1
|
Alashram AR. Effects of tinnitus retraining therapy on patients with tinnitus: a systematic review of randomized controlled trials. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08907-3. [PMID: 39153142 DOI: 10.1007/s00405-024-08907-3] [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: 07/12/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE This review aims to explore the influences of tinnitus retraining therapy (TRT) on patients with tinnitus. METHODS PubMed, MEDLINE, EMBASE, CINAHL, PEDro, SCOPUS, and Web of Science were screened for randomized controlled trials (RCTs) that explored the effects of TRT on patients with tinnitus from inception to June 30, 2024. The methodological quality of the included RCTs was evaluated using the physiotherapy evidence database (PEDro) scale. RESULTS Fifteen studies met our eligibility criteria. A total of 2069 patients with tinnitus (mean age 52.93 years; 66% male) were involved in the present review. The quality of the selected studies ranged from 5 to 8 on the PEDro scale, with a median score of 7. TRT did not provide superior effects in treating patients with tinnitus compared to tinnitus masking (TM), tinnitus educational counselling (TED), TRT with open ear hearing aids, Tailor-made notched music training (TMNMT), partial TRT, usual care, and smart TRT. CONCLUSIONS TRT intervention is considered a treatment option for patients with tinnitus. Combining TRT with other interventions, such as cognitive-behavioral therapy, pharmacotherapy, or tDS, may show even greater efficacy. Additional studies are strongly required to recognize the long-term effects of TRT on tinnitus, determine who most likely would benefit from the intervention regarding tinnitus type and severity, and identify the optimal treatment protocol.
Collapse
Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Airport Road 1666, Amman, Jordan.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
- Centre of SpaceBio-Medicine, Department of Systems Medicine, Faculty of Medicine and Surgery, University of Rome "Tor Vergata", 00133, Rome, Italy.
| |
Collapse
|
2
|
Alashram AR. The efficacy of transcranial random noise stimulation in treating tinnitus: a systematic review. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08858-9. [PMID: 39046497 DOI: 10.1007/s00405-024-08858-9] [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: 06/29/2024] [Accepted: 07/17/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE This review aims to examine the effects of transcranial random noise stimulation (tRNS) on tinnitus and to determine the optimal treatment parameters, if possible. METHODS A comprehensive search, including MEDLINE, PubMed, EMBASE, CINAHL, SCOPUS, and PEDro, was conducted to determine experiments studying the effects of tRNS on tinnitus from inception to March 1, 2024. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the quality of the included studies. RESULTS Seven studies met the eligibility criteria. A total of 616 patients with non-pulsatile tinnitus (mean age 50.93 years; 66% males) were included in this review. The included studies ranged from 3 to 8 out of 10 (median = 7) on the PEDro scale. The results showed that tRNS is an effective intervention in reducing tinnitus symptoms. CONCLUSIONS The evidence for the effects of tRNS on people with chronic non-pulsatile tinnitus is promising. Administering tRNS with an intensity of 1-2 mA, high-frequency (101-650 Hz), using a 35 cm² electrode size over the auditory cortex and DLPFC, for 20 min with eight sessions may demonstrate the desired tRNS effects. The tRNS stimulation should be contralateral for unilateral tinnitus and bilaterally for bilateral tinnitus. Combining tRNS with other concurrent interventions may show superior effects in reducing tinnitus compared to tRNS alone. Further high-quality studies with larger sample sizes are strongly needed.
Collapse
Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Airport Road, Amman, 1666, Jordan.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Centre of SpaceBio-Medicine, Department of Systems Medicine, Faculty of Medicine and Surgery, San Raffaele Roma Open University, University of Rome "Tor Vergata", Rome, 00133, Italy.
| |
Collapse
|
3
|
Reddy A, Pan Y, Finberg A, Dong H, Kesser B. Flow Analysis of Central Venous Outflow Tract: A New Approach to Understanding Pulse-Synchronous Tinnitus. Otolaryngol Head Neck Surg 2024. [PMID: 38984878 DOI: 10.1002/ohn.891] [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: 01/07/2024] [Revised: 06/02/2024] [Accepted: 06/05/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE Pulse-synchronous tinnitus (PST) has been linked to multiple anatomical variants of the central venous outflow tract (CVOT) including sigmoid sinus (SS) dehiscence and diverticulum. This study investigates flow turbulence, pressure, and wall shear stress along the CVOT and proposes a mechanism that results in SS dehiscence and PST. STUDY DESIGN Case series. SETTING Tertiary Academic Center. METHODS Venous models were reconstructed from computed tomography scans of 3 patients with unilateral PST. Two models for each patient are obtained: a symptomatic and contralateral asymptomatic side. A turbulent model-enabled commercial flow solver was used to simulate the pulsatile blood flow over the cardiac cycle through the models. Fluid flow through the transverse and SS junction was analyzed to observe the velocity, pressure, turbulent kinetic energy (TKE), and shear stress over a simulated cardiac cycle. RESULTS Fluid flow on the symptomatic side showed increased vorticity in the presence of an SS diverticulum. Higher TKE with periodicity following the cardiac cycle was observed on the symptomatic side, and a sharp increase was observed if SS diverticulum was present. Shear stress was highest near the narrowest segments of the vessel. Pressure was observed to be lower on the symptomatic side at the transverse-SS junction for all 3 patients. CONCLUSION Computational fluid dynamics modeling of blood flow through the CVOT in PST suggests that low pressure may be the cause of dehiscence, and tinnitus may result from periodic increases in TKE.
Collapse
Affiliation(s)
- Adithya Reddy
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Yu Pan
- Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Ariel Finberg
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Haibo Dong
- Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Bradley Kesser
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, 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
|
Capirossi C, Laiso A, Capasso F, Nappini S, Renieri L, Limbucci N. Pulsatile tinnitus due to stenosis of the supraclinoid segment of the internal carotid artery: Management with a low-profile self-expanding stent. Interv Neuroradiol 2024; 30:293-296. [PMID: 35656750 PMCID: PMC11095354 DOI: 10.1177/15910199221106036] [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: 03/17/2022] [Revised: 05/06/2022] [Accepted: 05/15/2022] [Indexed: 11/16/2022] Open
Abstract
Atherosclerotic stenosis of the internal carotid artery is a rare cause of pulsatile tinnitus. Stenosis responsible for tinnitus is usually located in the petrous segment of the vessel or, even more uncommonly, in the extracranial segment. However, to the best of our knowledge, a stenosis of the intradural supraclinoid segment of the internal carotid had never been reported as a source of pulsatile tinnitus. We describe the case of a man with a history of previous ischaemic stroke and invalidating pulsatile tinnitus, caused by a high grade, diaphragm-like shaped, stenosis of the supraclinoid internal carotid artery. The stenosis was treated with angioplasty and stenting with a low-profile self-expanding high radial force stent (Acclino flex HRF, Acandis). Tinnitus disappeared immediately after the procedure. At the two-year follow-up no recurrence of the tinnitus and the stenosis occurred. Intradural internal carotid artery stenosis should be considered as a very rare cause of pulsatile tinnitus.
Collapse
Affiliation(s)
- Carolina Capirossi
- Neurovascular Interventional Unit, University Hospital Careggi, Florence, Italy
| | - Antonio Laiso
- Neurovascular Interventional Unit, University Hospital Careggi, Florence, Italy
| | - Francesco Capasso
- Neurovascular Interventional Unit, University Hospital Careggi, Florence, Italy
| | - Sergio Nappini
- Neurovascular Interventional Unit, University Hospital Careggi, Florence, Italy
| | - Leonardo Renieri
- Neurovascular Interventional Unit, University Hospital Careggi, Florence, Italy
| | - Nicola Limbucci
- Neurovascular Interventional Unit, University Hospital Careggi, Florence, Italy
| |
Collapse
|
6
|
Widmeyer JR, Vemuri JP, Jacobs J, Sismanis AA, Haines SR, Felton WL, Coelho DH. Clinical Predictors of Pulsatile Tinnitus in Patients With Idiopathic Intracranial Hypertension: An Age-Matched Cohort Study. Otol Neurotol 2024; 45:195-199. [PMID: 38152027 DOI: 10.1097/mao.0000000000004084] [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: 12/29/2023]
Abstract
INTRODUCTION Pulsatile tinnitus (PT) occurs in many but not all patients with idiopathic intracranial hypertension (IIH). It is poorly understood why some patients with IIH develop PT, yet others do not. The purpose of this study was to determine if any clinical findings differ between those with and without PT in IIH, potentially shedding light on a pathophysiologic mechanism. METHODS Age-matched cohort analysis of patients with documented IIH and presence or absence of PT was performed, collecting data including body mass index (BMI), blood pressure, visual acuity, cerebrospinal fluid (CSF) opening pressure, sleep apnea, migraines, and transient visual obscurations, among others. Independent-sample t test and χ2 test were used to analyze continuous and binary variables, respectively, with multivariate analysis conducted including variables statistically significant on univariate analysis. RESULTS Eighty subjects with IIH met the inclusion criteria (40 PT+, 40 PT-). CSF opening pressure showed no significant difference between the two groups. The PT+ cohort was found to have an average BMI of 45.1 kg/m 2 , which was significantly higher than the PT- group (37.7 kg/m 2 ; p = 0.0023). PT+ pulse pressure (60.1 mm Hg) was also significantly higher than the PT- group (51.6 mm Hg; p = 0.019). PT+ patients were also significantly more likely to have sleep apnea ( p < 0.001) and migraines ( p = 0.0036). Multiple logistic regression revealed an adjusted odds ratio of 13.9 for sleep apnea, 4.1 for migraines, and 1.01 for every increase in unit of BMI. CONCLUSION Among patients with IIH, presence of PT is associated with higher BMI and pulse pressure, and increased incidence of sleep apnea and migraines. Given no significant difference in CSF pressures between the two groups, PT may not be a product of increased disease severity but may be related to sequelae of obesity, such as increased pulse pressure and sleep apnea.
Collapse
Affiliation(s)
| | | | - Jonathon Jacobs
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA
| | | | - Scott R Haines
- Division of Neuro-Ophthalmology, Department of Neurology
| | | | | |
Collapse
|
7
|
Wang F, Buchberger M, Böck K, Wirth M. Essential Palatal Myoclonus and Clicking Tinnitus in a Nine-Year-Old Boy-A Case Report. Laryngoscope 2024; 134:397-399. [PMID: 37161907 DOI: 10.1002/lary.30734] [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: 07/10/2022] [Revised: 02/22/2023] [Accepted: 04/01/2023] [Indexed: 05/11/2023]
Abstract
The work describes a case of palatal myoclonus with distressing tinnitus in a 9-year-old boy and its successful treatment with injections of botulinum toxin. This case report discusses common questions about myoclonic-induced clicking tinnitus and provides answers. Laryngoscope, 134:397-399, 2024.
Collapse
Affiliation(s)
- Fang Wang
- Department of Otorhinolaryngology/Head & Neck Surgery of the university hospital Klinikum rechts der Isar, The university hospital Klinikum rechts der Isar, Munich, Bayern, Germany
| | - Maria Buchberger
- Department of Otorhinolaryngology/Head & Neck Surgery of the university hospital Klinikum rechts der Isar, The university hospital Klinikum rechts der Isar, Munich, Bayern, Germany
| | - Katja Böck
- Department of Otorhinolaryngology/Head & Neck Surgery of the university hospital Klinikum rechts der Isar, The university hospital Klinikum rechts der Isar, Munich, Bayern, Germany
| | - Markus Wirth
- Department of Otorhinolaryngology/Head & Neck Surgery of the university hospital Klinikum rechts der Isar, The university hospital Klinikum rechts der Isar, Munich, Bayern, Germany
| |
Collapse
|
8
|
Vasilkov V, Caswell-Midwinter B, Zhao Y, de Gruttola V, Jung DH, Liberman MC, Maison SF. Evidence of cochlear neural degeneration in normal-hearing subjects with tinnitus. Sci Rep 2023; 13:19870. [PMID: 38036538 PMCID: PMC10689483 DOI: 10.1038/s41598-023-46741-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/04/2023] [Indexed: 12/02/2023] Open
Abstract
Tinnitus, reduced sound-level tolerance, and difficulties hearing in noisy environments are the most common complaints associated with sensorineural hearing loss in adult populations. This study aims to clarify if cochlear neural degeneration estimated in a large pool of participants with normal audiograms is associated with self-report of tinnitus using a test battery probing the different stages of the auditory processing from hair cell responses to the auditory reflexes of the brainstem. Self-report of chronic tinnitus was significantly associated with (1) reduced cochlear nerve responses, (2) weaker middle-ear muscle reflexes, (3) stronger medial olivocochlear efferent reflexes and (4) hyperactivity in the central auditory pathways. These results support the model of tinnitus generation whereby decreased neural activity from a damaged cochlea can elicit hyperactivity from decreased inhibition in the central nervous system.
Collapse
Affiliation(s)
- Viacheslav Vasilkov
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA
| | - Benjamin Caswell-Midwinter
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA
| | - Yan Zhao
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
| | - Victor de Gruttola
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02114, USA
| | - David H Jung
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA
| | - M Charles Liberman
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA
| | - Stéphane F Maison
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA.
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA.
| |
Collapse
|
9
|
Jain V, Policeni B, Juliano AF, Adunka O, Agarwal M, Dubey P, Friedman ER, Gule-Monroe MK, Hagiwara M, Hunt CH, Lo BM, Oh ES, Rath TJ, Roberts JK, Schultz D, Taheri MR, Zander D, Burns J. ACR Appropriateness Criteria® Tinnitus: 2023 Update. J Am Coll Radiol 2023; 20:S574-S591. [PMID: 38040471 DOI: 10.1016/j.jacr.2023.08.017] [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: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Tinnitus is abnormal perception of sound and has many subtypes. Clinical evaluation, audiometry, and otoscopy should be performed before ordering any imaging, as the choice of imaging will depend on various factors. Type of tinnitus (pulsatile or nonpulsatile) and otoscopy findings of a vascular retrotympanic lesion are key determinants to guide the choice of imaging studies. High-resolution CT temporal bone is an excellent tool to detect glomus tumors, abnormal course of vessels, and some other abnormalities when a vascular retrotympanic lesion is seen on otoscopy. CTA or a combination of MR and MRA/MRV are used to evaluate arterial or venous abnormalities like dural arteriovenous fistula, arteriovenous malformation, carotid stenosis, dural sinus stenosis, and bony abnormalities like sigmoid sinus wall abnormalities in cases of pulsatile tinnitus without a vascular retrotympanic lesion. MR of the brain is excellent in detecting mass lesions such as vestibular schwannomas in cases of unilateral nonpulsatile tinnitus. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
Affiliation(s)
- Vikas Jain
- MetroHealth Medical Center, Cleveland, Ohio.
| | - Bruno Policeni
- Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Oliver Adunka
- The Ohio State University Wexner Medical Center, Columbus, Ohio; American Academy of Otolaryngology-Head and Neck Surgery
| | - Mohit Agarwal
- Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | - Mari Hagiwara
- New York University Langone Medical Center, New York, New York
| | - Christopher H Hunt
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | - Bruce M Lo
- Sentara Norfolk General Hospital/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - Esther S Oh
- Johns Hopkins University School of Medicine, Baltimore, Maryland; American Geriatrics Society
| | | | - J Kirk Roberts
- Columbia University Medical Center, New York, New York; American Academy of Neurology
| | - David Schultz
- Evansville Primary Care, Evansville, Indiana; American Academy of Family Physicians
| | - M Reza Taheri
- George Washington University Hospital, Washington, District of Columbia
| | | | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
| |
Collapse
|
10
|
Ibrahim R, Ferng J, Pineda JRE, Lee K. A case report of self-audible pericardial rub secondary to acute pericarditis from post-pericardiotomy syndrome (pericardial rub tinnitus). Eur Heart J Case Rep 2023; 7:ytad333. [PMID: 37547373 PMCID: PMC10398423 DOI: 10.1093/ehjcr/ytad333] [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: 01/18/2023] [Revised: 02/27/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
Background Pericarditis is a common pericardial disorder that is frequently accompanied by a pericardial friction rub, which can be detected during a physical examination. Although patients' awareness of cardiac murmurs and vascular bruits has been extensively reported, there are no reports on patients' self-awareness of a pericardial friction rub. Case summary We present the first case of a patient with acute pericarditis associated with objective self-awareness of a pericardial friction rub, which we recorded with an electronic stethoscope and confirmed the sound with the patient. The patient had a recent history of three-vessel coronary artery bypass grafting and presented with a progressively worsening, rhythmic, and 'sandpaper-scratching' sound in both ears. The sound was more pronounced in the left lateral decubitus position. The symptom resolved with colchicine therapy and was associated with concomitant resolution of the pericardial friction rub. Discussion This is the first documented case of a patient demonstrating objective self-awareness of a pericardial rub resulting from acute pericarditis associated with post-pericardiotomy syndrome. Tinnitus refers to the perception of an auditory sensation that can be subjective or objective, depending on whether it is heard only by the individual or can also be heard by an observer. While objective tinnitus caused by cardiovascular conditions has been previously reported, no cases have attributed the pericardial friction rub as the underlying cause. Therefore, we suggest using the term pericardial rub tinnitus to describe this unique phenomenon.
Collapse
Affiliation(s)
| | - Jonathan Ferng
- Department of Medicine, University of Arizona–Banner University Medical Center, 6th Floor, Room 6336, 1501 N. Campbell Ave., Tucson, AZ 85719, USA
| | - J R Exequiel Pineda
- Department of Cardiology, Sarver Heart Center, University of Arizona–Banner University Medical Center, 1625 N, Campbell Ave., Tucson, AZ 85719, USA
| | | |
Collapse
|
11
|
Henry JA. Directed Attention and Habituation: Two Concepts Critical to Tinnitus Management. Am J Audiol 2023:1-8. [PMID: 36862559 DOI: 10.1044/2022_aja-22-00178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
PURPOSE Directed attention and habituation are key concepts pertaining to clinical intervention for bothersome tinnitus. Directed attention is the strategy of distracting attention away from the tinnitus. Habituation is the process of learning to stop paying attention to stimuli that are irrelevant or meaningless. Although tinnitus may be intrusive, it usually does not reflect some underlying condition requiring medical attention. Tinnitus in most instances is therefore considered an irrelevant, meaningless stimulus that is best treated by facilitating habituation to the phantom sound. This tutorial describes directed attention and habituation and how they relate to major behavioral methods of tinnitus intervention. METHOD Arguably, the four major behavioral methods of tinnitus intervention with the strongest research evidence are cognitive behavioral therapy (CBT), tinnitus retraining therapy (TRT), tinnitus activities treatment (TAT), and progressive tinnitus management (PTM). Each of these four methods was evaluated to determine the role of directed attention as a treatment strategy and habituation as a treatment goal. RESULTS All four of the methods (CBT, TRT, TAT, and PTM) utilize some form of directed attention as a component of their counseling. Habituation is the explicit or implicit goal of each of these methods. CONCLUSIONS Directed attention and habituation are essential concepts for all of the major methods of behavioral intervention for tinnitus that were studied. It would therefore seem appropriate to include directed attention as a universal treatment strategy for bothersome tinnitus. Likewise, the commonality of habituation as the objective of treatment would suggest that habituation should be the universal goal of any method that is intended to mitigate the emotional and functional effects of tinnitus.
Collapse
Affiliation(s)
- James A Henry
- VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR.,Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| |
Collapse
|
12
|
Grundfast KM, Jamil TL. Evaluation and Management of Tinnitus: Are There Opportunities for Improvement? Otolaryngol Head Neck Surg 2023; 168:45-58. [PMID: 35349391 DOI: 10.1177/01945998221088286] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review current information about diagnosis and management of tinnitus aiming to identify opportunities for achieving a cost-effective, efficient, evidence-based approach that meets the needs of tinnitus sufferers. DATA SOURCES PubMed/MEDLINE. REVIEW METHODS In total, 249 relevant published reports were reviewed. Pertinent keywords and MeSH terms identified reports via PubMed and EMBASE. Acknowledged experts were consulted on ways to improve tinnitus management. CONCLUSIONS There may be opportunities to improve evaluation and management of patients with tinnitus using modern modes of communication and a multidisciplinary therapeutic approach. IMPLICATIONS FOR PRACTICE Tinnitus can adversely affect quality of life while being time-consuming and costly to evaluate and manage. Based on both personal experience and the reports of others, patients with tinnitus who choose to see a physician primarily want to know two things: (1) that the tinnitus that is so distressing will not remain at the same level of severity forever and (2) that something can be done to help cope with the tinnitus that is so annoying. Recent advancements in internet communications, social media, information technology, artificial intelligence, machine learning, holistic medical care, mind-body integrative health care, and multidisciplinary approaches in medical therapeutics may be possibly making new ways of meeting the needs of patients with tinnitus.
Collapse
Affiliation(s)
- Kenneth M Grundfast
- Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Otology Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Taylor L Jamil
- Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
13
|
Yang B, Zhang F, Jiang X. Bilateral Pulsatile Tinnitus Caused by Bilateral Dilated Mastoid Emissary Vein. EAR, NOSE & THROAT JOURNAL 2022:1455613221077597. [PMID: 35171065 DOI: 10.1177/01455613221077597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pulsatile tinnitus is a rhythmic type of tinnitus. Most cases are caused by vascular disorders and present as synchronous with the patient's heartbeat. A dilated mastoid emissary vein may cause pulsatile tinnitus. Here, we report the first case of bilateral pulsatile tinnitus caused by dilated bilateral mastoid emissary vein. The patient suffered from bilateral pulsatile tinnitus for 2 years. His bilateral tinnitus disappeared temporarily when the bilateral mastoid processes were compressed. Temporal bone computed tomographic (CT) showed the bilateral dilated mastoid emissary canals. Cranial Magnetic resonance venograms (MRV) showed the bilateral dilated mastoid emissary veins. We explained the risk of surgery to the patient. Because the patient could tolerate his tinnitus and did not have a hemangioma or tumor, he did not choose to undergo surgery.
Collapse
Affiliation(s)
- Bo Yang
- Department of Otolaryngology Head and Neck Surgery, 159407The First Affiliated Hospital of China Medical University, China
| | - Fang Zhang
- Department of Otolaryngology Head and Neck Surgery, 462540The Fourth Affiliated Hospital of China Medical University, China
| | - Xuejun Jiang
- Department of Otolaryngology Head and Neck Surgery, 159407The First Affiliated Hospital of China Medical University, China
| |
Collapse
|
14
|
Pillai A, Arora P, Asokan R, Joseph N, S S. Extracranial Internal Carotid Aneurysm Manifesting With Tinnitus: A Rare Presentation. Cureus 2022; 14:e21349. [PMID: 35198266 PMCID: PMC8850808 DOI: 10.7759/cureus.21349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/05/2022] Open
|
15
|
Haas LJ, Sabel BR, Harger MC, Martins J, Staedele GV, Camilo LCDO, Marques NT. Prevalence of Tinnitus in Patients Diagnosed with Cerebral Arteriovenous Fistula Treated with Endovascular Technique. Int Arch Otorhinolaryngol 2021; 26:e428-e433. [PMID: 35846821 PMCID: PMC9282971 DOI: 10.1055/s-0041-1740399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction
Tinnitus is characterized as the conscious and involuntary perception of sound, and it affects ∼ 30% of the population. Despite careful physical examination, the etiology of tinnitus can be established for only 30% of patients. Tinnitus is a common symptom of cerebral arteriovenous fistulas and results from increased blood flow through the dural venous sinuses, leading to turbulent arterial flow, mainly related to sigmoid and transverse sinus lesions.
Objectives
To analyze the frequency of tinnitus, patient profile, and endovascular treatment characteristics in individuals diagnosed with cerebral arteriovenous fistulas.
Methods
A retrospective and observational study based on reviewed data from medical records on the PHILIPS Tasy system (Philips Healthcare, Cambridge, MA, USA) at the neurosurgery and interventional neuroradiology service of Hospital Santa Isabel in Blumenau–state of Santa Catarina, Brazil.
Results
The profile of 68 individuals diagnosed with cerebral arteriovenous fistula who underwent endovascular treatment were analyzed. Most patients were female, aged 31 to 60. Tinnitus affected 18 individuals. Dural fistulas were the most prevalent in the sample, and computed tomography alone was the most used diagnostic method for initial investigation.
Conclusion
The prevalence of this symptom in patients diagnosed with cerebral arteriovenous fistula was found in 26.5% of this sample, mainly in women with associated comorbidities. Tinnitus remission was observed in all patients who underwent endovascular treatment to correct cerebral fistula.
Collapse
Affiliation(s)
- Leandro José Haas
- Department of Neurosurgery and Interventional Neuroradiology, Hospital Santa Isabel Blumenau, Blumenau, Santa Catarina, Brazil
| | - Bruno Rafael Sabel
- Department of Health Sciences, Fundação Universidade Regional de Blumenau, Blumenau, Santa Catarina, Brazil
| | - Mateus Campestrini Harger
- Department of Health Sciences, Fundação Universidade Regional de Blumenau, Blumenau, Santa Catarina, Brazil
| | - Julia Martins
- Department of Health Sciences, Fundação Universidade Regional de Blumenau, Blumenau, Santa Catarina, Brazil
| | | | | | - Natalia Tozzi Marques
- Department of Health Sciences, Fundação Universidade Regional de Blumenau, Blumenau, Santa Catarina, Brazil
| |
Collapse
|
16
|
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
|
17
|
Henton A, Tzounopoulos T. What's the buzz? The neuroscience and the treatment of tinnitus. Physiol Rev 2021; 101:1609-1632. [PMID: 33769102 DOI: 10.1152/physrev.00029.2020] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Tinnitus is a pervasive public health issue that affects ∼15% of the United States population. Similar estimates have also been shown on a global scale, with similar prevalence found in Europe, Asia, and Africa. The severity of tinnitus is heterogeneous, ranging from mildly bothersome to extremely disruptive. In the United States, ∼10-20% of individuals who experience tinnitus report symptoms that severely reduce their quality of life. Due to the huge personal and societal burden, in the last 20 yr a concerted effort on basic and clinical research has significantly advanced our understanding and treatment of this disorder. Yet, neither full understanding, nor cure exists. We know that tinnitus is the persistent involuntary phantom percept of internally generated nonverbal indistinct noises and tones, which in most cases is initiated by acquired hearing loss and maintained only when this loss is coupled with distinct neuronal changes in auditory and extra-auditory brain networks. Yet, the exact mechanisms and patterns of neural activity that are necessary and sufficient for the perceptual generation and maintenance of tinnitus remain incompletely understood. Combinations of animal model and human research will be essential in filling these gaps. Nevertheless, the existing progress in investigating the neurophysiological mechanisms has improved current treatment and highlighted novel targets for drug development and clinical trials. The aim of this review is to thoroughly discuss the current state of human and animal tinnitus research, outline current challenges, and highlight new and exciting research opportunities.
Collapse
Affiliation(s)
- A Henton
- Pittsburgh Hearing Research Center and Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - T Tzounopoulos
- Pittsburgh Hearing Research Center and Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
18
|
Hsieh YL, Xu X, Hsieh YD, Hsieh YC, Wang D, Guo P, Wang W. Hydroacoustic analysis and extraluminal compression surgical insights of venous pulsatile tinnitus. Auris Nasus Larynx 2021; 48:852-863. [PMID: 33468352 DOI: 10.1016/j.anl.2021.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to quantitatively and qualitatively evaluate the hydroacoustic changes from "presence" to "disappearance" of pulsatile tinnitus (PT) with the extraluminal compression surgical technique. The recent issues of concern pertaining to the hydroacoustic characteristics of sigmoid sinus wall anomalies and distal transverse sinus stenosis (dTSS) were discussed. METHODS This study was based on a retrospective case series. Seventy-seven patients with PT and transverse-sigmoid sinus enlargement with or without transverse-sigmoid sinus junction anomalies and transverse sinus stenosis (TSS) who had undergone extraluminal compression surgery under local anesthesia were included. Management of intractable intraoperative challenges and techniques for reversal extraluminal compression were introduced. Anatomical measurements, intraoperative color-coded Doppler ultrasonography, spectro-temporal analysis, and computational fluid dynamics were employed to analyze the hydroacoustic characteristics of PT. RESULTS The efficacy of the extraluminal compression technique was evident with the significant reduction in peak turbulent kinetic energy, vorticity, and mean pressure gradient at the transverse-sigmoid junction, resulting in over 20% reduction in PT amplitude. dTSS is a common finding in patients with PT exhibiting transverse-sigmoid sinus enlargement. Patients with dTSS presented with significant differences in hemodynamic characteristics as compared to those without. Linear regression analysis showed that the flow disturbance (turbulent kinetic energy and vorticity) was closely associated with the degree of dTSS, whereas the flow amplitude was not related to the degree or location of TSS. Low-pulsatory vortex flow at the transverse-sigmoid junction was visualized during an intraoperative color-coded Doppler examination, and the displayed low-frequency PT sound corresponded to the patients' subjective perception of PT. CONCLUSION (1) A reduction of over 20% of the flow-induced noise is the therapeutic goal of extraluminal compression technique. Since reductions in the magnitude of hemodynamic parameters, including turbulent kinetic energy, vorticity, and mean pressure gradient, render the flow-induced noise inaudible, besides sigmoid sinus wall anomalies, it is likely that PT develops from the aggregation of flow-based pathologies. (2) Although dTSS and diverticulum may greatly affect the hemodynamics at the transverse-sigmoid junction, in contrast to dehiscence, dTSS and diverticulum may not be the limiting factors for PT development.
Collapse
Affiliation(s)
- Yue-Lin Hsieh
- Fudan University, Shanghai, China; Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key laboratory of Hearing Science, Ministry of Health, Shanghai, China; Numerical and Scientific Computing Laboratory, National Formosa University, Yunlin, Taiwan
| | - Xiaobing Xu
- Fudan University, Shanghai, China; Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Yue-Da Hsieh
- Department of Economics, London School of Economics and Political Science, London, United Kingdom
| | - Yi-Chern Hsieh
- Department of Power Mechanical Engineering, National Formosa University, Yunlin, Taiwan; Numerical and Scientific Computing Laboratory, National Formosa University, Yunlin, Taiwan
| | - Dan Wang
- Fudan University, Shanghai, China; Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Ping Guo
- Fudan University, Shanghai, China; Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Wuqing Wang
- Fudan University, Shanghai, China; Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key laboratory of Hearing Science, Ministry of Health, Shanghai, China.
| |
Collapse
|
19
|
|
20
|
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
|
21
|
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
|
22
|
Extraluminal Sigmoid Sinus Angioplasty: A Pertinent Reconstructive Surgical Method Targeting Dural Sinus Hemodynamics to Resolve Pulsatile Tinnitus. Otol Neurotol 2020; 41:e132-e145. [PMID: 31568136 DOI: 10.1097/mao.0000000000002464] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES 1) To provide information on the treatment of pulsatile tinnitus (PT) with transtemporal extraluminal sigmoid sinus angioplasty (ESSA); and 2) to discuss the current clinical management of PT. STUDY DESIGN This was a retrospective study. SETTINGS Multi-institutional tertiary university medical centers. PATIENTS Fifty-four PT patients with transverse-sigmoid sinus enlargement and prominent transverse-sigmoid junction with or without sigmoid sinus wall anomalies or transverse sinus anomalies. INTERVENTION All patients underwent ESSA under local anesthesia. MAIN OUTCOME MEASURES Intraoperative discoveries and surgical resolution of PT, morphology, and computational fluid dynamics. RESULTS Fifty-three of the 54 (98%) patients experienced a significant reduction in, or complete resolution of, PT after ESSA. No major surgical complications occurred, except for one case where we observed a full collapse of the sinus wall. On average, this surgery reduced the cross-sectional area at the transverse-sigmoid junction by 61.5%. Our intraoperative discoveries suggest that sigmoid sinus wall anomalies may not be a definitive cause of PT. The transverse-sigmoid sinus system was significantly larger (in term of both cross-sectional area and volume) on the ipsilesional side compared with the contralesional side. Following ESSA, the vascular wall pressure and vortex flow at the transverse-sigmoid junction decreased considerably, and the flow velocity and wall shear stress increased significantly. CONCLUSION ESSA is a highly effective surgical technique for PT patients with transverse-sigmoid sinus enlargement and prominent transverse-sigmoid junction, regardless of whether they also have sigmoid sinus wall or transverse sinus anomalies. A large transverse-sigmoid system with prominent transverse-sigmoid junction is a predisposing factor for PT, and only by improving patients' intrasinus hemodynamics could PT be resolved efficiently. In cases without complete obstruction of venous return, ESSA is safe. No postoperative complications related to neurological disorders were observed.
Collapse
|
23
|
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.
Collapse
|
24
|
Selleck AM, O'Connell B, Patel S, Clark JM. Intraparotid Superficial Temporal Artery Arteriovenous Malformation Causing Persistent Pulsatile Tinnitus. Otol Neurotol 2020; 41:e873-e875. [PMID: 32658403 DOI: 10.1097/mao.0000000000002666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This article discusses the diagnosis, imaging workup, and management of a rare cause of pulsatile tinnitus: intraparotid arteriovenous malformation. PATIENT A single patient with a superficial temporal arteriovenous malformation diagnosed by carotid duplex causing pulsatile tinnitus that failed initial surgical management. Repeat imaging failed to identify a cause for the persistent tinnitus. INTERVENTION Reoperation with a parotid approach based on physical exam findings. RESULTS Removal of a more proximal arteriovenous malformation in the parotid gland resulted in long-term resolution of the patient's pulsatile tinnitus. CONCLUSIONS Physical examination is essential in the workup and management of pulsatile tinnitus. Imaging is a useful adjunct in the diagnosis of pulsatile tinnitus but should not be solely relied upon.
Collapse
Affiliation(s)
- Anne Morgan Selleck
- Department of Otolaryngology Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina
| | | | | | | |
Collapse
|
25
|
Abstract
Tinnitus is spoken of as if it were a single thing, but there are many different causes, likely many different mechanisms, and many different subtypes. This article reviews a broad range of approaches to understand and demarcate different tinnitus subtypes, which will be critical for exploring and finding cures for different subtypes.
Collapse
|
26
|
Eliezer M, Freitas RK, Fantoni M, Guedon A, Houdart E. Selective embolization of the mastoid emissary vein for pulsatile tinnitus treatment: when is it indicated? J Neurointerv Surg 2020; 12:999-1001. [DOI: 10.1136/neurintsurg-2020-015855] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 12/28/2022]
Abstract
BackgroundVenous pulsatile tinnitus (PT) can be caused by the perception of blood flow through the mastoid emissary vein (MEV). However, the causal relationship of this anomaly has not been established as selective occlusion of this vein has never been performed. The aim of this study was to report on a small series of patients suspected of having PT caused by an MEV, who underwent MEV embolization as treatment for PT, and to identify the correct indications for this procedure.MethodsThis was a single center retrospective study (CNIL 2215065) including six patients with isolated disabling PT treated by embolization of the MEV, recruited between December 2017 and August 2019. Patient charts were systematically reviewed. All patients underwent non-contrast temporal bone CT and MRI.ResultsMean age of the patients (five women, one male) was 56.3 years (range 40–71 years). Two patients presented with venous PT and four had neutral PT. The MEV was in direct contact with the mastoid air cells on temporal bone CT in all patients. Based on clinical examination, two patients presented with venous PT while four patients had neutral PT. In all cases of venous PT, selective embolization of the MEV caused the tinnitus to disappear, suggesting technical success. In contrast, embolization of the MEV had no effect in patients with neutral PT.ConclusionsWe demonstrated that MEV could be a source of venous PT. Embolization of the MEV was effective only in cases of clinical venous PT.
Collapse
|
27
|
|
28
|
Sajadi S, Forogh B, ZoghAli M. Cervical Trigger Point Acupuncture for Treatment of Somatic Tinnitus. J Acupunct Meridian Stud 2019; 12:197-200. [PMID: 31369860 DOI: 10.1016/j.jams.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 07/15/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022] Open
Abstract
Cervicogenic somatic tinnitus is a subtype of subjective tinnitus and is defined as tinnitus in which forceful contractions of jaw and neck muscles modulate its psychoacoustic attributes. Various physical therapies have been proposed for the treatment of somatosensory tinnitus although there is no definitive cure for it. This report describes the use of acupuncture in the treatment of a 71-year-old woman with chronic neck pain who suffered from a left-sided tinnitus for 2 years as well. The tinnitus and neck pain severity was rated as 7 and 6, respectively, on a numeric rating scale of 10. On examination, she had restricted cervical range of motion and several myofascial trigger points in cervical muscles. Audiometric tests of the patient were normal. She received trigger point acupuncture of cervical muscles twice per week for 10 sessions. Her tinnitus completely disappeared after the third session and did not return during the 5-year follow-up. Her neck pain intensity also decreased to 1 on the numeric rating scale after 10 sessions. Based on the results of this study, direct trigger point acupuncture of cervical muscles may be beneficial in the treatment of somatic tinnitus with a long-duration effect.
Collapse
Affiliation(s)
- Simin Sajadi
- Neuromusculoskeletal Research Centre, Iran University of Medical Sciences, Tehran, Iran.
| | - Bijan Forogh
- Neuromusculoskeletal Research Centre, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Masoumeh ZoghAli
- Neuromusculoskeletal Research Centre, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
29
|
Cima RFF, Mazurek B, Haider H, Kikidis D, Lapira A, Noreña A, Hoare DJ. A multidisciplinary European guideline for tinnitus: diagnostics, assessment, and treatment. HNO 2019; 67:10-42. [DOI: 10.1007/s00106-019-0633-7] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
30
|
Pulsatile versus non-pulsatile tinnitus in idiopathic intracranial hypertension. Acta Neurochir (Wien) 2018; 160:2025-2029. [PMID: 30014363 DOI: 10.1007/s00701-018-3587-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Tinnitus is a symptom commonly associated with idiopathic intracranial hypertension (IIH) that can have a profound effect on quality of life. We aim to determine tinnitus symptom response after dural venous sinus stenting (DVSS) or CSF diversion with a shunt, in patients with both pulsatile (PT) and non-pulsatile tinnitus (NPT). METHODS Single-centre cohort of IIH patients (2006-2016) who underwent 24-h ICP monitoring (ICPM). An un-paired t test compared ICP and pulse amplitude (PA) values in IIH patients with PT vs. NPT. RESULTS We identified 59 patients with IIH (56 F:3 M), mean age 32.5 ± 9.49 years, 14 of whom suffered from tinnitus. Of these 14, seven reported PT and seven reported NPT. Patients with tinnitus had a mean 24-h ICP and PA of 9.09 ± 5.25 mmHg and 6.05 ± 1.07 mmHg respectively. All 7 patients with PT showed symptom improvement or resolution after DVSS (n = 4), secondary DVSS (n = 2) or shunting (n = 1). In contrast, of the 7 with NPT, only 1 improved post intervention (DVSS), despite 2 patients having shunts and 5 having DVSS. CONCLUSIONS NPT and PT were equally as common in our group of IIH patients. DVSS appears to be an effective management option for IIH patients with a clear history of pulsatile tinnitus. However, non-pulsatile tinnitus was more persistent and did not respond well to either DVSS or CSF diversion.
Collapse
|
31
|
Yeo W, Xu S, Tan T, Low Y, Yuen H. Surgical management of pulsatile tinnitus secondary to jugular bulb or sigmoid sinus diverticulum with review of literature. Am J Otolaryngol 2018; 39:247-252. [PMID: 29336902 DOI: 10.1016/j.amjoto.2017.12.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 12/29/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Jugular bulb and sigmoid sinus anomalies are well-known causes of vascular pulsatile tinnitus. Common anomalies reported in the literature include high-riding and/or dehiscent jugular bulb, and sigmoid sinus dehiscence. However, cases of pulsatile tinnitus due to diverticulosis of the jugular bulb or sigmoid sinus are less commonly encountered, with the best management option yet to be established. In particular, reports on surgical management of pulsatile tinnitus caused by jugular bulb diverticulum have been lacking in the literature. OBJECTIVES To report two cases of pulsatile tinnitus with jugular bulb and/or sigmoid sinus diverticulum, and their management strategies and outcomes. In this series, we describe the first reported successful case of pulsatile tinnitus due to jugular bulb diverticulum that was surgically-treated. SUBJECTS AND METHODS Two patients diagnosed with either jugular bulb and/or sigmoid sinus diverticulum, who had presented to the Otolaryngology clinic with pulsatile tinnitus between 2016 and 2017, were studied. Demographic and clinical data were obtained, including their management details and clinical outcomes. RESULTS Two cases (one with jugular bulb diverticulum and one with both sigmoid sinus and jugular bulb diverticula) underwent surgical intervention, and both had immediate resolution of pulsatile tinnitus post-operatively. This was sustained at subsequent follow-up visits at the outpatient clinic, and there were no major complications encountered for both cases intra- and post-operatively. CONCLUSION Transmastoid reconstruction/resurfacing of jugular bulb and sigmoid sinus diverticulum with/without obliteration of the diverticulum is a safe and effective approach in the management of bothersome pulsatile tinnitus arising from these causes.
Collapse
|
32
|
Breda MS, Amorim J, Rocha J, Dias L. Vertebro-vertebral fistula presenting as a pulsatile tinnitus. BMJ Case Rep 2018; 2018:bcr-2017-222815. [PMID: 29437736 DOI: 10.1136/bcr-2017-222815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tinnitus is the perception of sound in the absence of a corresponding external acoustic stimulus, resulting in an estimated prevalence of 10% to 15% in adults. Tinnitus may be classified as pulsatile (PT) or continuous (non-PT), and may be subjective (heard only by the patient) or objective (also audible to the examiner). PT is usually related to vascular causes and is pulse synchronous (coinciding with the patient's heartbeat). PT is much less common affecting approximately 4% of patients with tinnitus, but unlike non-PT, usually has a specific identifiable cause. We present a case of a man without previous otological disease or head trauma, with a left-ear subjective PT. MR angiography detected a left vertebro-vertebral arteriovenous fistula, which was treated by endovascular embolisation with important symptomatic relief.
Collapse
Affiliation(s)
- Miguel Sá Breda
- Otorhinolaryngology-Head and Neck Surgery, Hospital de Braga, Braga, Portugal
| | - José Amorim
- Neuroradiology Department, Hospital de Braga, Braga, Portugal
| | - Jaime Rocha
- Neuroradiology Department, Hospital de Braga, Braga, Portugal
| | - Luis Dias
- Otorhinolaryngology-Head and Neck Surgery, Hospital de Braga, Braga, Portugal
| |
Collapse
|
33
|
Kessler MM, Moussa M, Bykowski J, Kirsch CF, Aulino JM, Berger KL, Choudhri AF, Fife TD, Germano IM, Kendi AT, Kim JH, Luttrull MD, Nunez D, Shah LM, Sharma A, Shetty VS, Symko SC, Cornelius RS. ACR Appropriateness Criteria ® Tinnitus. J Am Coll Radiol 2017; 14:S584-S591. [DOI: 10.1016/j.jacr.2017.08.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
|
34
|
Imaging of carotid artery-cochlear dehiscence. A cause of pulsatile tinnitus. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
35
|
Tawfik KO, Stevens SM, Mihal D, Costello MS, Cornelius RS, Samy RN, Pensak ML. Radiographic Evidence of Occult Intracranial Hypertension in Patients with Ménière’s Disease. Otolaryngol Head Neck Surg 2017; 157:260-268. [DOI: 10.1177/0194599817699401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives (1) Describe the prevalence of radiographic signs of intracranial hypertension (ICH) in Ménière’s disease (MD) and (2) compare the prevalence of radiographic signs of ICH in MD patients managed medically to those managed surgically. Study Design Case-control study. Setting Academic neurotologic practice. Subjects and Methods Adult MD patients (aged ≥17 years) treated from 2011 to 2015 were reviewed. Inclusion required magnetic resonance imaging (MRI) of the head and follow-up >6 months. Patients with intracranial tumors, mass effect, trauma, previous intracranial surgery, and glaucoma were excluded. MD patients were separated by administered treatment into medical and surgical subgroups. Cochlear implant (CI) recipients served as radiographic controls. Eighty-four MD patients (46 surgical, 38 medical) and 37 CI controls were assessed. MRI measurements assessed for empty/partial sella (ES/PS), dilated/tortuous optic nerve sheath (ONS), and posterior globe flattening (PGF). Results Mean age was 53.8 ± 1.3 years and median body mass index (BMI) was 28.2 kg/m2. Of the patients, 64% were female and 92% were white. MRI findings in the MD cohort were as follows: ES/PS, 46.4%; ONS change, 42.8%; and PGF, 8.3%. The prevalence of ONS change was higher in MD patients than in controls (42.8% vs 13.5%, P = .003). The surgical MD group had higher prevalence of ONS change (52%) compared with the medical group (31.5%, P = .05) and controls (13.5%, P = .0004). The surgical group had a higher prevalence of ≥2 simultaneous MRI findings compared with medical MD patients (39% vs 10%, P = .01) and controls (14%, P = .01). Conclusion MD patients demonstrate a high prevalence of radiographic signs of ICH. MD patients who required surgery had a greater prevalence of radiographic signs of ICH compared with non-MD patients and medically managed MD patients.
Collapse
Affiliation(s)
- Kareem O. Tawfik
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Shawn M. Stevens
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David Mihal
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mark S. Costello
- Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rebecca S. Cornelius
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ravi N. Samy
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Neurosensory Disorders Center at UC Neuroscience Institute, Cincinnati, Ohio, USA
| | - Myles L. Pensak
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
36
|
Pirodda A, Savastio G, Stagni S, Ferri GG, Brandolini C, Zompatori M. The role of high-resolution computed tomography in the diagnostic protocol of cochleo-vestibular disorders. HEARING, BALANCE AND COMMUNICATION 2017. [DOI: 10.1080/21695717.2017.1286085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Antonio Pirodda
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | | | - Gian Gaetano Ferri
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Cristina Brandolini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | |
Collapse
|
37
|
Flow patterns in the jugular veins of pulsatile tinnitus patients. J Biomech 2016; 52:61-67. [PMID: 28057349 DOI: 10.1016/j.jbiomech.2016.12.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/08/2016] [Accepted: 12/09/2016] [Indexed: 11/24/2022]
Abstract
Pulsatile Tinnitus (PT) is a pulse-synchronous sound heard in the absence of an external source. PT is often related to abnormal flow in vascular structures near the cochlea. One vascular territory implicated in PT is the internal jugular vein (IJV). Using computational fluid dynamics (CFD) based on patient-specific Magnetic Resonance Imaging (MRI), we investigated the flow within the IJV of seven subjects, four symptomatic and three asymptomatic of PT. We found that there were two extreme anatomic types classified by the shape and position of the jugular bulbs: elevated and rounded. PT patients had elevated jugular bulbs that led to a distinctive helical flow pattern within the proximal internal jugular vein. Asymptomatic subjects generally had rounded jugular bulbs that neatly redirected flow from the sigmoid sinus directly into the jugular vein. These two flow patterns were quantified by calculating the length-averaged streamline curvature of the flow within the proximal jugular vein: 130.3±8.1m-1 for geometries with rounded bulbs, 260.7±29.4m-1 for those with elevated bulbs (P<0.005). Our results suggest that variations in the jugular bulb geometry lead to distinct flow patterns that are linked to PT, but further investigation is needed to determine if the vortex pattern is causal to sound generation.
Collapse
|
38
|
Boddu S, Dinkin M, Suurna M, Hannsgen K, Bui X, Patsalides A. Resolution of Pulsatile Tinnitus after Venous Sinus Stenting in Patients with Idiopathic Intracranial Hypertension. PLoS One 2016; 11:e0164466. [PMID: 27768690 PMCID: PMC5074492 DOI: 10.1371/journal.pone.0164466] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 09/26/2016] [Indexed: 12/02/2022] Open
Abstract
Objective Evaluate the role of venous sinus stenting in the treatment of pulsatile tinnitus among patients with Idiopathic Intracranial Hypertension (IIH) and significant venous sinus stenosis. Subjects and Methods A written informed consent approved by the Weill Cornell institutional review board was signed and obtained from the study participants. Thirty-seven consecutive patients with IIH and venous sinus stenosis who were treated with venous sinus stenting between Jan.2012-Jan.2016 were prospectively evaluated. Patients without pulsatile tinnitus were excluded. Tinnitus severity was categorized based on “Tinnitus Handicap Inventory” (THI) at pre-stent, day-0, 1-month, 3-month, 6-month, 12-month, 18-month and 2-year follow-up. Demographics, body-mass index (BMI), pre and post VSS trans-stenotic pressure gradient were documented. Statistical analysis performed using Pearson’s correlation, Chi-square analysis and Fischer’s exact test. Results 29 patients with a mean age of 29.5±8.5 years M:F = 1:28. Median (mean) THI pre and post stenting were: 4 (3.7) and 1 (1) respectively. Median time of tinnitus resolution post VSS was 0-days. There was significant improvement of THI (Δ Mean: 2.7 THI [95% CI: 2.3–3.1 THI], p<0.001) and transverse-distal sigmoid sinus gradient (Δ Mean: -15.3 mm Hg [95% CI: 12.7–18 mm Hg], p<0.001) post-stenting. Mean follow-up duration of 26.4±9.8 months (3–44 months). VSS was feasible in 100% patients with no procedural complications. Three-patients (10%) had recurrent sinus stenosis and tinnitus at mean follow-up of 12 months (6–30 months). Conclusion Venous sinus stenting is an effective treatment for pulsatile tinnitus in patients with IIH and venous sinus stenosis.
Collapse
Affiliation(s)
- Srikanth Boddu
- Department of Neurological surgery, Division of Interventional Neuroradiology, New York Presbyterian Hospital / Weill Cornell Medical Center, New York, New York, United States of America
- * E-mail: (SB); (AP)
| | - Marc Dinkin
- Department of Ophthalmology, New York Presbyterian Hospital / Weill Cornell Medical Center, New York, New York, United States of America
| | - Maria Suurna
- Department of Otolaryngology, New York Presbyterian Hospital / Weill Cornell Medical Center, New York, New York, United States of America
| | - Kelly Hannsgen
- Department of Neurological surgery, Division of Interventional Neuroradiology, New York Presbyterian Hospital / Weill Cornell Medical Center, New York, New York, United States of America
| | - Xem Bui
- Department of Neurological surgery, Division of Interventional Neuroradiology, New York Presbyterian Hospital / Weill Cornell Medical Center, New York, New York, United States of America
| | - Athos Patsalides
- Department of Neurological surgery, Division of Interventional Neuroradiology, New York Presbyterian Hospital / Weill Cornell Medical Center, New York, New York, United States of America
- * E-mail: (SB); (AP)
| |
Collapse
|
39
|
Zeng R, Wang GP, Liu ZH, Liang XH, Zhao PF, Wang ZC, Gong SS. Sigmoid Sinus Wall Reconstruction for Pulsatile Tinnitus Caused by Sigmoid Sinus Wall Dehiscence: A Single-Center Experience. PLoS One 2016; 11:e0164728. [PMID: 27736970 PMCID: PMC5088000 DOI: 10.1371/journal.pone.0164728] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/29/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To evaluate clinical characteristics and present surgical outcomes of PT caused by sigmoid sinus wall dehiscence (SSWD). METHODS This study retrospectively reviewed 34 patients with PT who were diagnosed with SSWD in our institution between December 2008 and July 2013. Among them, 27 patients underwent sigmoid sinus wall reconstruction (surgery group) and 7 patients refused surgery (non-surgery group). Preoperative data were obtained from the patients' medical records. All patients were followed up regularly for at least 25 months. Preoperative and postoperative computed tomography angiography (CTA) images were compared. Student's t-tests were used to compare age, body mass index (BMI) and preoperative Tinnitus Handicap Inventory (THI) scores between the surgery and the non-surgery groups and to compare pre- and follow-up THI scores. RESULTS There was no significant difference in age, body mass index, or preoperative THI scores between groups. Following surgery, 14 patients had complete resolution, 5 had partial resolution, 7 experienced no change and PT was aggravated in 1 patient. The difference between preoperative and postoperative THI scores was significant. No severe complications were found postoperatively. Comparison of the preoperative and postoperative CTA images revealed that remnant unrepaired dehiscences were the cause of unsatisfactory outcomes following surgery. In the non-surgery group, PT remained largely unchanged. CONCLUSIONS Sigmoid sinus wall reconstruction is an effective and safe treatment for PT caused by SSWD. It is imperative that all regions of the dehiscence are sufficiently exposed and resurfaced during surgery.
Collapse
Affiliation(s)
- Rong Zeng
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guo-Peng Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhao-Hui Liu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xi-Hong Liang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Peng-Fei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhen-Chang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- * E-mail: (SSG); (ZCW)
| | - Shu-Sheng Gong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- * E-mail: (SSG); (ZCW)
| |
Collapse
|
40
|
|
41
|
Abstract
Paragangliomas of the head and neck are rare vascular skull-base tumors derived from the paraganglionic system with an estimated incidence of 1:30,000 accounting for 3% of all paragangliomas. The most common paraganglioma locations of the head and neck in descending order are the carotid body, jugular, tympanic, and vagal paragangliomas. This article discusses the clinical characterics, normal anatamy, imaging findings and protocols, pathology, staging, and differential diagnosis for paragangliomas of the head and neck.
Collapse
|
42
|
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
|
43
|
Corrales CE, Fischbein N, Jackler RK. Imaging innovations in temporal bone disorders. Otolaryngol Clin North Am 2015; 48:263-80. [PMID: 25769351 DOI: 10.1016/j.otc.2014.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The development of new imaging techniques coupled with new treatment algorithms has created new possibilities in treating temporal bone diseases. This article provides an overview of recent imaging innovations that can be applied to temporal bone diseases. Topics covered include the role of magnetic resonance (MR) diffusion-weighted imaging in cholesteatomas and skull base epidermoids, whole-body molecular imaging in paragangliomas of the jugular foramen, and MR arterial spin labeling perfusion for dural arteriovenous fistulas and arteriovenous malformations.
Collapse
Affiliation(s)
- C Eduardo Corrales
- Department of Otology, Neurotology and Skull Base Surgery, Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA
| | - Nancy Fischbein
- Departments of Radiology, Otolaryngology-Head and Neck Surgery, Neurology, Neurosurgery and Radiation Oncology, Stanford University Medical Center, 300 Pasteur Drive, Room S-047, Stanford, CA 94305, USA
| | - Robert K Jackler
- Division of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA.
| |
Collapse
|
44
|
Degree of sigmoid sinus compression and the symptom relief using magnetic resonance angiography in venous pulsating tinnitus. Clin Exp Otorhinolaryngol 2015; 8:111-6. [PMID: 26045908 PMCID: PMC4451534 DOI: 10.3342/ceo.2015.8.2.111] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 04/07/2014] [Accepted: 04/14/2014] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To show that mechanical compression of sigmoid sinus is effective for treatment of pulsatile tinnitus caused by sigmoid sinus enlargement, and to evaluate the relationship between the compression degree of sigmoid sinus and the tinnitus symptom relief using magnetic resonance angiography. METHODS Medical records of twenty-four patients who were diagnosed with venous tinnitus caused by sigmoid sinus enlargement and underwent mechanical compression of sigmoid sinus were reviewed between April 2009 and May 2013. All these patients received computed tomography and magnetic resonance venography study before undergoing surgery and were followed for at least 4 months. RESULTS Twenty-three patients felt relief from tinnitus three months after the surgery, and the cross-sectional area of the sigmoid sinus on the tinnitus side was compressed approximately by half (46%-69%) after the surgery. There were 4 patients whose tinnitus suddenly disappeared while lying on the operating table before operation, which may be a result of the patient's emotional tension or postural changes from standing. One of the four patients felt no relief from tinnitus after the surgery, with the cross-sectional area of the sigmoid sinus only compressed by 30%. And two patients of them had a recurrence of tinnitus about 6 months after the surgery. Seven patients had sigmoid sinus diverticula, and tinnitus would not disappear merely by eliminating the diverticulum until by compressing the sigmoid sinus to certain degree. There were 3 minor complications, including aural fullness, head fullness and hyperacusis. The preoperative low frequency conductive and sensorineural hearing loss of 7 subjects subsided. CONCLUSION Mechanical compression of sigmoid sinus is an effective treatment for pulsatile tinnitus caused by sigmoid sinus enlargement, even if it might be accompanied by sigmoid sinus diverticulum. A compression degree of sigmoid sinus about 54% is adequate for the relief of tinnitus symptom. Cases in which patients' tinnitus suddenly disappeared before the surgery might be excluded to improve the efficacy of surgery.
Collapse
|
45
|
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
|
46
|
|
47
|
Henry JA, Roberts LE, Caspary DM, Theodoroff SM, Salvi RJ. Underlying mechanisms of tinnitus: review and clinical implications. J Am Acad Audiol 2014; 25:5-22; quiz 126. [PMID: 24622858 PMCID: PMC5063499 DOI: 10.3766/jaaa.25.1.2] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The study of tinnitus mechanisms has increased tenfold in the last decade. The common denominator for all of these studies is the goal of elucidating the underlying neural mechanisms of tinnitus with the ultimate purpose of finding a cure. While these basic science findings may not be immediately applicable to the clinician who works directly with patients to assist them in managing their reactions to tinnitus, a clear understanding of these findings is needed to develop the most effective procedures for alleviating tinnitus. PURPOSE The goal of this review is to provide audiologists and other health-care professionals with a basic understanding of the neurophysiological changes in the auditory system likely to be responsible for tinnitus. RESULTS It is increasingly clear that tinnitus is a pathology involving neuroplastic changes in central auditory structures that take place when the brain is deprived of its normal input by pathology in the cochlea. Cochlear pathology is not always expressed in the audiogram but may be detected by more sensitive measures. Neural changes can occur at the level of synapses between inner hair cells and the auditory nerve and within multiple levels of the central auditory pathway. Long-term maintenance of tinnitus is likely a function of a complex network of structures involving central auditory and nonauditory systems. CONCLUSIONS Patients often have expectations that a treatment exists to cure their tinnitus. They should be made aware that research is increasing to discover such a cure and that their reactions to tinnitus can be mitigated through the use of evidence-based behavioral interventions.
Collapse
Affiliation(s)
- James A. Henry
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), VA Medical Center, Portland, OR
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, OR
| | - Larry E. Roberts
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Donald M. Caspary
- Pharmacology Department, Southern Illinois University School of Medicine, Springfield, IL
| | - Sarah M. Theodoroff
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), VA Medical Center, Portland, OR
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, OR
| | - Richard J. Salvi
- Center for Hearing and Deafness, University of Buffalo, Buffalo, NY
| |
Collapse
|
48
|
Treatment of palatal myoclonus with botulinum toxin injection. Case Rep Otolaryngol 2013; 2013:231505. [PMID: 24223317 PMCID: PMC3816037 DOI: 10.1155/2013/231505] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/01/2013] [Indexed: 11/17/2022] Open
Abstract
Palatal myoclonus is a rare cause of pulsatile tinnitus in patients presenting to the otolaryngology office. Rhythmic involuntary contractions of the palatal muscles produce the pulsatile tinnitus in these patients. Treatment of this benign but distressing condition with anxiolytics, anticonvulsants, and surgery has been largely unsuccessful. A few investigators have obtained promising results with botulinum toxin injection into the palatal muscles. We present a patient with palatal myoclonus who failed conservative treatment with anxiolytics. Unilateral injection of botulinum toxin into her tensor veli palatini muscle under electromyographic guidance resolved pulsatile tinnitus in her ipsilateral ear and unmasked pulsatile tinnitus in the contralateral ear. A novel method of following transient postinjection symptoms using a diary is presented in this study. Botulinum toxin dose must be titrated to achieve optimal results in each individual patient, analogous to titrations done for spasmodic dysphonia. Knowledge of the temporal onset of postinjection side effects and symptomatic relief may aid physicians in dose titration and surveillance. We present suggestions on titrating the botulinum toxin dose to optimal levels. A review of the literature on the use of botulinum toxin for palatal myoclonus and some common complications are discussed.
Collapse
|
49
|
Hofmann E, Behr R, Neumann-Haefelin T, Schwager K. Pulsatile tinnitus: imaging and differential diagnosis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:451-8. [PMID: 23885280 DOI: 10.3238/arztebl.2013.0451] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 02/18/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pulsatile tinnitus, unlike idiopathic tinnitus, usually has a specific, identifiable cause. Nonetheless, uncertainty often arises in clinical practice about the findings to be sought and the strategy for work-up. METHODS Selective literature review and evaluation of our own series of patients. RESULTS Pulsatile tinnitus can have many causes. No prospective studies on this subject are available to date. Pulsatile tinnitus requires both a functional organ of hearing and a genuine, physical source of sound, which can, under certain conditions, even be objectified by an examiner. Pulsatile tinnitus can be classified by its site of generation as arterial, arteriovenous, or venous. Typical arterial causes are arteriosclerosis, dissection, and fibromuscular dysplasia. Common causes at the arteriovenous junction include arteriovenous fistulae and highly vascularized skull base tumors. Common venous causes are intracranial hypertension and, as predisposing factors, anomalies and normal variants of the basal veins and sinuses. In our own series of patients, pulsatile tinnitus was most often due to highly vascularized tumors of the temporal bone (16%), followed by venous normal variants and anomalies (14%) and vascular stenoses (9%). Dural arteriovenous fistulae, inflammatory hyperemia, and intracranial hypertension were tied for fourth place (8% each). CONCLUSION The clinical findings and imaging studies must always be evaluated together. Thorough history-taking and clinical examination are the basis for the efficient use of imaging studies to reveal the cause of pulsatile tinnitus.
Collapse
Affiliation(s)
- Erich Hofmann
- Klinikum Fulda gAG, Department of Neuroradiology, Germany.
| | | | | | | |
Collapse
|
50
|
Fussner LA, Harer KN, Poterucha TH. 51-year-old man with tinnitus. Mayo Clin Proc 2013; 88:636-9. [PMID: 23726403 DOI: 10.1016/j.mayocp.2012.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/16/2012] [Accepted: 09/24/2012] [Indexed: 11/17/2022]
Affiliation(s)
- Lynn A Fussner
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN 55905, USA
| | | | | |
Collapse
|