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Succop B, Thompson NJ, Dedmon MM, Gelinne A, Selleck A, Reed S, Sindelar MBD. Noninvasive Treatment of Venous Pulsatile Tinnitus with an Internal Jugular Vein Compression Collar. Laryngoscope 2024; 134:3342-3348. [PMID: 38345081 DOI: 10.1002/lary.31326] [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: 10/24/2023] [Revised: 12/11/2023] [Accepted: 01/17/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE The study was conducted to evaluate the safety and efficacy of mild internal jugular (IJV) compression via an FDA approved compression collar for symptomatic treatment of venous pulsatile tinnitus. METHODS This is a prospective study that recruited 20 adult patients with venous pulsatile tinnitus. Participants completed the Tinnitus Handicap Inventory (THI), were fitted with the collar, and rated symptom intensity on a 10-point tinnitus intensity scale before and during collar use. Once weekly for 4 weeks, they answered a survey quantifying days used, average tinnitus intensity before and after wearing the collar each day of use, and any safety concerns. Lastly, they completed an exit interview. The primary outcome was symptomatic relief, with secondary outcomes of safety, effect of treatment setting, effect of time, and quality of life assessed via nonparametric testing. RESULTS 18 participants completed the study, and 276 paired daily before use/during use intensity scores were submitted. The median symptom intensity without the collar was 6 (IQR 4, 7), whereas with the collar it was 3 (IQR 2, 5), for a median symptomatic relief of 50%. The collar had a significant effect in reducing symptom intensity (p < 0.0001) and burden of illness via the THI (p < 0.0001). There was no effect of setting, frequency, or time on symptomatic relief with the collar. There were no adverse safety events reported aside from minor discomfort upon initial application. CONCLUSIONS Venous compression collars offer acute symptom relief for patients with venous pulsatile tinnitus. Further study is needed to assess safety and efficacy of longitudinal use. LEVEL OF EVIDENCE 4 Laryngoscope, 134:3342-3348, 2024.
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Affiliation(s)
- Benjamin Succop
- Chapel Hill School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nicholas J Thompson
- Chapel Hill Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Matthew M Dedmon
- Chapel Hill Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Aaron Gelinne
- Chapel Hill Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anne Selleck
- Chapel Hill Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Samuel Reed
- Chapel Hill Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Maj Brian D Sindelar
- Chapel Hill Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
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Pandey A, Schreiber C, Garton ALA, Araveti N, Goldberg JL, Kocharian G, Carnevale JA, Boddu SR. Foundations of the Diagnosis and Management of Idiopathic Intracranial Hypertension and Pulsatile Tinnitus. World Neurosurg 2024; 184:361-371. [PMID: 38590070 DOI: 10.1016/j.wneu.2023.12.125] [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] [Received: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 04/10/2024]
Abstract
Venous sinus stenosis has garnered increasing academic attention as a potential etiology of idiopathic intracranial hypertension (IIH) and pulsatile tinnitus (PT). The complex anatomy of the cerebral venous sinuses and veins plays a crucial role in the pathophysiology of these conditions. Venous sinus stenosis, often found in the superior sagittal or transverse sinus, can lead to elevated intracranial pressure (ICP) and characteristic IIH symptoms. Stenosis, variations in dural venous anatomy, and flow dominance patterns contribute to aberrant flow and subsequent PT. Accurate imaging plays a vital role in diagnosis, and magnetic resonance (MR) venography is particularly useful for detecting stenosis. Management strategies for IIH and PT focus on treating the underlying disease, weight management, medical interventions, and, in severe cases, surgical or endovascular procedures. Recently, venous sinus stenting has gained interest as a minimally invasive treatment option for IIH and PT. Stenting addresses venous sinus stenosis, breaking the feedback loop between elevated ICP and stenosis, thus reducing ICP and promoting cerebrospinal fluid outflow. The correction and resolution of flow aberrances can also mitigate or resolve PT symptoms. While venous sinus stenting remains an emerging field, initial results are promising. Further research is needed to refine patient selection criteria and evaluate the long-term efficacy of stenting as compared to traditional treatments.
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Affiliation(s)
- Abhinav Pandey
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Craig Schreiber
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Andrew L A Garton
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | | | - Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Gary Kocharian
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Joseph A Carnevale
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Srikanth R Boddu
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA.
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3
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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.
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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
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4
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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.
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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
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5
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Tao AJ, Parikh NS, Patsalides A. The role of noninvasive imaging in the diagnostic workup for pulsatile tinnitus. Neuroradiol J 2021; 35:220-225. [PMID: 34459683 DOI: 10.1177/19714009211036696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE We sought to assess the diagnostic yield of advanced noninvasive imaging in the evaluation of patients with pulsatile tinnitus. BACKGROUND Pulsatile tinnitus can be caused by high-risk cerebrovascular pathologies such as arteriovenous fistulae. The role of advanced noninvasive imaging, including magnetic resonance angiography and magnetic resonance venography, in the diagnostic evaluation of pulsatile tinnitus is not well defined. DESIGN AND METHODS We performed a retrospective cohort study of patients presenting for outpatient diagnostic evaluation of pulsatile tinnitus from January 2018 to March 2020 at Weill Cornell Medicine. Patients with non-pulsatile tinnitus and established etiologic diagnoses were excluded. Systematic chart abstraction was summarized using standard descriptive statistics. Univariate logistic regression was used to identify factors associated with nondiagnostic noninvasive imaging. RESULTS A total of 187 patients (139 (74.3%) women) took part in this study, with a mean age of 48.6 years (standard deviation (SD) = 15.5 years) and a mean body mass index (BMI) of 26.9 kg/m2 (SD = 6.1 kg/m2). Of the 187 patients, 121 (64.7%) underwent exclusively noninvasive imaging, and 66 (35.3%) patients also had digital subtraction angiography (DSA). In patients who had exclusively noninvasive imaging, 62 (51.2%) patients received a diagnosis. In patients who underwent noninvasive and DSA imaging, 14 (21.2%) patients received a diagnosis based on DSA. Patients who were older at symptom onset (odds ratio (OR) = 1.05; 95% confidence interval (CI) 1.01-1.09) and those with a lower BMI (OR = 0.88, 95% CI 0.77-0.98) were more likely to have nondiagnostic noninvasive imaging. CONCLUSION Noninvasive cerebrovascular imaging often uncovers the etiology of pulsatile tinnitus. DSA remains useful for additional evaluation for patients with specific associated features.
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Affiliation(s)
- Alice J Tao
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, USA
| | - Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, USA
| | - Athos Patsalides
- Department of Neurological Surgery, 24945North Shore University Hospital, North Shore University Hospital, Manhasset, NY
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Foo SY, Swaminathan SK, Krings T. Dilated MMA sign in cDAVF and other arterial feeders on 3D TOF MRA. Neuroradiol J 2021; 35:290-299. [PMID: 34449286 PMCID: PMC9244742 DOI: 10.1177/19714009211041530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Among the varied causes of pulsatile tinnitus, the condition that can cause
severe mortality and morbidity is a cranial dural arteriovenous fistula
(cDAVF). This study aimed to assess the diagnostic accuracy of the dilated
middle meningeal artery on three-dimensional time-of-flight magnetic
resonance angiography in cranial dural arteriovenous fistula and to identify
other feeders that can aid in the detection of these lesions. Method Magnetic resonance angiography and digital subtraction angiography data of
all patients with cranial dural arteriovenous fistula treated in a single
tertiary referral center between 2007–2020 were included. The middle
meningeal artery and other feeders recorded from digital subtraction
angiography were assessed on magnetic resonance angiography. Results The overall agreement between readers in identifying the dilated middle
meningeal artery was substantial (κ = 0.878, 95% confidence interval:
0.775–0.982). The dilated middle meningeal artery indicated the presence of
a cranial dural arteriovenous fistula with a sensitivity of 79.49% (95%
confidence interval: 66.81–92.16), specificity of 100% (95% confidence
interval: 100.00–100.00), and negative predictive value of 94.56% (95%
confidence interval: 90.89–98.02). An area under the curve of 0.8341 was
observed for the ipsilateral middle meningeal artery, with a sensitivity of
92.2% and a specificity of 75.0% at a cut-off of 0.30 mm for identifying a
cranial dural arteriovenous fistula. Of 73 other feeders, the occipital,
meningohypophyseal trunk, ascending pharyngeal, and posterior meningeal
arteries contributed to a large proportion visualized on magnetic resonance
angiography (83.6% (41/49)). Conclusion The dilated middle meningeal artery sign is useful for identifying a cranial
dural arteriovenous fistula. Dilatation of the occipital and ascending
pharyngeal arteries and meningohypophyseal trunk should be assessed to
facilitate the detection of a cranial dural arteriovenous fistula,
particularly in the transverse-sigmoid and petrous regions.
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Affiliation(s)
- Sin Y Foo
- Diagnostic Neuroradiology Fellowship Program, Temerty Faculty of Medicine, Canada
| | | | - Timo Krings
- Division of Neuroradiology, Toronto Western Hospital (University Health Network), Canada
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7
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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.
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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.
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8
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Pulsatile tinnitus caused by an aberrant artery running over the surface of mastoid bone. Auris Nasus Larynx 2020; 48:1181-1188. [PMID: 32682595 DOI: 10.1016/j.anl.2020.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/11/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Pulsatile tinnitus (PT) caused by an aberrant artery is rare. We report an unprecedented cause of PT resulting from an aberrant artery coursing the mastoid surface, and qualitatively discuss the pathophysiology of PT. METHODS This case study reports a 41-year-old woman who presented with persistent PT at her right retromastoid region. Contrast-enhanced computed tomography revealed an aberrant branch of the artery that coursed over the cortex of the mastoid bone. Surgical ligation of this aberrant artery was performed under local anesthesia. RESULTS Intraoperative findings suggested that PT transmitted via bone-conduction route due to the direct contact of the vascular and mastoid surface. PT was completely resolved upon surgical removal of this causative segment. Ultrasonographic and hemodynamic analysis showed that the turbulent kinetic energy and high regional wall pressure were the major contributory factors causing PT. Spectro-temporal analysis showed that PT fluctuates at frequency 500~2000 Hz, which differs from those of venous PT. CONCLUSION Judicious preoperative and intraoperative assessments of PT ensure the surgical efficacy of PT. Objective ultrasonographic and computational studies can provide detailed hydroacoustic characteristics of PT.
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Onishi ET, Coelho CCDB, Oiticica J, Figueiredo RR, Guimarães RDCC, Sanchez TG, Gürtler AL, Venosa AR, Sampaio ALL, Azevedo AA, Pires APBDÁ, Barros BBDC, Oliveira CACPD, Saba C, Yonamine FK, Medeiros ÍRTD, Rosito LPS, Rates MJA, Kii MA, Fávero ML, Santos MADO, Person OC, Ciminelli P, Marcondes RDA, Moreira RKDP, Torres SDMS. Tinnitus and sound intolerance: evidence and experience of a Brazilian group. Braz J Otorhinolaryngol 2018; 84:135-149. [PMID: 29339026 PMCID: PMC9449167 DOI: 10.1016/j.bjorl.2017.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 12/07/2017] [Indexed: 12/13/2022] Open
Abstract
Introduction Tinnitus and sound intolerance are frequent and subjective complaints that may have an impact on a patient's quality of life. Objective To present a review of the salient points including concepts, pathophysiology, diagnosis and approach of the patient with tinnitus and sensitivity to sounds. Methods Literature review with bibliographic survey in LILACS, SciELO, Pubmed and MEDLINE database. Articles and book chapters on tinnitus and sound sensitivity were selected. The several topics were discussed by a group of Brazilian professionals and the conclusions were described. Results The prevalence of tinnitus has increased over the years, often associated with hearing loss, metabolic factors and inadequate diet. Medical evaluation should be performed carefully to guide the request of subsidiary exams. Currently available treatments range from medications to the use of sounds with specific characteristics and meditation techniques, with variable results. Conclusion A review on tinnitus and auditory sensitivity was presented, allowing the reader a broad view of the approach to these patients, based on scientific evidence and national experience.
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Ergen B, Baykara M, Polat C. Determination of the relationship between internal auditory canal nerves and tinnitus based on the findings of brain magnetic resonance imaging. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2017.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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.
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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
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12
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Lin YH, Wang YF, Liu HM, Lee CW, Chen YF, Hsieh HJ. Diagnostic accuracy of CTA and MRI/MRA in the evaluation of the cortical venous reflux in the intracranial dural arteriovenous fistula DAVF. Neuroradiology 2017; 60:7-15. [PMID: 29188304 DOI: 10.1007/s00234-017-1948-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 11/09/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Computed tomography angiography (CTA) and magnetic resonance imaging/angiography (MRI/MRA) are used for the diagnosis of intracranial dural arteriovenous fistulas (DAVFs). The purpose of this study was to compare the diagnostic accuracy of CTA and magnetic resonance imaging/angiography (MRI/MRA) for detection of cortical venous reflux (CVR) in intracranial DAVFs. METHODS The records of patients with angiography-confirmed intracranial DAVFs who also received CTA and MRI/MRA from January 2008 to July 2016 were reviewed. CTA and MRI/MRA were reviewed for signs of CVR, and the diagnostic accuracy of individual signs was evaluated by receiver operating curve (ROC) analysis. RESULTS A total 108 patients were included in this study. CTA signs of CVR included abnormal dilatation, early enhancement, and the presence of a medullary or pial vein. MRI/MRA signs of CVR included abnormal dilatation, early enhancement, flow-related enhancement, flow void, and medullary or pial venous collaterals. The sensitivity of individual CTA signs ranged from 62 to 96%, and specificities from 79 to 94%. The sensitivities of individual MRI/MRA signs ranged from 58 to 83%, and specificities from 77 to 93%. The area under ROC curve (AUC) of CTA and MRI/MRA were 0.91 and 0.87, respectively (P = 0.04 in direct comparison). In subgroup analysis, CTA had better diagnostic accuracy for higher grade disease (P = 0.05) and non-aggressive manifestation (P = 0.04). CONCLUSIONS Both CTA and MRI/MRA have good diagnostic accuracy for detection of CVR in patients with intracranial DAVFs. There is modest evidence that CTA is better than MRI/MRA.
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Affiliation(s)
- Yen-Heng Lin
- Department of Medical Imaging and Radiology, Hospital and Medical College, National Taiwan University, Taipei, Taiwan
- Department of Medical Imaging, National Taiwan University Hospital, Yun-Lin branch, Douliu City, Taiwan
| | - Yu-Fen Wang
- Department of Medical Imaging and Radiology, Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Hon-Man Liu
- Department of Medical Imaging and Radiology, Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
- Department of Medical Imaging and Radiology, Hospital and Medical College, Fu Jen Catholic University, New Taipei City, Taiwan.
- Department of Medical Imaging, Fu Jen Catholic University Hospital, 69, Guizi Rd., Taishan Dist., New Taipei City, 24352, Taiwan.
| | - Chung-Wei Lee
- Department of Medical Imaging and Radiology, Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Ya-Fang Chen
- Department of Medical Imaging and Radiology, Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Hong-Jen Hsieh
- Department of Medical Imaging, National Taiwan University Hospital, Yun-Lin branch, Douliu City, Taiwan
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Thomassin JM, Rossi ME, Reyre A. Acufeni oggettivi. Neurologia 2017. [DOI: 10.1016/s1634-7072(17)83855-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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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.
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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
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Lin YH, Lin HH, Liu HM, Lee CW, Chen YF. Diagnostic performance of CT and MRI on the detection of symptomatic intracranial dural arteriovenous fistula: a meta-analysis with indirect comparison. Neuroradiology 2016; 58:753-63. [PMID: 27185610 DOI: 10.1007/s00234-016-1696-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 05/03/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study aims to review the diagnostic performance of computed tomography (CT) and magnetic resonance imaging (MRI) in symptomatic dural arteriovenous fistula (DAVF). METHODS EMBASE, PubMed, and Cochrane Library were searched until April 2015 for studies which compared CT, MRI, or both with angiography for the detection of DAVF. The diagnostic performances of MRI and CT were indirectly compared using modality as a covariate in the analysis. RESULTS Thirteen studies met our inclusion criteria. MRI had a sensitivity of 0.90 (95 % confidence interval (CI) = 0.83-0.94) and specificity of 0.94 (95 % CI = 0.90-0.96). CT had a sensitivity of 0.80 (95 % CI = 0.62-0.90) and specificity of 0.87 (95 % CI = 0.74-0.94). MRI showed better diagnostic performance than CT (p = 0.02). Contrast medium use and time-resolved MR angiography did not improve MRI diagnostic performance (p = 0.31 and 0.44, respectively). CONCLUSION Both CT and MRI had good diagnostic performance. MRI was better than CT on the detection of symptomatic intracranial dural arteriovenous fistula in the indirect comparison.
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Affiliation(s)
- Yen-Heng Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medical Imaging and Radiology, Hospital and Medical College, National Taiwan University Hospital in Taipei and Yuan-Lin Branch, 7, Chung-Shan South Road, Taipei, Taiwan, 10016
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Hon-Man Liu
- Department of Medical Imaging and Radiology, Hospital and Medical College, National Taiwan University Hospital in Taipei and Yuan-Lin Branch, 7, Chung-Shan South Road, Taipei, Taiwan, 10016.
| | - Chung-Wei Lee
- Department of Medical Imaging and Radiology, Hospital and Medical College, National Taiwan University Hospital in Taipei and Yuan-Lin Branch, 7, Chung-Shan South Road, Taipei, Taiwan, 10016
| | - Ya-Fang Chen
- Department of Medical Imaging and Radiology, Hospital and Medical College, National Taiwan University Hospital in Taipei and Yuan-Lin Branch, 7, Chung-Shan South Road, Taipei, Taiwan, 10016
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Onishi ET, Barros BBDC, Hirose FT, Yonamine FK. Pulsatile tinnitus related to progestin from intrauterine device. Braz J Otorhinolaryngol 2016; 82:365-7. [PMID: 26480906 PMCID: PMC9444590 DOI: 10.1016/j.bjorl.2015.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 03/29/2015] [Accepted: 04/11/2015] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ektor Tsuneo Onishi
- Division of Otology and Otoneurology, Department of Otolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Bruno Borges de Carvalho Barros
- Division of Otology and Otoneurology, Department of Otolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Fernando Takashi Hirose
- Division of Otology and Otoneurology, Department of Otolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Fernando Kaoru Yonamine
- Division of Otology and Otoneurology, Department of Otolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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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.
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Affiliation(s)
- Pravin Mundada
- Department of Radiology, Changi General Hospital, Singapore
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Ahsan SF, Seidman M, Yaremchuk K. What is the best imaging modality in evaluating patients with unilateral pulsatile tinnitus? Laryngoscope 2014; 125:284-5. [PMID: 25042105 DOI: 10.1002/lary.24822] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/16/2014] [Accepted: 06/16/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Syed F Ahsan
- Department of Otolaryngolog-Head and Neck Surgery, Henry Ford Health Systems, Detroit, Michigan, U.S.A
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