1
|
Cavarocchi C, Wong K, Cao AC, Hwa TP, Quimby AE, Eliades SJ, Ruckenstein MJ, Bigelow DC, Choudhri OA, Brant JA. Toward a Diagnostic Imaging Algorithm for Undifferentiated Pulsatile Tinnitus. Otol Neurotol 2024; 45:895-900. [PMID: 39052898 DOI: 10.1097/mao.0000000000004254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Decisions around the diagnostic evaluation for pulsatile tinnitus (PT) remain challenging. We describe the usage patterns and diagnostic accuracy of imaging modalities and propose an evidence-based diagnostic approach for undifferentiated PT. STUDY DESIGN Retrospective. SETTING Single otology/neurotology clinic. SUBJECTS Patients with PT presenting between 2009 and 2020. MAIN OUTCOME MEASURES Sensitivity, specificity, diagnostic yield, and diagnostic accuracy. RESULTS A total of 315 subjects met inclusion criteria (74% female, mean ± SD age = 52 ± 17 years). Subjects were divided into four cohorts based on exam findings: normal (n = 229), venous cohort (n = 34), arterial cohort (n = 16), and outer/middle ear pathology cohort (n = 40). In total, 53% of patients received a nonidiopathic diagnosis for PT. The most common identifiable cause was sigmoid sinus dehiscence (78%) in the venous cohort, carotid stenosis (36%) in the arterial cohort, and glomus tumor (56%) in the outer/middle ear pathology cohort. There was a higher diagnostic rate among patients with positive exam findings compared to those with unrevealing exams ( p = 0.04). Imaging studies with the highest diagnostic yield were computed tomography (CT) venography (44%), formal angiography (42%), and magnetic resonance venography (40%); studies with the highest specificity were formal angiography (0.82), CT angiography (0.67), and CT venography (0.67). A diagnostic algorithm is proposed. CONCLUSIONS Reaching a diagnosis in patients with PT requires a systematic approach, taking into account both clinical and radiographic information. Physical examination is a key first step for differentiating patients into venous, arterial, and other cohorts to narrow down the likely pathology and determine which radiographic studies have the highest yield and accuracy.
Collapse
Affiliation(s)
- Caitlin Cavarocchi
- Department of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Kevin Wong
- Department of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Austin C Cao
- Department of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Tiffany P Hwa
- Department of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Alexandra E Quimby
- Department of Otolaryngology, State University of New York Upstate, Syracuse, NY
| | - Steven J Eliades
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Michael J Ruckenstein
- Department of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Douglas C Bigelow
- Department of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Omar A Choudhri
- Department of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | |
Collapse
|
2
|
Wang H, Stern JI, Robertson CE, Chiang CC. Pulsatile Tinnitus: Differential Diagnosis and Approach to Management. Curr Pain Headache Rep 2024; 28:815-824. [PMID: 38842617 DOI: 10.1007/s11916-024-01263-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an updated approach to the evaluation and management of pulsatile tinnitus (PT), an uncommon but often treatable subtype of tinnitus. RECENT FINDINGS Secondary PT can be due to either vascular or non-vascular etiologies, including, but not limited to: neoplasm, arteriovenous malformation or fistula, idiopathic intracranial hypertension, dural venous sinus stenosis, otoacoustic etiologies (e.g., otosclerosis, patulous eustachian tube) and bony defects (e.g., superior semicircular canal dehiscence). Computed tomography (CT) and magnetic resonance imaging (MRI) imaging have comparable diagnostic yield, though each may be more sensitive to specific etiologies. If initial vascular imaging is negative and a vascular etiology is strongly suspected, digital subtraction angiography (DSA) may further aid in the diagnosis. Many vascular etiologies of PT can be managed endovascularly, often leading to PT improvement or resolution. Notably, venous sinus stenting is an emerging therapy for PT secondary to idiopathic intracranial hypertension with venous sinus stenosis. Careful history and physical exam can help establish the differential diagnosis for PT and guide subsequent evaluation and management. Additional studies on the efficacy and long-term outcome of venous sinus stenting for venous stenosis are warranted.
Collapse
Affiliation(s)
- Han Wang
- Department of Neurology, Mayo Clinic Health System, Mankato, MN, USA.
| | | | | | | |
Collapse
|
3
|
Cummins DD, Caton MT, Hemphill K, Lamboy A, Tu-Chan A, Meisel K, Narsinh KH, Amans MR. Clinical evaluation of pulsatile tinnitus: history and physical examination techniques to predict vascular etiology. J Neurointerv Surg 2024; 16:516-521. [PMID: 37311640 PMCID: PMC10716354 DOI: 10.1136/jnis-2023-020440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Pulsatile tinnitus (PT) may be due to a spectrum of cerebrovascular etiologies, ranging from benign venous turbulence to life threatening dural arteriovenous fistulas. A focused clinical history and physical examination provide clues to the ultimate diagnosis; however, the predictive accuracy of these features in determining PT etiology remains uncertain. METHODS Patients with clinical PT evaluation and DSA were included. The final etiology of PT after DSA was categorized as shunting, venous, arterial, or non-vascular. Clinical variables were compared between etiologies using multivariate logistic regression, and performance at predicting PT etiology was determined by area under the receiver operating curve (AUROC). RESULTS 164 patients were included. On multivariate analysis, patient reported high pitch PT (relative risk (RR) 33.81; 95% CI 3.81 to 882.80) compared with exclusively low pitch PT and presence of a bruit on physical examination (9.95; 2.04 to 62.08; P=0.007) were associated with shunting PT. Hearing loss was associated with a lower risk of shunting PT (0.16; 0.03 to 0.79; P=0.029). Alleviation of PT with ipsilateral lateral neck pressure was associated with a higher risk of venous PT (5.24; 1.62 to 21.01; P=0.010). An AUROC of 0.882 was achieved for predicting the presence or absence of a shunt and 0.751 for venous PT. CONCLUSION In patients with PT, clinical history and physical examination can achieve high performance at detecting a shunting lesion. Potentially treatable venous etiologies may also be suggested by relief with neck compression.
Collapse
Affiliation(s)
- Daniel D Cummins
- Departments of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - M Travis Caton
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Kafi Hemphill
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Allison Lamboy
- Departments of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Adelyn Tu-Chan
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Karl Meisel
- McClaren Northern Michigan, Petoskey, Michigan, USA
| | - Kazim H Narsinh
- Department of Radiology and Biomedical Imaging, Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Matthew R Amans
- Department of Radiology and Biomedical Imaging, Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
4
|
Jain V, Markovic M, Agarwal M. Imaging of Pulsatile Tinnitus. Semin Roentgenol 2024; 59:203-214. [PMID: 38880518 DOI: 10.1053/j.ro.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Vikas Jain
- MetroHealth Medical Center, Affiliated with Case Western Reserve University, Cleveland, OH
| | - Michael Markovic
- MetroHealth Medical Center, Affiliated with Case Western Reserve University, Cleveland, OH
| | - Mohit Agarwal
- Department of Radiology, Section of Neuroradiology, Froedtert and Medical College of Wisconsin, Milwaukee, WI.
| |
Collapse
|
5
|
Trennheuser S, Reith W, Kühn JP, Morris LGT, Bozzato A, Naumann A, Schick B, Yilmaz U, Linxweiler M. Transorbital embolization of cavernous sinus dural arterio-venous malformations with surgical exposure and catheterization of the superior ophthalmic vein. Interv Neuroradiol 2023; 29:715-724. [PMID: 35758285 PMCID: PMC10680959 DOI: 10.1177/15910199221110967] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/11/2022] [Accepted: 06/14/2022] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Cavernous sinus dural arterio-venous malformations (dAVF) represent a pathologic connection between branches of the internal and/or external carotid artery and the cavernous sinus. Standard endovascular approaches for dAVF treatment are transvenous embolization through the inferior petrosal sinus or the facial vein and transarterial embolization. These approaches are not always successful or feasible, and alternative techniques are required. Here, we present a case series of a minimally invasive transorbital approach with surgical exposure and catheterization of the superior ophthalmic vein for transvenous fistula coiling. METHODS 14 patients with dAVFs (Barrow Type B to D) that were treated at a tertiary care medical center over a period of 13 years were included in the study. Patients with persisting dAVF associated symptoms were selected for this approach when conventional endovascular interventions were not successful or not feasible. The surgical procedure was performed under general anaesthesia. RESULTS A successful transorbital approach was performed in all 14 cases. In 12 of 14 patients a catheter assisted successful embolization of the fistula was performed using platinum coils with no relevant residual fistula flow. In two cases, a spontaneous thrombosis of the fistula during the surgical procedure required no further embolization. No postoperative therapy-associated complications were observed. CONCLUSION The described approach is an effective method to embolize dAVFs in selected cases when catheter assisted transvenous and/or transarterial embolization is not successful or not feasible. In this case series we demonstrate an excellent success rate with no therapy-associated major complications.
Collapse
Affiliation(s)
- Sophie Trennheuser
- Department of Otorhinolaryngology, Head and Neck Surgery; Saarland University Medical Center, Homburg/Saar, Germany
| | - Wolfgang Reith
- Department of Diagnostic and Interventional Neuroradiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Jan Philipp Kühn
- Department of Otorhinolaryngology, Head and Neck Surgery; Saarland University Medical Center, Homburg/Saar, Germany
| | - Luc G T Morris
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Alessandro Bozzato
- Department of Otorhinolaryngology, Head and Neck Surgery; Saarland University Medical Center, Homburg/Saar, Germany
| | - Andreas Naumann
- Department of Otorhinolaryngology, plastic surgery and special pain therapy, Bremen Mitte Hospital, Bremen, Germany
| | - Bernhard Schick
- Department of Otorhinolaryngology, Head and Neck Surgery; Saarland University Medical Center, Homburg/Saar, Germany
| | - Umut Yilmaz
- Department of Diagnostic and Interventional Neuroradiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Maximilian Linxweiler
- Department of Otorhinolaryngology, Head and Neck Surgery; Saarland University Medical Center, Homburg/Saar, Germany
| |
Collapse
|
6
|
Curry SD, Kocharyan A, Lekovic GP. Multi-Disciplinary Approach to Skull Base Paragangliomas. Brain Sci 2023; 13:1533. [PMID: 38002493 PMCID: PMC10669609 DOI: 10.3390/brainsci13111533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023] Open
Abstract
The treatment of skull base paragangliomas has moved towards the use of cranial nerve preservation strategies, using radiation therapy and subtotal resection in instances when aiming for gross total resection would be expected to cause increased morbidity compared to the natural history of the tumor itself. The goal of this study was to analyze the role of surgery in patients with skull base paragangliomas treated with CyberKnife stereotactic radiosurgery (SRS) for definitive tumor control. A retrospective review identified 22 patients (median age 65.5 years, 50% female) treated with SRS from 2010-2022. Fourteen patients (63.6%) underwent microsurgical resection. Gross total resection was performed in four patients for tympanic paraganglioma (n = 2), contralateral paraganglioma (n = 1), and intracranial tumor with multiple cranial neuropathies (n = 1). Partial/subtotal resection was performed for the treatment of pulsatile tinnitus and conductive hearing loss (n = 6), chronic otitis and otorrhea (n = 2), intracranial extension (n = 1), or episodic vertigo due to perilymphatic fistula (n = 1). Eighteen patients had clinical and imaging follow-up for a mean (SD) of 4.5 (3.4) years after SRS, with all patients having clinical and radiological tumor control and no mortalities. Surgery remains an important component in the multidisciplinary treatment of skull base paraganglioma when considering other outcomes besides local tumor control.
Collapse
Affiliation(s)
- Steven D. Curry
- House Clinic, Los Angeles, CA 90017, USA
- Department of Head and Neck Surgery, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA
| | - Armine Kocharyan
- House Clinic, Los Angeles, CA 90017, USA
- Department of Head and Neck Surgery, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA
| | - Gregory P. Lekovic
- House Clinic, Los Angeles, CA 90017, USA
- Department of Neurosurgery, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA
| |
Collapse
|
7
|
Cao AC, Hwa TP, Cavarocchi C, Quimby A, Eliades SJ, Ruckenstein MJ, Bigelow DC, Choudhri OA, Brant JA. Diagnostic Yield and Utility of Radiographic Imaging in the Evaluation of Pulsatile Tinnitus: A Systematic Review. OTOLOGY & NEUROTOLOGY OPEN 2023; 3:e030. [PMID: 38516122 PMCID: PMC10950154 DOI: 10.1097/ono.0000000000000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/06/2023] [Indexed: 03/23/2024]
Abstract
Objective The objective of this study is to assess diagnostic yield of imaging modalities used to evaluate patients presenting with pulsatile tinnitus (PT). Databases Reviewed PubMed, Embase, and Scopus were queried using the search terms "pulsatile tinnitus," "pulse-synchronous tinnitus," and "pulse synchronous tinnitus" with no date limitations. Methods Studies that reported diagnostic imaging for patients presenting with PT were included. Data were reviewed for sample size, gender, age, imaging study, indications, and diagnoses. The primary outcome measure from aggregated data was the yield of positive diagnoses made with each imaging modality. The quality of evidence was assessed for risk of bias. Results From an initial search of 1145 articles, 17 manuscripts met inclusion criteria, of which 12 studies evaluated individual imaging modalities. The number of unique patients included was 1232. The diagnostic yield varied between modalities: carotid ultrasound (21%, 95% confidence interval [CI]: 12%-35%), CT temporal bone (65%, CI: 20%-93%), computed tomographic angiography (86%, CI: 80%-90%), and MRI/magnetic resonance angiography (58%, CI: 43%-72%). Conclusion Studies on the diagnostic approach to PT are limited by heterogeneity in both inclusion criteria and reporting standards. A wide range of imaging modalities are used in practice during the initial evaluation of PT, and the diagnostic yield for imaging can be improved by utilizing more specific clinical indications.
Collapse
Affiliation(s)
- Austin C Cao
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Tiffany P Hwa
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Caitlin Cavarocchi
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Alexandra Quimby
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Steven J Eliades
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Michael J Ruckenstein
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Douglas C Bigelow
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Omar A Choudhri
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jason A Brant
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
8
|
Nurimanov C, Mammadinova I, Makhambetov Y, Akshulakov S. An Uncommon Case of Moyamoya Syndrome Is Accompanied by an Arteriovenous Malformation with the Involvement of Dural Arteries. Int J Mol Sci 2023; 24:ijms24065911. [PMID: 36982983 PMCID: PMC10056675 DOI: 10.3390/ijms24065911] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: This report describes the surgical management of a case of concurrent AVM with the involvement of dural arteries and moyamoya syndrome. Given the infrequency of this combination, there is currently no established management strategy available. (2) Case Description: A 49-year-old male patient with multiple symptoms including headaches, tinnitus, and visual impairment diagnosed with the coexistence of an arteriovenous malformation with the involvement of dural arteries and moyamoya syndrome was admitted to the national tertiary hospital. The patient underwent surgical management through embolization of the AVM from the afferents of the dural arteries, which has resulted in positive clinical outcomes. However, this approach may not be suitable for all cases, and a multidisciplinary team approach may be required to develop an individualized treatment strategy. (3) Conclusion: The contradictory nature of the treatment approaches in cases of combined AVM with the involvement of dural arteries and MMD highlights the complex nature of this condition and the need for further research to identify the most effective treatment strategies.
Collapse
Affiliation(s)
- Chingiz Nurimanov
- Vascular and Functional Neurosurgery Department, National Center for Neurosurgery, Astana 010000, Kazakhstan
| | - Iroda Mammadinova
- Vascular and Functional Neurosurgery Department, National Center for Neurosurgery, Astana 010000, Kazakhstan
| | - Yerbol Makhambetov
- Vascular and Functional Neurosurgery Department, National Center for Neurosurgery, Astana 010000, Kazakhstan
| | - Serik Akshulakov
- Vascular and Functional Neurosurgery Department, National Center for Neurosurgery, Astana 010000, Kazakhstan
| |
Collapse
|
9
|
CT evaluation of unilateral pulsatile tinnitus with jugular bulb wall dehiscence. Eur Radiol 2023; 33:4464-4471. [PMID: 36648550 DOI: 10.1007/s00330-022-09352-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 10/12/2022] [Accepted: 11/29/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To investigate the imaging features of unilateral pulsatile tinnitus (PT) with jugular bulb wall dehiscence (JBWD). METHODS Computerized tomography angiography images of unilateral PT patients were reviewed between 2019 and 2021. Thirty-one symptomatic JBWD patients without sigmoid sinus wall dehiscence (SSWD) were included. Thirty-eight patients with SSWD were used as the control group. The prevalence of JBWD was calculated. The area and height of the jugular bulb, the extent of dehiscence, the presence of jugular bulb diverticulum, posterior condylar emissary vein (PCEV), oblique occipital sinus (OOS), venous outflow laterality (VOL), the degree of transverse sinus stenosis (TSS), and the pituitary height to sella turcica ratio were compared between the two groups. RESULTS The prevalence of JBWD was 12.1%, and JBWD was established as a causative diagnosis in 5.0% of unilateral PT patients. There were no statistical differences in the gender, symptomatic side, or VOL between the two groups. The area of the jugular bulb was larger and the height was higher (parea < 0.001, pheight = 0.005). The prevalence of jugular bulb diverticulum was higher in the JBWD group (p = 0.002). The degree of symptomatic TSS was less severe (p < 0.001), and the prevalence of bilateral TSS was lower in the JBWD group (p < 0.001). The pituitary height to sella turcica ratio was greater (p = 0.004), the prevalence of PCEV (p = 0.014) was lower, and OOS (p = 0.015) was greater in the JBWD group. CONCLUSIONS The correlating factors of PT with JBWD and PT with SSWD are significantly different. These findings can further facilitate early and efficient PT treatment. KEY POINTS • The incidence of jugular bulb dehiscence (JBWD) accounted for approximately 12.1% in pulsatile tinnitus (PT) patients, and JBWD was established as a causative diagnosis in 5.0% of PT patients. • PT required large blood flows and abnormal flow patterns, whether in JBWD or sigmoid sinus wall dehiscence groups. • JBWD causing PT has some unique characteristic findings on CT.
Collapse
|
10
|
An Integrated Approach on the Diagnosis of Cerebral Veins and Dural Sinuses Thrombosis. Life (Basel) 2022; 12:life12050717. [PMID: 35629384 PMCID: PMC9145675 DOI: 10.3390/life12050717] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 01/05/2023] Open
Abstract
(1) Objective: This review paper aims to discuss multiple aspects of cerebral venous thrombosis (CVT), including epidemiology, etiology, pathophysiology, and clinical presentation. Different neuroimaging methods for diagnosis of CVT, such as computer tomography CT/CT Venography (CTV), and Magnetic Resonance Imaging (MRI)/MR Venography (MRV) will be presented. (2) Methods: A literature analysis using PubMed and the MEDLINE sub-engine was done using the terms: cerebral venous thrombosis, thrombophilia, and imaging. Different studies concerning risk factors, clinical picture, and imaging signs of patients with CVT were examined. (3) Results: At least one risk factor can be identified in 85% of CVT cases. Searching for a thrombophilic state should be realized for patients with CVT who present a high pretest probability of severe thrombophilia. Two pathophysiological mechanisms contribute to their highly variable clinical presentation: augmentation of venular and capillary pressure, and diminution of cerebrospinal fluid absorption. The clinical spectrum of CVT is frequently non-specific and presents a high level of clinical suspicion. Four major syndromes have been described: isolated intracranial hypertension, seizures, focal neurological abnormalities, and encephalopathy. Cavernous sinus thrombosis is the single CVT that presents a characteristic clinical syndrome. Non-enhanced CT (NECT) of the Head is the most frequently performed imaging study in the emergency department. Features of CVT on NECT can be divided into direct signs (demonstration of dense venous clot within a cerebral vein or a cerebral venous sinus), and more frequently indirect signs (such as cerebral edema, or cerebral venous infarct). CVT diagnosis is confirmed with CTV, directly detecting the venous clot as a filling defect, or MRI/MRV, which also realizes a better description of parenchymal abnormalities. (4) Conclusions: CVT is a relatively rare disorder in the general population and is frequently misdiagnosed upon initial examination. The knowledge of wide clinical aspects and imaging signs will be essential in providing a timely diagnosis.
Collapse
|
11
|
Pingree GM, Fleming C, Reavey-Cantwell J, Coelho DH. Neurosurgical Causes of Pulsatile Tinnitus: Contemporary Update. Neurosurgery 2022; 90:161-169. [PMID: 34995248 DOI: 10.1227/neu.0000000000001778] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/31/2021] [Indexed: 12/15/2022] Open
Abstract
Traditionally in the domain of the otolaryngologist, pulsatile tinnitus (PT) has become increasingly relevant to neurosurgeons. PT may prove to be a harbinger of life-threatening pathology; however, often, it is a marker of a more benign process. Irrespectively, the neurosurgeon should be familiar with the many potential etiologies of this unique and challenging patient population. In this review, we discuss the myriad causes of PT, categorized by pulse-phase rhythmicity.
Collapse
Affiliation(s)
- Graham M Pingree
- Department of Otolaryngology - Head & Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Charles Fleming
- Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - John Reavey-Cantwell
- Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Daniel H Coelho
- Department of Otolaryngology - Head & Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| |
Collapse
|
12
|
Lynch P, Mitton T, Killeen DE, Kutz JW, Newcomer M. Diagnosing Pulsatile Tinnitus: A Review of 251 Patients. Otol Neurotol 2022; 43:128-136. [PMID: 34629443 DOI: 10.1097/mao.0000000000003370] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the underlying etiologies, presenting characteristics, and diagnostic workup of patients with pulsatile tinnitus (PT). STUDY DESIGN Retrospective review. SETTING Tertiary referral center. PATIENTS All patients who received a diagnostic workup for PT from January 01, 2015 and May 31, 2020. MAIN OUTCOME MEASURE Diagnostic rate of imaging studies. RESULTS Among 251 patients with PT, the most common etiologies included neoplasms (16%), arteriopathies (14%), venopathies (8.5%), middle/inner ear pathology (9.0%), or idiopathic (50%). Patients with identifiable etiologies of PT more often had hypertension, obesity, vision changes, ipsilateral asymmetric hearing loss, or an abnormal otologic examination. Only 18.5% of patients without those characteristics had an identifiable etiology of PT. The most commonly ordered diagnostic studies were magnetic resonance imaging with contrast (n = 146), MR angiography (MRA) (n = 105), CT angiography (CTA) (n = 84), computed tomography (CT) without contrast (n = 76), and MR Venogram (MRV) (n = 62). Magnetic resonance imaging with contrast and CT without contrast preferentially identified patients with nonvascular etiologies of PT, while MRA and CTA identified patients with vascular etiologies of PT. MRV did not demonstrate high diagnostic rate for either type of PT. No difference in diagnostic rate was found between MR-based or CT-based imaging. CONCLUSIONS Patients who lack a history of hypertension, obesity, vision changes, ipsilateral asymmetric hearing loss, or an abnormal otologic examination are less likely to have an identifiable cause for PT. In cases where a specific etiology was identified, MR-based imaging (MRI with contrast and MRA) or CT-based imaging (CT without contrast and CTA) were equally efficacious in identifying that etiology. MR-based imaging is preferred for neoplasms, while CT-based imaging is preferred for semicircular canal dehiscence.
Collapse
Affiliation(s)
- Patrick Lynch
- Department of Otolaryngology, UT Southwestern Medical Center, Dallas, Texas
| | | | | | | | | |
Collapse
|
13
|
Ferro JM, de Sousa DA, Canhão P. Cerebral Venous Thrombosis. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00045-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
14
|
Lekovic GP, Barnard ZR, Master A, Mehta GU, Maya MM, Wilkinson EP. Role of cerebral digital subtraction angiography in the evaluation of pulse synchronous tinnitus. J Otol 2021; 16:225-230. [PMID: 34548868 PMCID: PMC8438631 DOI: 10.1016/j.joto.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives The aim of this study was to evaluate the value of digital subtraction angiography (DSA) in the diagnostic evaluation of a highly selected patient population presenting with pulse-synchronous tinnitus (PST). Methods We retrospectively reviewed the charts of all patients referred for evaluation of possible vascular etiology of pulsatile tinnitus. Patients were evaluated with regards to presenting signs, comorbidities, non-invasive imaging results, angiographic findings and outcomes. Results Fifteen patients underwent cerebral DSA. Dural arteriovenous fistula (dAVF) was identified in six patients, and five patients had other significant vascular pathology identified on DSA. Seven patients with ‘negative’ non-invasive imaging were found to have significant pathology on DSA. Conclusions Catheter angiography may have a significant yield in appropriately selected patients presenting with pulse synchronous tinnitus.
Collapse
Affiliation(s)
- Gregory P Lekovic
- Division of Neurosurgery, House Institute, 2100 West 3rd Street, Los Angeles, CA, 90057, United States
| | - Zachary R Barnard
- Department of Neurosurgery, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, Los Angeles, CA, 90048, United States.,Division of Neurosurgery, House Institute, 2100 West 3rd Street, Los Angeles, CA, 90057, United States
| | - Adam Master
- Division of Neurosurgery, House Institute, 2100 West 3rd Street, Los Angeles, CA, 90057, United States
| | - Gautam U Mehta
- Division of Neurosurgery, House Institute, 2100 West 3rd Street, Los Angeles, CA, 90057, United States
| | - M Marcel Maya
- Department of Imaging, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, Los Angeles, CA, 90048, United States
| | - Eric P Wilkinson
- Division of Neurotology, House Institute, 2100 West 3rd Street, Los Angeles, CA, 90057, United States
| |
Collapse
|
15
|
Dicks AB, Gornik HL, Gu X, Bacharach JM, Fendrikova Mahlay N, Froehlich JB, Gupta K, Gray BH, Kim ESH, Mahmood R, Sharma AM, Wells BJ, Olin JW, Weinberg I. Association of Fibromuscular Dysplasia and Pulsatile Tinnitus: A Report of the US Registry for Fibromuscular Dysplasia. J Am Heart Assoc 2021; 10:e021962. [PMID: 34459232 PMCID: PMC8649251 DOI: 10.1161/jaha.121.021962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Fibromuscular dysplasia (FMD) is a nonatherosclerotic arterial disease that has a variable presentation including pulsatile tinnitus (PT). The frequency and characteristics of PT in FMD are not well understood. The objective of this study was to evaluate the frequency of PT in FMD and compare characteristics between patients with and without PT. Methods and Results Data were queried from the US Registry for FMD from 2009 to 2020. The primary outcomes were frequency of PT among the FMD population and prevalence of baseline characteristics, signs/symptoms, and vascular bed involvement in patients with and without PT. Of 2613 patients with FMD who were included in the analysis, 972 (37.2%) reported PT. Univariable analysis and multivariable logistic regression were performed to explore factors associated with PT. Compared with those without PT, patients with PT were more likely to have involvement of the extracranial carotid artery (90.0% versus 78.6%; odds ratio, 1.49; P=0.005) and to have higher prevalence of other neurovascular signs/symptoms including headache (82.5% versus 62.7%; odds ratio, 1.82; P<0.001), dizziness (44.9% versus 22.9%; odds ratio, 2.01; P<0.001), and cervical bruit (37.5% versus 15.8%; odds ratio, 2.73; P<0.001) compared with those without PT. Conclusions PT is common among patients with FMD. Patients with FMD who present with PT have higher rates of neurovascular signs/symptoms, cervical bruit, and involvement of the extracranial carotid arteries. The coexistence of the 2 conditions should be recognized, and providers who evaluate patients with PT should be aware of FMD as a potential cause.
Collapse
Affiliation(s)
- Andrew B Dicks
- Fireman Vascular Center Massachusetts General Hospital Boston MA
| | - Heather L Gornik
- Harrington Heart and Vascular InstituteUniversity Hospitals Cleveland OH
| | - Xiaokui Gu
- Division of Cardiovascular Medicine Department of Medicine University of Michigan Health System Ann Arbor MI
| | | | - Natalia Fendrikova Mahlay
- Department of Cardiovascular Medicine Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH
| | - James B Froehlich
- Harrington Heart and Vascular InstituteUniversity Hospitals Cleveland OH
| | - Kamal Gupta
- University of Kansas School of Medicine Kansas City KS
| | - Bruce H Gray
- Department of Surgery Prisma Health SystemUniversity of South Carolina School of Medicine Greenville SC
| | - Esther S H Kim
- Division of Cardiovascular Medicine Department of Medicine Vanderbilt University Medical Center Nashville TN
| | | | - Aditya M Sharma
- Division of Cardiovascular Medicine University of Virginia Charlottesville VA
| | | | - Jeffrey W Olin
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Joseé and Henry R. Kravis Center for Cardiovascular Health Icahn School of Medicine at Mount Sinai New York NY
| | - Ido Weinberg
- Fireman Vascular Center Massachusetts General Hospital Boston MA
| |
Collapse
|
16
|
Hübner L, Struffert T, Mardin CY, Engelhorn T, Holbach L, Weller J, Hohberger B, Gusek-Schneider G. [Clinical and sonographic examination findings in patients with carotid-cavernous sinus fistulas]. Ophthalmologe 2021; 118:919-925. [PMID: 33459810 PMCID: PMC8413193 DOI: 10.1007/s00347-020-01310-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/07/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Symptoms and clinical findings in patients with carotid-cavernous fistulas are specific. Nevertheless, they can be very mildly expressed. This study aims to point out the potential diagnostic value of ultrasound of the orbit. METHODS A total of 25 patients with a reliable angiographic diagnosis of a fistula were reviewed retrospectively. We analyzed the symptoms, clinical findings and demonstrability in ultrasound of the orbit. RESULTS The most common clinical findings were nerve palsy, dilation of episcleral vessels and exophthalmos. If an ultrasound had been part of the examination a dilation of the superior ophthalmic vein could be demonstrated in all cases. CONCLUSION The expeditious ultrasound investigation provides valuable information for the diagnosis of red eyes which are resistant to treatment. The examiner has to consider a fistula and perform an ultrasound especially when diplopia has newly occurred. Finally, the expedient neuroimaging can be arranged.
Collapse
Affiliation(s)
- L Hübner
- Universitätsaugenklinik Erlangen, FAU Erlangen-Nürnberg, Erlangen, Deutschland.
| | - T Struffert
- Abteilung für Neuroradiologie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - C Y Mardin
- Universitätsaugenklinik Erlangen, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - T Engelhorn
- Abteilung Neuroradiologie, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - L Holbach
- Universitätsaugenklinik Erlangen, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - J Weller
- Universitätsaugenklinik Erlangen, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - B Hohberger
- Universitätsaugenklinik Erlangen, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - G Gusek-Schneider
- Universitätsaugenklinik Erlangen, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| |
Collapse
|
17
|
Agilinko J, Drever SK, Wai Low WK, Shakeel M, Hussain A. Acellular dermis (SureDerm ®) use for managing pulsatile tinnitus: a long-term follow-up of a novel surgical technique. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2021; 10:Doc06. [PMID: 34194917 PMCID: PMC8204668 DOI: 10.3205/iprs000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Pulsatile tinnitus (PT) can be very distressing for the patient. An identifiable abnormality is rarely detected. Dural AV malformation is responsible for arterial PT. Venous PT has rarely been attributed to an obvious abnormality on venogram. Dehiscent high jugular bulb or sigmoid sinus have been thought to be potential cause for venous PT. Ligation of internal jugular vein (IJV) has been advocated as a definitive surgical treatment. To our knowledge the use of acellular dermal matrix for treatment of venous PT has not been reported previously. Objectives: To share our experience of a successful treatment of PT using acellular dermis. Methodology: Case report and literature review. Case description: A 23-year-old Caucasian female presented with right-sided PT of 9 months duration. All clinical and audiological investigations were normal. MRI brain and internal auditory canals was normal but the CT scan showed a high right jugular bulb. It also showed dehiscence of the right sigmoid plate with herniation of sigmoid sinus into the mastoid. She underwent transmastoid correction of dehiscent sigmoid sinus and jugular bulb. Acellular dermis was used for extra luminal packing of mastoid cavity and hypotympanum. The patient made a good post-operative recovery and reported resolution of tinnitus on recovering from anaesthesia. The patient was discharged home the following day. There were no sequelae from surgery. The patient has remained symptom-free 11 years following her treatment. Conclusion: The surgical goal of dehiscent sigmoid sinus correction can be accomplished with acellular dermis packing. Traditionally ligation of the IJV or rigid correction of herniated sinus has been recommended; however, we have demonstrated that a relatively thick pliable acellular dermis is more than adequate to correct herniation of the sigmoid venous sinus.
Collapse
Affiliation(s)
- Joshua Agilinko
- Department of Otolaryngology, Head and Neck Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Sara Katharine Drever
- Department of Otolaryngology, Head and Neck Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Winston Kin Wai Low
- Department of Otolaryngology, Head and Neck Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Muhammad Shakeel
- Department of Otolaryngology, Head and Neck Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Akhtar Hussain
- Department of Otolaryngology, Head and Neck Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| |
Collapse
|
18
|
Abdalkader M, Nguyen TN, Norbash AM, Raz E, Shapiro M, Lenck S, Brinjikji W, Weber P, Sakai O. State of the Art: Venous Causes of Pulsatile Tinnitus and Diagnostic Considerations Guiding Endovascular Therapy. Radiology 2021; 300:2-16. [PMID: 34032509 DOI: 10.1148/radiol.2021202584] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Venous variants and pathologic abnormalities are the most common causes of pulsatile tinnitus. These conditions include causes of turbulence within normally located veins and sinuses, and abnormally enlarged or abnormally located veins in close transmissive proximity to the conductive auditory pathway. Such disorders include pathologic abnormalities of the lateral sinus (transverse sinus stenosis and sigmoid sinus wall anomalies), abnormalities and variants of the emissary veins, and anomalies of the jugular bulb and jugular vein. Despite being the most common causes for pulsatile tinnitus, venous variants and pathologic abnormalities are often overlooked in the workup of pulsatile tinnitus. Such oversights can result in delayed patient care and prolonged patient discomfort. Advances in both cerebrovascular imaging and endovascular techniques allow for improved diagnostic accuracy and an increasing range of endovascular therapeutic options to address pulsatile tinnitus. This review illustrates the venous causes of pulsatile tinnitus and demonstrates the associated endovascular treatment. © RSNA, 2021.
Collapse
Affiliation(s)
- Mohamad Abdalkader
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Thanh N Nguyen
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Alexander M Norbash
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Eytan Raz
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Maksim Shapiro
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Stéphanie Lenck
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Waleed Brinjikji
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Peter Weber
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Osamu Sakai
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| |
Collapse
|
19
|
Kumar R, Rice S, Lingam RK. Detecting causes of pulsatile tinnitus on CT arteriography-venography: A pictorial review. Eur J Radiol 2021; 139:109722. [PMID: 33894642 DOI: 10.1016/j.ejrad.2021.109722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 12/19/2022]
Abstract
Pulsatile tinnitus (PT) can be a mild or debilitating symptom. Following clinical examination and otoscopy, when the underlying aetiology is not apparent, radiological imaging can be used to evaluate further. CT arteriography-venography (CT A-V) of the head and neck has recently been introduced as a single 'one catch' modality for identifying the many causes of PT including those which are treatable and potentially serious whilst also providing reassurance through negative studies or studies with benign findings. CT A-V is performed as a single phase study allowing both arterial and venous assessment, hence limiting radiation exposure. Additional multiplanar reformats and bone reconstructions are desirable. Understanding the limitations of CT A-V is also required, with an awareness of the scenarios where other imaging modalities should be considered. The causes of PT can be divided into systemic and non-systemic categories. Non-systemic aetiologies in the head and neck should be carefully reviewed on CT A-V and include a variety of vascular causes (arteriovenous malformations/fistulas, venous or arterial aetiologies) and non-vascular causes (tumours and bony dysplasias). Venous causes (dominant, aberrant, stenosed or thrombosed venous vessels) are more common than arterial aetiologies (aberrant or stenosed internal carotid artery, aneurysms or a persistent stapedial artery). Glomus tumours that are not visible on otoscopy and osseous pathologies such as bony dehiscence and otospongiosis should also be excluded. Careful assessment of all the potential vascular and non-vascular causes should be reviewed in a systematic approach, with correlation made with the clinical history. A structured reporting template for the reporting radiologist is provided in this review to ensure all the potential causes of PT are considered on a CT A-V study. This will help in providing a comprehensive radiological evaluation, hence justifying the radiation dose and for patient assessment and prognostication.
Collapse
Affiliation(s)
- Raekha Kumar
- Northwick Park, London North West University Healthcare NHS Trust, Watford Road, Harrow, HA13UJ, United Kingdom; Watford General Hospital, West Hertfordshire Hospitals NHS Trust, Vicarage Road, Watford, Hertfordshire, WD180HB, United Kingdom.
| | - Scott Rice
- Northwick Park, London North West University Healthcare NHS Trust, Watford Road, Harrow, HA13UJ, United Kingdom.
| | - Ravi Kumar Lingam
- Northwick Park, London North West University Healthcare NHS Trust, Watford Road, Harrow, HA13UJ, United Kingdom.
| |
Collapse
|
20
|
Fiani B, Kondilis A, Doan T, Runnels J, Fiani NJ, Sarno E. Venous sinus stenting for intractable pulsatile tinnitus: A review of indications and outcomes. Surg Neurol Int 2021; 12:81. [PMID: 33767885 PMCID: PMC7982104 DOI: 10.25259/sni_1_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/09/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Pulsatile tinnitus presents as a unique variation of tinnitus in which a conscious perception of the heartbeat is localized to the ears in either unilateral or bilateral fashion. The sensation is typically caused by an increase in turbulent blood flow in the affected ear, in most cases, due to a structural abnormality of the venous sinuses – the most common of which being stenosis. Herein, we discuss the etiology of pulsatile tinnitus followed by indications for treatment of various pathologies which have been successfully treated with venous sinus stenting and have led to resolution of auditory symptoms. Methods: The authors queried PubMed database using combinations of the keywords “venous sinus stenting,” “endovascular treatment,” and “pulsatile tinnitus” to identify relevant studies published in English after 2001 and before December 1, 2020 and verified selected. Results: Our results corroborate those published in prior reviews reporting a high rate of pulsatile tinnitus resolution with venous sinus stenting. Conclusion: The success of venous sinus stenting is clinically relevant as an effective treatment option for patients suffering from pulsatile tinnitus. Future applications and studies are needed and are currently being developed to further demonstrate the effectiveness of stents in the treatment of pulsatile tinnitus.
Collapse
Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, CA, United States
| | - Athanasios Kondilis
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States
| | - Thao Doan
- University of Texas Medical Branch, Galveston, Texas, United States
| | - Juliana Runnels
- School of Medicine, University of New Mexico, Albuquerque, New Mexico, United States
| | - Nicholas J Fiani
- University of Medicine and Health Sciences Medical School, New York, NY, United States
| | - Erika Sarno
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States
| |
Collapse
|
21
|
Walters H, Drever SKM, Abdelgalil A, Robson AK. Spontaneous superficial arteriovenous malformation causing pulsatile tinnitus: A case report. Clin Case Rep 2021; 9:870-872. [PMID: 33598262 PMCID: PMC7869349 DOI: 10.1002/ccr3.3670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/04/2020] [Indexed: 11/13/2022] Open
Abstract
Superficial arteriovenous fistulae in the absence of other complicating features can be easily treatable with simple surgical excision. In this case, the patient's troublesome symptoms were completely cured with a straightforward procedure.
Collapse
Affiliation(s)
- Holt Walters
- Department of OtolaryngologyCumberland InfirmaryCarlisleUK
| | | | | | | |
Collapse
|
22
|
Slater P, Korla N, Slater C. Transtemporal Venous Decompression for Idiopathic Venous Pulsatile Tinnitus. J Neurol Surg B Skull Base 2020; 83:177-184. [DOI: 10.1055/s-0040-1721819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/11/2020] [Indexed: 10/22/2022] Open
Abstract
Abstract
Objective To evaluate the clinical characteristics and present surgical outcomes of transtemporal venous decompression technique in the treatment of pulsatile tinnitus (PT).
Study Design This is a prospective cohort study.
Setting This study was done at the tertiary private neurotologic skull base clinic.
Participants The primary author, between March 2012 and February 2013, evaluated 55 patients with the complaint of PT. Seven out of the 55 patients were diagnosed with severe, unrelenting idiopathic pulsatile tinnitus (IPT), and were placed into the study. These seven patients had temporal bone computed tomography, magnetic resonance imaging, arteriogram, videonystagmography, electrocochleography, and lumbar puncture based on the symptoms. All the seven patients underwent transtemporal venous decompression surgery.
Main Outcome Measure Resolution of PT was determined as the primary outcome measure.
Results Six out of seven patients had complete resolution of their PT immediately after surgery and at 3 to 4 years follow-up. One patient developed intracranial hypertension after 3 months requiring ventriculoperitoneal shunt, which resolved PT as well. No complications occurred.
Conclusion A significant subset of the PT patient population has known reversible causes. The more common includes conductive hearing loss, superior canal dehiscence, benign intracranial hypertension, jugulosigmoid venous anomalies, stapedial myoclonus, etc. There exists a subset of patients who have IPT. Transtemporal venous decompression is a surgical technique that can be employed to give patients with IPT long-term relief.
Collapse
Affiliation(s)
| | - Neha Korla
- Austin Ear Clinic, Austin, Texas, United States
| | | |
Collapse
|
23
|
Bathla G, Hegde A, Nagpal P, Agarwal A. Imaging in Pulsatile Tinnitus: Case Based Review. J Clin Imaging Sci 2020; 10:84. [PMID: 33408959 PMCID: PMC7771399 DOI: 10.25259/jcis_196_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/02/2020] [Indexed: 11/04/2022] Open
Abstract
Tinnitus refers to auditory perception of internal origin. It is a relatively common problem and affects men and women equally. Clinically, it may be divided as pulsatile or non-pulsatile and subjective and objective. Although pulsatile tinnitus (PT) is less common, it is more likely to be associated with underlying vascular tumors, lesions or anomalies. Imaging forms the baseline for evaluation of objective tinnitus, primarily in the form of computed tomography or magnetic resonance imaging. We present a review of common causes of PT, along with emphasis on key imaging findings.
Collapse
Affiliation(s)
- Girish Bathla
- Department of Radiology, University of Iowa, Iowa, United States,
| | - Amogh Hegde
- Department of Radiology, Raffles Hospital, Singapore,
| | - Prashant Nagpal
- Department of Radiology, University of Iowa, Iowa, United States,
| | - Amit Agarwal
- Department of Radiology, University Texas Southwestern, Dallas, Texas, United States,
| |
Collapse
|
24
|
Simple Things Are Not Simple: Pulsatile Tinnitus due to Tortuous Occipital Artery. Ann Vasc Surg 2020; 72:664.e11-664.e13. [PMID: 33227477 DOI: 10.1016/j.avsg.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/30/2020] [Accepted: 10/04/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pulsatile tinnitus is often a chronic and debilitating condition and normally has a vascular origin. We describe a case of pulsatile tinnitus due to an aberrant branch of the external carotid artery (ECA), which has not been reported previously. METHOD A 67-year-old female with chronic unilateral pulsatile tinnitus, which could be controlled completely with direct pressure on a small tortuous superficial branch behind her left ear. This was confirmed with doppler to be an unusually tortuous occipital branch of the ECA. Under local anesthesia, this vessel was identified with intraoperative doppler and ligated. RESULT Complete resolution of tinnitus immediately, with consistent results 3 months postoperatively. CONCLUSIONS Pulsatile tinnitus due to aberrances in the occipital ECA branch is rare, and in this case, was successfully treated with minor surgery.
Collapse
|
25
|
Kim HS, Song JH, Oh JK, Ahn JH, Kim JH, Chang IB. Endovascular Treatment of Traumatic Arteriovenous Fistula in Young Adults with Pulsatile Tinnitus. J Korean Neurosurg Soc 2020; 63:532-538. [PMID: 32126747 PMCID: PMC7365271 DOI: 10.3340/jkns.2019.0233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/17/2019] [Indexed: 11/27/2022] Open
Abstract
Traumatic arteriovenous fistulas (AVFs) involving the external carotid artery are exceedingly rare in young adults. Since an AVF is the most common life-threatening cause for pulsatile tinnitus (PT), meticulous evaluation and treatment of patients with PT is crucial. Here, we present two traumatic AVF cases treated with coil embolization leading to no residual fistulous connections followed by an immediate and complete resolution of PT. A 20-year-old man developed left ear tinnitus three months after a traumatic brain injury involving the right temporal bone fracture. Cerebral angiography demonstrated an enlarged left middle meningeal artery (MMA) and a fistular point at the posterior branch of the MMA draining to the middle meningeal vein (MMV) and the left pterygoid plexus, suggesting an AVF. Another 18-year-old girl developed left tinnitus, left exophthalmos, and conjunctival injection 6 months after a traffic accident involving no demonstrable abnormal findings in the radiologic exam. Magnetic resonance angiography demonstrated a markedly dilated left MMA draining to the MMV, left cavernous sinus, and left superior ophthalmic vein. In both cases, coil embolization was performed with total obliteration of the fistular point.
Collapse
Affiliation(s)
- Hyun Sik Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Joon Ho Song
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jae Keun Oh
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jun Hyong Ahn
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - In Bok Chang
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| |
Collapse
|
26
|
Park SN, Han JS, Mee Park J, Jin HJ, Joo HA, Park JT, Yoon Koo J, Kim Y, Kwak MY, Seo JW, Song CI, Park HJ. A novel water occlusion test for disorders causing pulsatile tinnitus: Our experience in 32 patients. Clin Otolaryngol 2020; 45:280-285. [DOI: 10.1111/coa.13493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/25/2019] [Accepted: 12/12/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Shi Nae Park
- Department of Otolaryngology‐Head and Neck Surgery College of Medicine The Catholic University of Korea Seoul Korea
| | - Jae Sang Han
- Department of Otolaryngology‐Head and Neck Surgery College of Medicine The Catholic University of Korea Seoul Korea
| | - Jung Mee Park
- Department of Otolaryngology‐Head and Neck Surgery College of Medicine The Catholic University of Korea Seoul Korea
| | - Ho Jun Jin
- Department of Otolaryngology‐Head and Neck Surgery College of Medicine The Catholic University of Korea Seoul Korea
| | - Hye Ah Joo
- Department of Otorhinolaryngology‐Head and Neck Surgery Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Jin Taek Park
- Department of Otorhinolaryngology‐Head and Neck Surgery Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Ja Yoon Koo
- Department of Otorhinolaryngology‐Head and Neck Surgery Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Yehree Kim
- Department of Otorhinolaryngology‐Head and Neck Surgery Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Min Young Kwak
- Department of Otorhinolaryngology‐Head and Neck Surgery Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Ji Won Seo
- Department of Otorhinolaryngology‐Head and Neck Surgery Samsung Changwon Hospital Sungkyunkwan University College of Medicine Changwon Korea
| | - Chan Il Song
- Department of Otorhinolaryngology Yonsei University College of Medicine Seoul Korea
| | - Hong Ju Park
- Department of Otorhinolaryngology‐Head and Neck Surgery Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| |
Collapse
|
27
|
Sunwoo W, Lee DY, Lee JY, Lee M, Kang Y, Park MH, Kim YH. Characteristics of tinnitus found in anemia patients and analysis of population-based survey. Auris Nasus Larynx 2018; 45:1152-1158. [DOI: 10.1016/j.anl.2018.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/05/2018] [Accepted: 04/06/2018] [Indexed: 12/17/2022]
|
28
|
Kim SM, Kim CH, Lee CY. Petrous Carotid Aneurysm Causing Pulsatile Tinnitus: Case Report and Review of the Literature. J Cerebrovasc Endovasc Neurosurg 2018; 20:35-39. [PMID: 30370238 PMCID: PMC6196136 DOI: 10.7461/jcen.2018.20.1.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 09/21/2017] [Accepted: 01/07/2018] [Indexed: 12/18/2022] Open
Abstract
We present the case of a patient who developed pulsatile tinnitus that was found to be associated with a petrous carotid aneurysm. The aneurysm was successfully obliterated using stent-assisted coiling, after which the patient was symptom-free. Although aneurysms arising from the petrous segment of the internal carotid artery are rare, this pathology must be considered as a causative factor in patients with pulsatile tinnitus. Endovascular treatment appears to have been successful in resolving the symptoms associated with this pathology.
Collapse
Affiliation(s)
- Seong-Mook Kim
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Chang-Hyun Kim
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Chang-Young Lee
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| |
Collapse
|
29
|
The Incidence of Cranial Arteriovenous Shunts in Patients With Pulsatile Tinnitus: A Prospective Observational Study. Otol Neurotol 2018; 39:648-653. [PMID: 29561378 DOI: 10.1097/mao.0000000000001767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Finding the underlying cause for pulsatile tinnitus can be challenging. We aimed to determine the incidence of arteriovenous shunts, i.e., arteriovenous malformations (AVMs) or dural arteriovenous fistulas (dAVFs), in patients referred for catheter angiography (digital subtraction angiography [DSA]). Furthermore, we assessed which clinical features were predictive for the presence of such a lesion. STUDY DESIGN AND METHODS Fifty-one patients with pulsatile tinnitus, who were referred to us for DSA to exclude an arteriovenous shunt, were enrolled, prospectively. MAIN OUTCOME MEASURES DSA determined the presence of a dAVF or AVM. Clinical characteristics were recorded systematically and all patients underwent a physical examination. RESULTS Fifty patients were included in the final analyses. While no AVMs were found, a dAVF was found in 12 cases (24%). Three of these demonstrated cortical venous reflux, thus requiring treatment due to the risk of hemorrhage. In three cases (6%), DSA demonstrated a non-arteriovenous-shunt abnormality, likely causing the tinnitus. The odds of having a dAVF were significantly raised by unilaterality, objective bruit, and the ability to influence the tinnitus with compression. Unilaterality even had a negative predictive value of 1 and, if used as selection criterion, would have raised dAVF prevalence from 24 to 32%. CONCLUSION In a tertiary care setting, the prevalence of dAVFs in patients with pulsatile tinnitus is not negligible. Thus, patients with unilateral pulsatile tinnitus should be offered dynamic vascular imaging to rule out a dAVF. Especially, since some of these patients are at risk of intracranial hemorrhage and treatment options exist.
Collapse
|
30
|
Neuroanatomical Alterations in Patients with Early Stage of Unilateral Pulsatile Tinnitus: A Voxel-Based Morphometry Study. Neural Plast 2018; 2018:4756471. [PMID: 29681925 PMCID: PMC5851320 DOI: 10.1155/2018/4756471] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/14/2017] [Accepted: 01/16/2018] [Indexed: 11/18/2022] Open
Abstract
During the past several years, the rapid development of neuroimaging techniques has contributed greatly in the noninvasive imaging studies of tinnitus. The aim of the present study was to explore the brain anatomical alterations in patients with right-sided unilateral pulsatile tinnitus (PT) in the early stage of PT symptom using voxel-based morphometry (VBM) analysis. Twenty-four patients with right-sided pulsatile tinnitus and 24 age- and gender-matched normal controls were recruited to this study. Structural image data preprocessing was performed using VBM8 toolbox. Tinnitus Handicap Inventory (THI) score was acquired in the tinnitus group to assess the severity of tinnitus and tinnitus-related distress. Two-sample t-test and Pearson's correlation analysis were used in statistical analysis. Patients with unilateral pulsatile tinnitus had significantly increased gray matter (GM) volume in bilateral superior temporal gyrus compared with the normal controls. However, the left cerebellum posterior lobe, left frontal superior orbital lobe (gyrus rectus), right middle occipital gyrus (MOG), and bilateral putamen showed significantly decreased brain volumes. This was the first study which demonstrated the features of neuroanatomical changes in patients with unilateral PT during their early stages of the symptom.
Collapse
|
31
|
Shimizu Y, Yagi M. Pulsatile tinnitus and carotid artery dissection. Auris Nasus Larynx 2018; 45:175-177. [DOI: 10.1016/j.anl.2016.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/26/2016] [Accepted: 12/24/2016] [Indexed: 11/16/2022]
|
32
|
Lyu AR, Park SJ, Kim D, Lee HY, Park YH. Radiologic features of vascular pulsatile tinnitus - suggestion of optimal diagnostic image workup modalities. Acta Otolaryngol 2018; 138:128-134. [PMID: 28990828 DOI: 10.1080/00016489.2017.1385847] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this study was to determine the optimal diagnostic workup modalities for vascular pulsatile tinnitus through analysis of clinical and radiologic findings. MATERIALS AND METHODS A total of 49 patients diagnosed with vascular pulsatile tinnitus along with their medical records and radiologic findings were thoroughly reviewed. RESULTS Of these patients, 84% had venous lesions. The jugular bulb variants (67%) were the most common venous lesions followed by sigmoid sinus variants (12%). About 88% (43/49) of these lesions were detected with computed tomography of the temporal bone (TBCT) alone and the lesions were either venous or intratemporal artery in origin. Simple manual neck compression test was 93% sensitive in predicting venous lesions. A high suspicion for venous lesion coupled with manual neck compression test and selection of the optimal imaging technique are useful for the proper evaluation of vascular pulsatile tinnitus at the initial visit. CONCLUSION Our stepwise strategy may increase the cost-effectiveness of the chosen imaging workup by reducing redundancy of multiple and simultaneous radiologic tests in patients with vascular pulsatile tinnitus.
Collapse
Affiliation(s)
- Ah-Ra Lyu
- Department of Medical Science, Chungnam National University, Daejeon, Republic of Korea
| | - Sung Jae Park
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University, Daejeon, Republic of Korea
| | - Dami Kim
- Department of Radiology, Chungnam National University, Daejeon, Republic of Korea
| | - Ho Yun Lee
- Department of Otolaryngology-Head and Neck Surgery, Eulji University, Daejeon, Republic of Korea
| | - Yong-Ho Park
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University, Daejeon, Republic of Korea
- Brain Research Institute, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| |
Collapse
|
33
|
Oh SJ, Chon YI, Kong SK, Goh EK. Multiple Dural Arteriovenous Fistulas Presenting as Pulsatile Tinnitus Treated with External Manual Compression. J Audiol Otol 2017; 21:156-159. [PMID: 28942629 PMCID: PMC5621796 DOI: 10.7874/jao.2017.00115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 12/27/2022] Open
Abstract
Dural arteriovenous fistula (DAVF) have been treated by transarterial or transvenous embolization, surgery, and radiosurgery. Besides these treatment options, the external compression technique is a non-invasive, low-cost form of treatment. This article reports that a 60-year-old man with DAVF between multiple arterial branches and transverse/sigmoid sinus was treated by repeated external manual compression method.
Collapse
Affiliation(s)
- Se-Joon Oh
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yong-Il Chon
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eui-Kyung Goh
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| |
Collapse
|
34
|
Pegge SAH, Steens SCA, Kunst HPM, Meijer FJA. Pulsatile Tinnitus: Differential Diagnosis and Radiological Work-Up. CURRENT RADIOLOGY REPORTS 2017; 5:5. [PMID: 28203490 PMCID: PMC5263210 DOI: 10.1007/s40134-017-0199-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE OF REVIEW Identification of the underlying cause of pulsatile tinnitus is important for treatment decision making and for prognosis estimation. For this, an adequate diagnostic imaging strategy is crucial. RECENT FINDINGS Both CT and MRI can be useful, and in general, these modalities provide complementary diagnostic information. The scanning protocol can be optimized based on the estimated a priori chance for finding specific pathology, or the need to rule out more rare but clinical significant disease. In recent years, dynamic CTA, also referred to as 4D-CTA, has become available as a new technique that enables non-invasive evaluation of hemodynamics for the detection, classification, and follow-up of vascular malformations. SUMMARY The value of different diagnostic imaging modalities in the work-up of pulsatile tinnitus is discussed in relation to the differential diagnosis. Furthermore, imaging findings of different diseases are presented, both for CT and MRI.
Collapse
Affiliation(s)
- Sjoert A. H. Pegge
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein 10, P/O Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Stefan C. A. Steens
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein 10, P/O Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Henricus P. M. Kunst
- Department of Otorhinolaryngology, Radboud University Medical Center Nijmegen, P/O Box 9101, Nijmegen, The Netherlands
| | - Frederick J. A. Meijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein 10, P/O Box 9101, 6500 HB Nijmegen, The Netherlands
| |
Collapse
|
35
|
Kefayati S, Amans M, Faraji F, Ballweber M, Kao E, Ahn S, Meisel K, Halbach V, Saloner D. The manifestation of vortical and secondary flow in the cerebral venous outflow tract: An in vivo MR velocimetry study. J Biomech 2017; 50:180-187. [PMID: 27894675 PMCID: PMC5191981 DOI: 10.1016/j.jbiomech.2016.11.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Abstract
Aberrations in flow in the cerebral venous outflow tract (CVOT) have been implicated as the cause of several pathologic conditions including idiopathic intracranial hypertension (IIH), multiple sclerosis (MS), and pulsatile tinnitus (PT). The advent of 4D flow magnetic resonance imaging (4D-flow MRI) has recently allowed researchers to evaluate blood flow patterns in the arterial structures with great success. We utilized similar imaging techniques and found several distinct flow characteristics in the CVOT of subjects with and without lumenal irregularities. We present the flow patterns of 8 out of 38 subjects who have varying heights of the internal jugular bulb and varying lumenal irregularities including stenosis and diverticulum. In the internal jugular vein (IJV) with an elevated jugular bulb (JB), 4Dflow MRI revealed a characteristic spiral flow that was dependent on the level of JB elevation. Vortical flow was also observed in the diverticula of the venous sinuses and IJV. The diversity of flow complexity in the CVOT illustrates the potential importance of hemodynamic investigations in elucidating venous pathologies.
Collapse
Affiliation(s)
- Sarah Kefayati
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Matthew Amans
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Farshid Faraji
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Megan Ballweber
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Evan Kao
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | | | - Karl Meisel
- Department of Neurology, UCSF, San Francisco, CA, USA
| | - Van Halbach
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - David Saloner
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA; Radiology Service, VA Medical Center, San Francisco, USA
| |
Collapse
|
36
|
Dural arteriovenous fistula masquerading as pulsatile tinnitus: radiologic assessment and clinical implications. Sci Rep 2016; 6:36601. [PMID: 27812001 PMCID: PMC5095646 DOI: 10.1038/srep36601] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/17/2016] [Indexed: 11/16/2022] Open
Abstract
Pulsatile tinnitus (PT) is often an initial presenting symptom of dural arteriovenous fistula (dAVF), but it may be overlooked or diagnosed late if not suspected on initial diagnostic work-up. Here, we assess anatomical features, treatment outcomes, and clinical implications of patients with PT due to dAVF. Of 220 patients who were diagnosed with dAVF between 2003 and 2014, 30 (13.6%) presented with only PT as their initial symptom. The transverse-sigmoid sinus (70.0%) was the most common site, followed by the hypoglossal canal (10.0%) and the middle cranial fossa (6.7%) on radiologic evaluation. Regarding venous drainage patterns, sinus or meningeal venous drainage pattern was the most common type (73.3%), followed by sinus drainage with a cortical venous reflux (26.7%). PT disappeared completely in 21 (80.8%) of 26 patients who underwent therapeutic intervention with transarterial embolization of the fistula, improved markedly in 3 (11.5%), and remained the same in 2 (7.7%). In conclusion, considering that PT may be the only initial symptom in more than 10% of dAVF, not only otolaryngologists but also neurologists and neurosurgeons should meticulously evaluate patients with PT. In most cases, PT originating from dAVF can be cured with transarterial embolization regardless of location and venous drainage pattern.
Collapse
|
37
|
|
38
|
Lv H, Zhao P, Liu Z, Wang G, Zeng R, Yan F, Dong C, Zhang L, Li R, Wang P, Li T, Gong S, Wang Z. Frequency-Dependent Neural Activity in Patients with Unilateral Vascular Pulsatile Tinnitus. Neural Plast 2016; 2016:4918186. [PMID: 27413554 PMCID: PMC4931090 DOI: 10.1155/2016/4918186] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 05/09/2016] [Indexed: 02/07/2023] Open
Abstract
Previous resting-state functional magnetic resonance imaging (rs-fMRI) studies have shown that neurological changes are important findings in vascular pulsatile tinnitus (PT) patients. Here, we utilized rs-fMRI to measure the amplitude of low-frequency fluctuations (ALFF) in forty patients with unilateral PT and forty age-, gender-, and education-matched normal control subjects. Two different frequency bands (slow-4, 0.027-0.073 Hz, and slow-5, 0.010-0.027 Hz, which are more sensitive to subcortical and cortical neurological signal changes, resp.) were analyzed to examine the intrinsic brain activity in detail. Compared to controls, PT patients had increased ALFF values mainly in the PCu, bilateral IPL (inferior parietal lobule), left IFG (inferior frontal gyrus), and right IFG/anterior insula and decreased ALFF values in the multiple occipital areas including bilateral middle-inferior occipital lobe. For the differences of the two frequency bands, widespread ALFF differences were observed. The ALFF abnormalities in aMPFC/ACC, PCu, right IPL, and some regions of occipital and parietal cortices were greater in the slow-5 band compared to the slow-4 band. Additionally, the THI score of PT patients was positively correlated with changes in slow-5 and slow-4 band in PCu. Pulsatile tinnitus is a disease affecting the neurological activities of multiple brain regions. Slow-5 band is more sensitive in detecting the alternations. Our results also indicated the importance of pathophysiological investigations in patients with pulsatile tinnitus in the future.
Collapse
Affiliation(s)
- Han Lv
- 1Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
- 2Neuroradiology Division, Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - Pengfei Zhao
- 1Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Zhaohui Liu
- 3Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Guopeng Wang
- 4Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Rong Zeng
- 4Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Fei Yan
- 3Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Cheng Dong
- 1Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Ling Zhang
- 1Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Rui Li
- 1Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Peng Wang
- 1Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Ting Li
- 3Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Shusheng Gong
- 4Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
- *Shusheng Gong: and
| | - Zhenchang Wang
- 1Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
- *Zhenchang Wang:
| |
Collapse
|
39
|
Pulsatile tinnitus as the presenting symptom in a patient with posterior reversible encephalopathy syndrome. Eur Arch Otorhinolaryngol 2015; 273:2847-51. [PMID: 26661070 DOI: 10.1007/s00405-015-3847-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES We present a case of posterior reversible encephalopathy syndrome (PRES) presenting with pulsatile tinnitus. We highlight the significance of a detailed neurological and cardiovascular assessment including the measurement of blood pressure in patients presenting with pulsatile tinnitus. METHOD Case presentation and literature review. RESULTS One patient with undiagnosed PRES, who presented to our ear, nose and throat surgery department with pulsatile tinnitus is discussed. Symptoms, signs, investigations and treatments are presented. A literature review is also included. CONCLUSION Pulsatile tinnitus can be the presenting symptom of neurovascular disorders, some of which might have serious sequelae if not treated promptly. Detailed neurological and cardiovascular history is recommended in addition to radiological investigations in patients presenting with pulsatile tinnitus.
Collapse
|
40
|
Cassandro E, Cassandro C, Sequino G, Scarpa A, Petrolo C, Chiarella G. Inner Ear Conductive Hearing Loss and Unilateral Pulsatile Tinnitus Associated with a Dural Arteriovenous Fistula: Case Based Review and Analysis of Relationship between Intracranial Vascular Abnormalities and Inner Ear Fluids. Case Rep Otolaryngol 2015; 2015:817313. [PMID: 26693371 PMCID: PMC4674581 DOI: 10.1155/2015/817313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/11/2015] [Indexed: 11/17/2022] Open
Abstract
While pulsatile tinnitus (PT) and dural arteriovenous fistula (DAVF) are not rarely associated, the finding of a conductive hearing loss (CHL) in this clinical picture is unusual. Starting from a case of CHL and PT, diagnosed to be due to a DAVF, we analyzed relationship between intracranial vascular abnormalities and inner ear fluids. DAVF was treated with endovascular embolization. Following this, there was a dramatic recovery of PT and of CHL, confirming their cause-effect link with DAVF. We critically evaluated the papers reporting this association. This is the first case of CHL associated with PT and DAVF. We describe the most significant experiences and theories reported in literature, with a personal analysis about the possible relationship between vascular intracranial system and labyrinthine fluids. In conclusion, we believe that this association may be a challenge for otolaryngologists. So we suggest to consider the possibility of a DAVF or other AVMs when PT is associated with CHL, without alterations of tympanic membrane and middle ear tests.
Collapse
Affiliation(s)
- Ettore Cassandro
- Department of Medicine and Surgery, University of Salerno, 84084 Salerno, Italy
| | - Claudia Cassandro
- ENT Department, San Giovanni Battista Hospital, University of Torino, 10124 Torino, Italy
| | - Giuliano Sequino
- Department of Medicine and Surgery, University of Salerno, 84084 Salerno, Italy
| | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, 84084 Salerno, Italy
| | - Claudio Petrolo
- Department of Experimental and Clinical Medicine, Audiology and Phoniatrics Unit, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy
| | - Giuseppe Chiarella
- Department of Experimental and Clinical Medicine, Audiology and Phoniatrics Unit, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy
| |
Collapse
|
41
|
Liu Z, Bi W, Li J, Li Q, Dong C, Zhao P, Lv H, Wang Z. Superior semicircular canal dehiscence in relation to the superior petrosal sinus: a potential cause of pulsatile tinnitus. Clin Radiol 2015; 70:943-7. [PMID: 26072165 DOI: 10.1016/j.crad.2015.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 04/08/2015] [Accepted: 04/28/2015] [Indexed: 02/07/2023]
Abstract
AIM To examine the association between superior semicircular canal dehiscence (SSCD) and pulsatile tinnitus (PT). MATERIALS AND METHODS Two SSCD groups included 408 unilateral persistent PT patients, and 511 controls undergoing head and neck dual-phase contrast-enhanced computed tomography (DP-CECT) for reasons other than PT. The prevalence of type I (no the superior petrosal sinus running through the dehiscence) and type II (superior semicircular canal dehiscence in relation to the superior petrosal sinus) SSCD was analysed using chi-square test. RESULTS SSCD was identified in 5.1% (21/408) of PT ears, significantly different from 2% (8/408) of non-PT ears and 0.7% (7/1022) of controls. There was no significant difference in SSCD prevalence between non-PT ears in the PT group and controls. In the PT group, 15/21 ears were type II SSCD; 6/21 ears were type I. Fifteen combined non-PT and control ears with SSCD included two type II and 13 type I SSCD. The prevalence of type II SSCD in PT ears was significantly higher than that of non-PT ears in both groups, and the prevalence of type I SSCD in PT ears was similar to that of non-PT ears in both groups. CONCLUSION Compared with type I SSCD, there may be a causal relationship between type II SSCD and PT.
Collapse
Affiliation(s)
- Z Liu
- Capital Medical University, Beijing Tongren Hospital, No. 1 Dong Jiao Min Street, Dongcheng District, Beijing, 100730, China.
| | - W Bi
- Shandong Medical Imaging Research Institute, No. 324 Jing 5 Road, Jinan, 250021, China
| | - J Li
- Capital Medical University, Beijing Tongren Hospital, No. 1 Dong Jiao Min Street, Dongcheng District, Beijing, 100730, China
| | - Q Li
- Capital Medical University, Beijing Tongren Hospital, No. 1 Dong Jiao Min Street, Dongcheng District, Beijing, 100730, China
| | - C Dong
- Capital Medical University, Beijing Friendship Hospital, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - P Zhao
- Capital Medical University, Beijing Friendship Hospital, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - H Lv
- Capital Medical University, Beijing Friendship Hospital, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Z Wang
- Capital Medical University, Beijing Friendship Hospital, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China.
| |
Collapse
|
42
|
Schaumberg J, Tomandl B, Brunner F. Ultrasonographic, CTI and MRI of Aberrant Internal Carotid Artery: Infrequent but Important to Know. Int J Angiol 2015; 25:e142-e144. [PMID: 28031680 DOI: 10.1055/s-0035-1559827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
This article describes the aberrant course of the internal carotid artery (ICA) through the middle ear as an extremely rare vascular anomaly. On the basis of a case report, the findings of magnetic resonance imaging, computed tomography imaging, and especially color-coded duplex sonography are presented. The diagnosis of an aberrant ICA is important to avoid severe surgical complications of a retrotympanic mass as well as unnecessary diagnostic or therapeutic approaches in expectation of a stroke.
Collapse
Affiliation(s)
- J Schaumberg
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany; Department of Neurology, Asklepios Klinik Hamburg Altona, Hamburg, Germany
| | - B Tomandl
- Department of Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany; Department of Radiology and Neuroradiology, Klinikum Christophsbad, Göppingen, Germany
| | - F Brunner
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany
| |
Collapse
|
43
|
Han L, Zhaohui L, Fei Y, Pengfei Z, Ting L, Cheng D, Zhenchang W. Disrupted neural activity in unilateral vascular pulsatile tinnitus patients in the early stage of disease: evidence from resting-state fMRI. Prog Neuropsychopharmacol Biol Psychiatry 2015; 59:91-99. [PMID: 25645870 DOI: 10.1016/j.pnpbp.2015.01.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/20/2015] [Accepted: 01/23/2015] [Indexed: 02/07/2023]
Abstract
Numerous studies have shown that neurological changes are important findings of tinnitus patients. Previous studies on tinnitus have indicated that patients with pulsatile tinnitus (PT) often show altered baseline brain activity in the resting state. This study used resting-state functional magnetic resonance imaging (rs-fMRI) to investigate changes in spontaneous brain activity among patients with unilateral pulsatile tinnitus in the early stage of disease (less than forty-eight months) and determined the relationship of these changes with clinical data. The PT patients (n=34) and matched normal control subjects (n=34) were enrolled in this study. Spontaneous brain activity was revealed by the regional homogeneity (ReHo) and amplitude of low-frequency fluctuation (ALFF) values. Compared with normal controls, the patients with PT had significantly increased ReHo and ALFF in the posterior cingulate cortex, right inferior parietal lobule (IPL) and right cerebellum posterior lobe. The PT group showed increased ReHo in the posterior cingulate cortex (PCC), precuneus, right IPL, right superior frontal gyrus, some occipital areas and part of the right cerebellum posterior lobe. For ALFF, the increased clusters were in the PCC and precuneus and in some areas of the cerebellum posterior lobe, bilateral IPL and inferior frontal gyrus (IFG). Increased PT duration was correlated with increased ALFF in the bilateral inferior frontal gyrus (IFG) and precuneus. An increased THI score was correlated with ReHo and ALFF values in the precuneus. Taken together, the combined study of ReHo and ALFF measurements may yield a more comprehensive neurological pathophysiology framework for PT patients in the early stage of the disease.
Collapse
Affiliation(s)
- Lv Han
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Liu Zhaohui
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yan Fei
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Zhao Pengfei
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Li Ting
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Dong Cheng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Wang Zhenchang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| |
Collapse
|
44
|
Increased Atherosclerosis Correlates with Subjective Tinnitus Severity. Indian J Otolaryngol Head Neck Surg 2015; 70:119-124. [PMID: 29456955 DOI: 10.1007/s12070-015-0845-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/13/2015] [Indexed: 12/28/2022] Open
Abstract
The aim of the present study was to investigate whether increased intima media thickness was associated with the severity of subjective non-pulsatile tinnitus and hearing loss. Data of the patients who came to Otorhinolaryngology Department of Isparta Government Hospital with subjective non-pulsatile tinnitus complaint, between January 2012 and June 2013, were evaluated retrospectively. A total of 215 patients were included in the present study. Hearing tests, biochemical analysis, tinnitus handicap inventory (THI), visual analogue scale (VAS) and doppler ultrasonography results of the patients were reviewed and recorded. The patients were classified into two groups as those having an increased intima media thickness and those having a normal intima media thickness. The said groups were compared with respect to age, gender, THI, VAS, hearing test findings and lipid values. Moreover, THI and VAS groups were compared with respect to intima-media thickness. In the group having increased intima-media thickness, THI and VAS average, frequency of hypertension, total cholesterol, low density lipoprotein and triglyceride averages and mean frequencies obtained by hearing test were significantly higher. Comparison of THI and VAS groups showed that intima-media thickness was significantly different between those having a mild tinnitus and those having a severe tinnitus. Increased intima-media thickness was associated with the severity of subjective non-pulsatile tinnitus and hearing loss. For this reason, the carotid system should be examined in subjective non-pulsatile tinnitus patients.
Collapse
|
45
|
Dong C, Zhao PF, Yang JG, Liu ZH, Wang ZC. Incidence of vascular anomalies and variants associated with unilateral venous pulsatile tinnitus in 242 patients based on dual-phase contrast-enhanced computed tomography. Chin Med J (Engl) 2015; 128:581-5. [PMID: 25698187 PMCID: PMC4834766 DOI: 10.4103/0366-6999.151648] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A comprehensive assessment of various vascular anomalies and variants associated with venous pulsatile tinnitus (PT) by radiography is essential for therapeutic planning and improving the clinical outcome. This study evaluated the incidence of various vascular anomalies and variants on the PT side and determined whether these lesions occurred as multiple or single entities. METHODS The dual-phase contrast-enhanced computed tomography images of 242 patients with unilateral venous PT were retrospectively reviewed. The vascular anomalies and variants on the symptomatic and asymptomatic sides were analyzed, and the incidences of anomalies or variants on each side were compared. The number of anomalies and variants on the symptomatic side in each patient was calculated. RESULTS (1) A total 170 patients (170/242) had more than one anomaly or variant on the symptomatic side, and 58 patients (58/242) had a single lesion on tomography. (2) There was a statistically significant difference in the incidence of dehiscent sigmoid plate (P = 0.000), lateral sinus stenosis (P = 0.014), high jugular bulb (P = 0.000), sigmoid sinus diverticulum (P = 0.000), jugular bulb diverticulum (P = 0.000), dehiscent jugular bulb (P = 0.000), and a large emissary vein (P = 0.006) between the symptomatic and asymptomatic sides. (3) Dehiscent sigmoid plate (86.4%) was the most frequent lesion on the symptomatic side, followed by lateral sinus stenosis (55.8%), high jugular bulb (47.1%), sigmoid sinus diverticulum (34.3%), jugular bulb diverticulum (13.6%), dehiscent jugular bulb (13.6%), large emissary vein (4.1%), sinus thrombosis (1.2%), and petrosquamosal sinus (0.8%). CONCLUSIONS Various vascular anomalies and variants occur more frequently on the venous PT side. Preliminary findings suggest that venous PT patients may have multiple vascular anomalies or variants on the symptomatic side.
Collapse
Affiliation(s)
- Cheng Dong
- Department of Radiology, Capital Medical University, Beijing Friendship Hospital, Beijing 100000, China
| | - Peng-Fei Zhao
- Department of Radiology, Capital Medical University, Beijing Tongren Hospital, Beijing 100000, China
| | - Ji-Gang Yang
- Department of Nuclear Medicine, Capital Medical University, Beijing Friendship Hospital, Beijing 100000, China
| | - Zhao-Hui Liu
- Department of Radiology, Capital Medical University, Beijing Tongren Hospital, Beijing 100000, China
| | - Zhen-Chang Wang
- Department of Radiology, Capital Medical University, Beijing Friendship Hospital, Beijing 100000, China
- Address for correspondence: Prof. Zhen-Chang Wang, Department of Radiology, Capital Medical University, Beijing Friendship Hospital, Beijing 100000, China E-Mail:
| |
Collapse
|
46
|
Deuschl C, Göricke S, Gramsch C, Özkan N, Lehnerdt G, Kastrup O, Ringelstein A, Wanke I, Forsting M, Schlamann M. Value of DSA in the diagnostic workup of pulsatile tinnitus. PLoS One 2015; 10:e0117814. [PMID: 25689158 PMCID: PMC4331557 DOI: 10.1371/journal.pone.0117814] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 12/30/2014] [Indexed: 11/28/2022] Open
Abstract
Objectives Pulsatile tinnitus (PT) is a rare complaint, but can be a symptom of life-threatening disease. It is often caused by vascular pathologies, e.g. dural arteriovenous fistula (dAVF), arteriovenous malformation (AVM) or vascularized tumors. The current diagnostic pathway includes clinical examination, cranial MRI and additional DSA. The aim of this study was to evaluate the diagnostic impact of DSA in the diagnostic workup of patients with PT in comparison to MRI alone. Methods Retrospectively, 54 consecutive patients with pulsatile tinnitus were evaluated. All patients had a diagnostic workup including cranial MRI and DSA. MRI examinations were blinded to the results of DSA and retrospectively analyzed in consensus by two experienced neuroradiologists. The MR-examinations were evaluated for each performed sequence separately: time-of-flight-angiography, ce-MRA, T2, ce-T1-sequence and ce-T1-sequence with fat saturation. Results 37 of the 54 patients revealed a pathology explaining PT on MRI, which was detected by the readers in 100% and proofed by means of DSA. 24 dAVF, four paraganglioma, two AVM and seven more pathologies were described. All patients without pathology on MRI did also not show any pathology in DSA. Conclusions MR imaging is sufficient to exclude pathology in patients with pulsatile tinnitus.
Collapse
Affiliation(s)
- Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany
- * E-mail:
| | - Sophia Göricke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany
| | - Carolin Gramsch
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany
| | - Neriman Özkan
- Clinic of Neurosurgery, University Hospital of Essen, Essen, Germany
| | - Götz Lehnerdt
- Clinic of Otolaryngology, University Hospital of Essen, Essen, Germany
| | - Oliver Kastrup
- Clinic of Neurology, University Hospital of Essen, Essen, Germany
| | - Adrian Ringelstein
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany
| | - Isabel Wanke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany
| | - Marc Schlamann
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany
| |
Collapse
|
47
|
Terzi S, Arslanoğlu S, Demiray U, Eren E, Cancuri O. Carotid Doppler ultrasound evaluation in patients with pulsatile tinnitus. Indian J Otolaryngol Head Neck Surg 2015; 67:43-7. [PMID: 25621231 DOI: 10.1007/s12070-014-0756-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 07/28/2014] [Indexed: 10/24/2022] Open
Abstract
A wide range of conditions, including atherosclerosis, may lead to pulsatile tinnitus. The objective of this study was to evaluate the patients with pulsatile tinnitus by means of carotid Doppler ultrasound parameters. Thirty-four patients with pulsatile tinnitus were enrolled in the study. Internal carotid artery intima-media thickness (IMT), blood flow velocities and arterial lumen diameters (LD) were measured and compared with the control group. Mean end diastolic velocity (EDV) (32.29 ± 17.22) and IMT (1.06 ± 0.36) values were significantly higher and mean LD (6.69 ± 1.20) was significantly lower compared to the control group. Peak systolic velocity and EDV values were significantly higher in patients whose IMT were greater than 1 mm. Pulsatile tinnitus may be the first symptom of a severe, life threatening disease. Doppler sonography is a noninvasive, safe and easily applicable diagnostic tool for the evaluation of the vascular structures, in patients with pulsatile tinnitus.
Collapse
Affiliation(s)
- S Terzi
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - S Arslanoğlu
- Department of Otolaryngology Head and Neck Surgery, Atatürk Research and Training Hospital, İzmir, Turkey
| | - U Demiray
- Department of Otolaryngology Head and Neck Surgery, State Hospital, Tatvan, Turkey
| | - E Eren
- Department of Otolaryngology Head and Neck Surgery, Atatürk Research and Training Hospital, İzmir, Turkey
| | - O Cancuri
- Department of Radiology, State Hospital, Gazimagusa, Famagusta, Turkish Republic of Northern Cyprus
| |
Collapse
|
48
|
Mundada P, Singh A, Lingam RK. CT arteriography and venography in the evaluation of Pulsatile tinnitus with normal otoscopic examination. Laryngoscope 2014; 125:979-84. [PMID: 25379666 DOI: 10.1002/lary.25010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/13/2014] [Accepted: 10/08/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS Our retrospective study aims to assess the ability of computed tomography arteriography and venography (CT A/V) to detect various findings that suggest a potential cause of pulsatile tinnitus and to examine the association between these findings and the side of pulsatile tinnitus. STUDY DESIGN A retrospective review of CT arteriography and venography of 32 patients with established pulsatile tinnitus and normal otoscopic examination was performed. The scans were performed using a 64-slice multidetector scanner and were reviewed to look for findings that are known to cause pulsatile tinnitus. RESULTS One or more findings that are known to cause pulsatile tinnitus were detected on the symptomatic side in 30 patients; on the asymptomatic side in 3 patients, one patient with bilateral pulsatile tinnitus showed a potential cause of symptoms only on one side, and in one patient no potential cause could be identified. There is a significant association seen between the side of pulsatile tinnitus and various potential causes of pulsatile tinnitus detected (P < 0.001), between the side of pulsatile tinnitus and various potential venous cause detected (P < 0.001), and between the side of pulsatile tinnitus and the side of dominant venous system (P = 0.02). CONCLUSION CT arteriography and venography is a useful tool in detecting many described potential causes of pulsatile tinnitus. Significant association is demonstrated between the side of pulsatile tinnitus and the potential causes of pulsatile tinnitus detected by CT arteriography and venography when the otoscopic examination is normal.
Collapse
Affiliation(s)
- Pravin Mundada
- Department of Radiology, Changi General Hospital, Singapore
| | | | | |
Collapse
|
49
|
Kim S, Byun J, Park M, Lee S. Pulsatile tinnitus with a dural arterio-venous fistula diagnosed by computed tomography-angiography. KOREAN JOURNAL OF AUDIOLOGY 2014; 17:133-7. [PMID: 24653921 PMCID: PMC3936554 DOI: 10.7874/kja.2013.17.3.133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 09/11/2013] [Accepted: 10/18/2013] [Indexed: 12/27/2022]
Abstract
A 43 year-old female patient suffered the sudden onset of pulsatile tinnitus in the left ear 2 months ago. The tinnitus did not subside spontaneously and remained unchanged. The patient had no history of head trauma or surgery of the head and neck. The character of the tinnitus was pulsatile, and it was synchronous with the heart beat. Audiologic examinations were performed and all of the results were normal. Computed tomography with angiography was performed and evidence of an arterio-venous fistula (AVF) was found. 4-vessel angiography was performed to confirm the dural AVF between the external carotid artery and sigmoid sinus. Embolization of the feeder-vessels was done under a fluoroscope and 70% of the fistula flow was controlled after embolization and the tinnitus totally subsided during the embolization.
Collapse
Affiliation(s)
- Sujin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jaeyong Byun
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Moonsuh Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sunkyu Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| |
Collapse
|
50
|
Srirompotong S, Srirompotong S. Movement of the tympanic membrane causing pulsatile tinnitus. ASIAN BIOMED 2014. [DOI: 10.5372/1905-7415.0801.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Movement of the tympanic membrane can be a cause of pulsatile tinnitus. There are many etiologies that cause movement of the tympanic membrane, including otogenic pneumocephalus. This is an uncommon presentation after head injury that may be missed as the diagnosis of the primary cause of the symptoms.
Objective: To report a rare case of pulsatile tinnitus because of otogenic pneumocephalus.
Methods: Case report from chart review with relevant investigations and treatment.
Results: We describe the very interesting case of a patient who presented with pulsatile tinnitus because of otogenic pneumocephalus. On examination, we found a moving tympanic membrane. A CT scan revealed pneumocephalus in the right temporoparietal region that was continuous with the adjacent mastoid air cells. There was a transverse fracture through the mastoid process. A meticulous mastoidectomy with unroofing of the epitympanum was performed with widening of the aditus ad antrum. The mastoid cavity was closed without fat obliteration. After the operation, the pulsatile tinnitus ceased completely.
Conclusion: Mastoidectomy and unroofing the epitympanum without fat obliteration is a very simple and effective option for the treatment of pulsatile tinnitus because of pneumocephalus.
Collapse
Affiliation(s)
- Supaporn Srirompotong
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Somchai Srirompotong
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| |
Collapse
|