Pulsatile tinnitus in cerebrovascular arterial diseases

Quantitative patient graph analysis for transient ischemic attack risk factor distribution based on electronic medical records

A transient ischemic attack (TIA) affects millions of people worldwide. Although TIA risk factors have been identified individually, a systemic quantitative analysis of all health factors relevant to TIA using electronic medical records (EMR) remains lacking. This study employed a data-driven approach, leveraging hospital EMR data to create a TIA patient health factor graph. This graph consisted of 737 TIA and 737 control patient nodes, 740 health factor nodes, and over 33,000 relations between patients and factors. For all health factors in the graph, the connection delta ratios (CDRs) were determined and ranked, generating a quantitative distribution of TIA health factors. A literature review confirmed 56 risk factors in the distribution and unveiled a potential new risk factor "rhinosinusitis" for future validation. Moreover, the patient graph was visualized together with the TIA knowledge graph in the Unified Medical Language System. This integration enables clinicians to access and visualize patient data and international standard knowledge within a unified graph. In conclusion, graph CDR analysis can effectively quantify the distribution of TIA risk factors. The resulting TIA risk factor distribution might be instrumental in developing new risk prediction machine learning models for screening and early detection of TIA.

Pulsatile tinnitus caused by an aberrant artery running over the surface of mastoid bone

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.

Increased prevalence and risk of anxiety disorders in adults with tinnitus: A population-based study in Taiwan

OBJECTIVE

Tinnitus is a common disorder that may cause psychological distress and anxiety. The aim of this study was to investigate the association between anxiety disorders (ADs) and tinnitus in a large population.

METHOD

We conducted a cross-sectional study using the National Health Insurance Research Database in Taiwan. Study subjects included 14,772 patients with tinnitus and 709,963 people in the general population who sought treatment in 2005. Distributions in ADs, age, sex, and medical comorbidities were compared between groups using chi-squared tests. Multivariate logistic regression models adjusted for age, sex, and medical comorbidities were used to analyze the association between tinnitus and ADs.

RESULTS

Prevalence of ADs in tinnitus and general population groups was 3.9% and 1.5%, respectively, and this difference was significant (P<0.001). Diabetes mellitus, hypertension, hyperlipidemia, concussion or head injury, Meniere's disease, sensorineural hearing impairment, renal disease, coronary artery disease, and cerebrovascular disease were significantly more prevalent in the tinnitus group (all P-values<0.001). Multivariate logistic regression model demonstrated that patients with tinnitus were significantly associated with increased risk of ADs (adjusted OR=1.99; 95% CI=1.81-2.19; P<0.001).

CONCLUSION

Because the risk of ADs was significantly higher in patients with tinnitus than in the general population, physicians should be aware of the importance of psychological factors in tinnitus management.

Imaging in pulsatile tinnitus

Tinnitus may be continuous or pulsatile. Vascular lesions are the most frequent radiologically demonstrable cause of pulsatile tinnitus. These include congenital vascular anomalies (which may be arterial or venous), vascular tumours, and a variety of acquired vasculopathies. The choice of imaging depends on the clinical findings. If a mass is present at otoscopy, thin-section computed tomography (CT) is indicated. In the otoscopically normal patient, there is a range of possible imaging approaches. However, combined CT angiography and venography is particularly useful.

Isolated petrous carotid stenosis and transient ischemic attack

Although anterior circulation transient ischemic attacks (TIAs) tend to be more common in patients with extra- cranial carotid arterial disease than in those with intracranial carotid or middle cerebral arterial disease, the authors recently encountered 4 patients with both recurrent, stereotypical TIAs as well as isolated stenosis of their petrous internal carotid artery (ICA). While the gold standard for establishing the diagnosis of intracranial large-artery disease has always been conventional angiography, magnetic resonance angiography changes, confirmed with intra-arterial digital subtraction angiography in 2 of these patients, were quite sufficient to define the occlusive disease in each of the cases. Petrous ICA stenosis is not uncommon, but it has often been overshadowed by the search for extracranial ICA disease that might be amenable to surgical reconstruction.

[Patient education in chronic polyarthritis. 3. Intermediate results of a prospective, controlled study of the effectiveness and side effects of patient seminars for polyarthritis patients]

Efficacy and possible negative side effects of a patient education program for rheumatoid arthritis were evaluated in a controlled, prospective study over 3 months. 34 outpatients were educated over a total of 8 h in three groups within a patient-centred design. Before the program the knowledge of the disease depended only on the formal grade of education but not on disease-related variables such as disease duration or disability. Probably due to its individualizing method, the program improved the knowledge of all patients to the same extent, regardless of their intellectual and social prerequisites. The increased cognitive knowledge did not result in negative side effects like increased pain or depression. The pain score remained unchanged. Depression decreased after the education. The group sessions made us suppose that the participants may have represented a selected group of active, psychologically stable patients, who cope well with rheumatoid arthritis. In contrast, we felt that non-participation was the response of the inactive, fatalistic patients with rheumatoid arthritis, who live in social isolation and especially need our care. Therefore, future efforts must particularly focus on the problem of motivation and on an increase in the rate of participation.