al . Sigmoid sinus diverticulum: a new surgical approach to the correction of pulsatile tinnitus[J]. Otol Neurotol, 2007, 28(1): 48-53. doi:10.1097/01.mao.0000247814.85829.f6 .
doi: 10.1097/01.mao.0000247814.85829.f6
16 Duvillard C , Ballester M , Redon E , et al . Pulsatile tinnitus cured by mastoidectomy[J]. Ann Otol Rhinol Laryngol, 2004, 113(9): 730-733. doi:10.1177/000348940411300910.
doi: 10.1177/000348940411300910.
17 Overton SB , Ritter FN . A high placed jugular bulb in the middle ear: a clinical and temporal bone study[J]. Laryngoscope, 1973, 83(12): 1986-1991. doi:10.1288/00005537-197312000-00008 .
doi: 10.1288/00005537-197312000-00008
18 Wadin K , Wilbrand H . The jugular bulb diverticulum. A radioanatomic investigation[J]. Acta Radiol Diagn (Stockh), 1986, 27(4): 395-401.
19 Madani G , Connor SE . Imaging in pulsatile tinnitus[J]. Clin Radiol, 2009, 64(3): 319-328. doi:10.1016/j.crad. 2008.08.014 .
doi: 10.1016/j.crad. 2008.08.014
20 Zenteno M , Murillo-Bonilla L , Martínez S , et al . Endovascular treatment of a transverse-sigmoid sinus aneurysm presenting as pulsatile tinnitus. Case report[J]. J Neurosurg, 2004, 100(1): 120-122. doi:10.3171/jns. 2004.100.1.0120 .
doi: 10.3171/jns. 2004.100.1.0120
21 Park YH , Kwon HJ . Awake embolization of sigmoid sinus diverticulum causing pulsatile tinnitus: simultaneous confirmative diagnosis and treatment[J]. Interv Neuroradiol, 2011, 17(3): 376-379. doi:10.1177/15910-1991101700316 .
doi: 10.1177/15910-1991101700316
22 Su H , Li BM , Wang J , et al . Headache attributed to cranial venous sinus stenting: A case series and literature review[J]. Cephalalgia, 2019: 333102419847752. doi:10.1177/0333102419847752 .
doi: 10.1177/0333102419847752
23 吴松林, 李茜, 龚元, 等 . 乙状窦憩室致搏动性耳鸣手术治疗的疗效分析[J]. 中国耳鼻咽喉头颈外科, 2015, 22(7): 337-340. doi:10.16066/j.1672-7002.2015.07.004 .
doi: 10.16066/j.1672-7002. 2015.07.004
WU Songlin ， LI Qian , GONG Yuan , et al . Analysis of the surgical effect of the pulsatile tinnitus caused by sigmoid sinus diverticulum[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2015, 22(7): 337-340. doi:10.16066/j.1672-7002. 2015.07.004 .
doi: 10.16066/j.1672-7002. 2015.07.004
24 郭平, 王武庆 . 乙状窦缩窄术治疗乙状窦相关静脉源性搏动性耳鸣的疗效分析[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(4): 265-269. doi:10.3760/cma.j.issn.1673-0860.2013.04.001 .
doi: 10.3760/cma.j.issn. 1673-0860.2013.04.001
GUO Ping , WANG Wuqing . Effect of sigmoid sinus plasty in sigmoid sinus original pulsatile tinnitus[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2013, 48(4): 265-269. doi:10.3760/cma.j.issn. 1673-0860.2013.04.001 .
doi: 10.3760/cma.j.issn. 1673-0860.2013.04.001
25 Zhang C , Li Q , Li SF . Physical and psychological outcomes of simple sigmoid sinus bony wall repair for pulsatile tinnitus due to sigmoid sinus wall anomalies[J]. Eur Arch Otorhinolaryngol, 2019, 276(5): 1327-1334. doi:10.1007/s00405-019-05380-1 .
doi: 10.1007/s00405-019-05380-1
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