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Lim JH, Han JS, Aliyeva A, Seo JH, Park SY, Park SN. Surgical Outcomes of Sigmoid Sinus Resurfacing for Pulsatile Tinnitus: The Predictive Value of the Water Occlusion Test and Imaging Studies. Clin Exp Otorhinolaryngol 2023; 16:244-250. [PMID: 37475140 PMCID: PMC10471903 DOI: 10.21053/ceo.2023.00388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/19/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES Sigmoid sinus resurfacing (SS-R) is one of the most effective surgical treatments for patients with pulsatile tinnitus (PT) originating from anatomical variants of the vascular walls in the temporal bone. This study aimed to provide updated information on the clinical outcomes of SS-R and evaluate the efficacy of the water occlusion test (WOT) as an additional diagnostic modality. METHODS We retrospectively reviewed medical records including tinnitus questionnaires, temporal bone computed tomography (TBCT) scans, audiologic tests, and preoperative WOT. RESULTS from patients who underwent SS-R. RESULTS In total, 26 patients were included in the study. The mean age was 44 years, and the mean symptom duration was 3 months. Fourteen patients (53.8%) were completely cured, seven (26.9%) significantly improved, and five (19.2%) remained stable. The mean visual analog scale loudness score decreased from 5.26 to 1.34 (P<0.001) and the mean Tinnitus Handicap Inventory score also improved from 50.23 to 5.5 (P<0.001) after SS-R surgery. In 10 patients with discrepancies between the preoperative TBCT and intraoperative findings, WOT showed a significant additive effect in predicting surgical outcomes. No patients experienced severe intraoperative or postoperative complications during the entire follow-up period. CONCLUSION SS-R provides significant symptom improvement in patients with sigmoid sinus dehiscence who had a positive WOT without other sigmoid sinus variants. A combined diagnostic approach with TBCT, WOT, and intraoperative findings is crucial for achieving better surgical outcomes in patients with PT caused by sigmoid sinus variants.
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Affiliation(s)
- Ji Hyung Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Sang Han
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Aynur Aliyeva
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Private Körfez Hospital, Edremit, Türkiye
| | - Jae-Hyun Seo
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Young Park
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Shi Nae Park
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Combined Arterial and Venous Phase Computed Tomographic Imaging of the Skull Base in Pulsatile Tinnitus. Otol Neurotol 2022; 43:1049-1055. [PMID: 36075103 DOI: 10.1097/mao.0000000000003672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe the demographic, clinical, and radiologic findings in a consecutive series of patients presenting with a chief complaint of pulsatile tinnitus (PT). STUDY DESIGN Retrospective review of 157 patients undergoing a combined arterial/venous phase computed tomographic (CT) imaging study. SETTING Tertiary referral center. PATIENTS Adult patients referred to neurotology faculty for evaluation of PT between 2016 and 2020. INTERVENTIONS Triple phase high-resolution arteriography/venography/temporal bone CT. MAIN OUTCOME MEASURES Prevalence of osseous, venous, and/or arterial pathology, clinicodemographic characteristics. RESULTS One hundred fifty-seven adults (mean age, 52 years; 79.6% female) were evaluated. A history of migraine headaches was common (19.7%). The average body mass index was 30.0 (standard deviation, 6.8), and 17.2% of subjects had a diagnosis of obstructive sleep apnea. Idiopathic intracranial hypertension was diagnosed by elevated opening pressure on lumbar puncture in 13.4%. Comorbid depression and anxiety were common (25.5% and 26.1%, respectively). Overall, abnormalities were found in 79.0% of scans, with bilateral transverse sinus stenosis (TSS) seen in 38.9% and unilateral TSS found in 20.4%. Fifteen subjects (9.6%) had evidence of osseous etiologies, including superior canal dehiscence or thinning in 8.9% and sigmoid sinus dehiscence in one subject. There were 3 dural arteriovenous fistulae identified. Unilateral PT was ipsilateral to the side of TSS in 84.4% of subjects with unilateral TSS. CONCLUSION In a large consecutive series of patients with PT referred for CT venography/arteriography, transverse sinus stenosis was the most common finding at 59%. Venous etiologies for PT should be suspected when patients are referred to neurotologists for evaluation.
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Lee SJ, Lee SY, Choi BY, Koo JW, Hong SH, Song JJ. Preoperative Significance of Ipsilateral Manual Neck Compression in Patients With Pulsatile Tinnitus Secondary to Sigmoid Sinus Dehiscences and Diverticula. Front Neurol 2022; 13:869244. [PMID: 35370915 PMCID: PMC8968956 DOI: 10.3389/fneur.2022.869244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Venous pulsatile tinnitus (PT) is characterized by an auditory perception of pulse-synchronous sound, suppressed by compression of the ipsilateral internal jugular vein. We sought to determine the preoperative prognostic significance of the effect of ipsilateral neck manual compression on the PT loudness and audiometric changes in patients with sigmoid sinus dehiscences (SS-Deh) and diverticula (SS-Div) by comparing postoperative improvements in ipsilateral low-frequency hearing loss (LFHL) in pure-tone audiogram (PTA) and PT symptoms. Twenty-two subjects with PT originating from SS-Deh/Div were recruited. Air-conduction hearing thresholds were measured using PTA at three time points: twice preoperatively (with neutral neck position and with ipsilateral manual compression of internal jugular vein) and once at 3-months postoperatively with neutral neck position. We defined a positive neck compression effect as a threshold improvement of ≥ 10 dB HL at 250 or 500 Hz after manual neck compression. All but two subjects presented with ipsilateral LFHL in the neutral position. The average hearing threshold in the neutral position markedly improved after manual neck compression, indicating that LFHL originated from the masking effect of venous PT. All subjects had subjective improvements in PT and LFHL after sigmoid sinus surgeries, confirming that LFHL resulted from the masking effect of PT. Additionally, improvement of LFHL after neck compression could be regarded as a positive prognostic indicator after surgery. Collectively, elimination of PT loudness and improvement of LFHL with manual compression over the ipsilateral neck may suggest the venous origin of the PT and predict a favorable outcome following repair of SS-Deh/SS-Div.
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Affiliation(s)
- Seung Jae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, South Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ja-Won Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung Hwa Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, South Korea
- *Correspondence: Jae-Jin Song ;
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Lee SJ, Lee SY, An GS, Lee K, Choi BY, Koo JW, Song JJ. Treatment Outcomes of Patients with Glomus Tympanicum Tumors Presenting with Pulsatile Tinnitus. J Clin Med 2021; 10:2348. [PMID: 34071897 PMCID: PMC8198089 DOI: 10.3390/jcm10112348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
We reviewed the clinical characteristics and treatment outcomes of patients with glomus tympanicum tumors (GTTs) presenting with pulsatile tinnitus (PT). We explored whether transcanal sound recording-spectro-temporal analysis (TSR-STA) usefully evaluated changes in PT. The medical records of 13 patients who underwent surgical removal of GTTs were reviewed retrospectively. Two patients underwent preoperative endovascular embolization. Changes in PT, pre- and postoperative audiometry data, TSR-STA results, and clinical outcomes were evaluated. PT was the chief complaint in eight patients (61.5%) and resolved immediately after surgical intervention in all. Two patients exhibited ipsilateral, pseudo-low-frequency hearing loss (PLFHL); surgical GTT removal elicited postoperative improvements in the ipsilesional low-frequency hearing thresholds. Five patients underwent TSR-STA using previously described methods. TSR-STA revealed definite rise-and-fall patterns; surgical tumor removal abated this pattern in one patient, but, for the other four, the patterns did not change greatly post-intervention. Thus, GTT-related PT can be treated successfully (via surgical GTT removal) without complications. In selected cases, preoperative embolization reduces intraoperative hemorrhage. In PT patients with PLFHL, a detailed otoendoscopic examination of the middle ear is required to rule out a GTT. TSR-STA may usefully (and objectively) assess postoperative improvements in GTT-related PT.
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Affiliation(s)
- Seung-Jae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam 13620, Korea; (S.-J.L.); (B.-Y.C.); (J.-W.K.)
| | - Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea;
| | - Gwang-Seok An
- Music and Audio Research Group, Graduate School of Convergence Science and Technology, Seoul National University, Gwanak-gu, Seoul 08826, Korea; (G.-S.A.); (K.L.)
| | - Kyogu Lee
- Music and Audio Research Group, Graduate School of Convergence Science and Technology, Seoul National University, Gwanak-gu, Seoul 08826, Korea; (G.-S.A.); (K.L.)
| | - Byung-Yoon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam 13620, Korea; (S.-J.L.); (B.-Y.C.); (J.-W.K.)
| | - Ja-Won Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam 13620, Korea; (S.-J.L.); (B.-Y.C.); (J.-W.K.)
| | - Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam 13620, Korea; (S.-J.L.); (B.-Y.C.); (J.-W.K.)
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Prevalence, Surgical Management, and Audiologic Impact of Sigmoid Sinus Dehiscence Causing Pulsatile Tinnitus. Otol Neurotol 2021; 42:82-91. [PMID: 33301285 DOI: 10.1097/mao.0000000000002846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the prevalence, surgical management, and audiologic impact of pulsatile tinnitus caused by sigmoid sinus dehiscence. STUDY DESIGN AND SETTING Retrospective chart review at a tertiary care hospital. PATIENTS Adults with unilateral pulsatile tinnitus attributable to sigmoid sinus dehiscence who underwent resurfacing between January 2010 and January 2020. INTERVENTIONS Transmastoid sigmoid resurfacing. MAIN OUTCOME MEASURES Resolution of pulsatile tinnitus; audiologic outcomes; complications; tinnitus etiologies. RESULTS Nineteen patients (89.4% women) had surgery for suspected sigmoid sinus dehiscence. The mean dehiscence size was 6.1 mm (range, 1-10.7 mm). Eight patients had concurrent sigmoid sinus diverticulum and one patient also had jugular bulb dehiscence. Only two patients (10.5%) had the defect identified by radiology. Low-frequency pure-tone average, measured at frequencies of 250 and 500 Hz, showed a significant median improvement of 8.8 dB following resurfacing (18.8 dB versus 10.0 dB, p = 0.02). The majority of patients had complete resolution of pulsatile tinnitus (16/19, 84.2%). Of those without complete resolution, two patients had partial response and one patient had no improvement. There were no significant complications. Of 41 consecutively tracked patients with a pulsatile tinnitus chief complaint, sigmoid pathology represented 32% of cases. CONCLUSIONS Sigmoid sinus dehiscence represents a common vascular cause of pulsatile tinnitus that, if properly assessed, may be amenable to surgical intervention. Sigmoid sinus resurfacing is safe, does not require decompression, and may improve low-frequency hearing. Radiographic findings of dehiscence are often overlooked without a high index of clinical suspicion. Its relationship with transverse sinus pathology and idiopathic intracranial hypertension remain unclear.
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Wang S, Dai J, Xiang C, Chen Z, Ouyang X, Zhu L, Yu F, Zong X, Kang H. Association Between Sigmoid Sinusoidal Tinnitus and Low-Frequency Sensorineural Hearing Loss: A Retrospective Study at a Single Center. Med Sci Monit 2021; 27:e929300. [PMID: 33744908 PMCID: PMC7992498 DOI: 10.12659/msm.929300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/11/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We aimed to explore the correlation between patients' sigmoid sinusoidal tinnitus (SST) and low-frequency sensorineural hearing loss (LFSHL) and illustrate the underlying mechanism. MATERIAL AND METHODS Seven healthy volunteers with normal hearing were subjected to 125-, 250-, and 500-Hz pure sound and different white noise-masking intensities. A retrospective analysis was made on the clinical data and postoperative follow-up data of 59 patients with SST in the First Affiliated Hospital of Chongqing Medical University. The patients' sex, age, chief complaints, affected site, concomitant symptoms, course of disease, pure-tone audiometry (PTA) results, tinnitus discomfort loudness scale results, imaging examination, and complications were collected. RESULTS The results of the simulation experiment showed that the threshold of each frequency segment was higher after noise masking than before masking; the intensity of noise masking was positively correlated with hearing loss, and the changes of the hearing threshold of the 3 frequencies before and after masking were statistically significant (P<0.05). Fifty-nine patients with SST were documented between January 2015 and January 2020. After the operation, their low-frequency hearing was recovered to normal; 11 cases had significantly alleviated tinnitus and 9 cases were cured. CONCLUSIONS SST often causes corresponding pseudo-low-frequency hearing loss due to the noise-masking effect. The center frequency of tinnitus appears not to be 250-Hz or 500-Hz octave frequency of PTA, barring the detection of the pseudo-hearing loss in the audiometry chart of most patients. Surgery positively affects patients with SST, and the pseudo-LFSHL can be completely recovered after the operation as a result of tinnitus elimination.
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Genitsaridi E, Hoare DJ, Kypraios T, Hall DA. A Review and a Framework of Variables for Defining and Characterizing Tinnitus Subphenotypes. Brain Sci 2020; 10:E938. [PMID: 33291859 PMCID: PMC7762072 DOI: 10.3390/brainsci10120938] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023] Open
Abstract
Tinnitus patients can present with various characteristics, such as those related to the tinnitus perception, symptom severity, and pattern of comorbidities. It is speculated that this phenotypic heterogeneity is associated with differences in the underlying pathophysiology and personal reaction to the condition. However, there is as yet no established protocol for tinnitus profiling or subtyping, hindering progress in treatment development. This review summarizes data on variables that have been used in studies investigating phenotypic differences in subgroups of tinnitus, including variables used to both define and compare subgroups. A PubMed search led to the identification of 64 eligible articles. In most studies, variables for subgrouping were chosen by the researchers (hypothesis-driven approach). Other approaches included application of unsupervised machine-learning techniques for the definition of subgroups (data-driven), and subgroup definition based on the response to a tinnitus treatment (treatment response). A framework of 94 variable concepts was created to summarize variables used across all studies. Frequency statistics for the use of each variable concept are presented, demonstrating those most and least commonly assessed. This review highlights the high dimensionality of tinnitus heterogeneity. The framework of variables can contribute to the design of future studies, helping to decide on tinnitus assessment and subgrouping.
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Affiliation(s)
- Eleni Genitsaridi
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (D.J.H.); (D.A.H.)
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK
| | - Derek J. Hoare
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (D.J.H.); (D.A.H.)
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK
| | - Theodore Kypraios
- School of Mathematical Sciences, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Deborah A. Hall
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (D.J.H.); (D.A.H.)
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK
- Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- University of Nottingham Malaysia, Semenyih 43500, Selangor Darul Ehsan, Malaysia
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Bhatnagar K, Lataille AT, Eisenman DJ. Patterns of audiometric threshold shifts from pulsatile tinnitus due to sigmoid sinus wall anomalies. Am J Otolaryngol 2020; 41:102647. [PMID: 32683189 DOI: 10.1016/j.amjoto.2020.102647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/06/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine the severity and nature of audiometric threshold shifts for patients with pulsatile tinnitus (PT) due to sigmoid sinus wall anomalies (SSWA). MATERIALS AND METHODS 38 patients with SSWAs and available pre-operative audiograms were examined. Low- and high-frequency pure tone averages (LF-PTA, HF-PTA) were calculated. Audiometric data were compared between affected and unaffected ears, with the interaural difference (affected-unaffected PTA) representing the change in hearing due to PT. Additionally, post-operative change was examined in 14 patients with available data. RESULTS The average pre-operative air conduction (AC) LF-PTA was 17.04 dB on the affected side and 11.38 dB on the unaffected side (p < 0.001). The mean AC HF-PTA was significantly higher on the affected side as well (16.45 dB vs. 14.08 dB, p = 0.008). All shifts were sensorineural, with no significant air-bone gaps, and most subjects still had low-frequency thresholds in the normal range. Though the post-op change was not significant due to attrition, 5/14 patients (35.7%) had complete resolution of their pre-op interaural difference. A similar number developed a HF-PTA post-op threshold elevation in the surgical ear. CONCLUSIONS PT due to SSWAs causes a mean 6 dB low-frequency bone-conduction threshold elevation, and smaller high-frequency threshold shifts, due to masking. Patients with larger threshold shifts should have other potential causes of hearing loss explored. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Kavita Bhatnagar
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Angela T Lataille
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David J Eisenman
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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Longitudinal analysis of surgical outcome in subjects with pulsatile tinnitus originating from the sigmoid sinus. Sci Rep 2020; 10:18194. [PMID: 33097817 PMCID: PMC7584625 DOI: 10.1038/s41598-020-75348-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/08/2020] [Indexed: 12/17/2022] Open
Abstract
A dominant sigmoid sinus with either diverticulum or dehiscence (SS-Div/SS-Deh) is a common cause of pulsatile tinnitus (PT). For PT originating from SS-Div/SS-Deh, an etiology-specific and secure reconstruction using firm materials is vital for optimal outcomes. As a follow-up to our previous reports on transmastoid SS resurfacing or reshaping for SS-Div/SS-Deh, this study aimed to evaluate the long-term results of transmastoid resurfacing/reshaping. We retrospectively reviewed 20 PT patients who were diagnosed with SS-Div/SS-Deh, underwent transmastoid resurfacing/reshaping, and were followed up for more than 1 year postoperatively. For PT, immediate and long-term changes (> 1 year) in loudness and annoyance were analyzed using the visual analog scale (VAS). Additionally, pre and postoperative objective measurements of PT using transcanal sound recording and spectro-temporal analysis (TSR-STA), imaging results, and audiological findings were comprehensively analyzed. Significant improvements in PT were sustained or enhanced for > 1 year (median follow-up period: 37 months, range: 12–54 months). On TSR-STA, both peak and root mean square amplitudes decreased after surgery. Also, the average pure-tone threshold at 250 Hz improved after surgery. Thus, our long-term follow-up data confirmed that the surgical management of PT originating from SS-Div/SS-Deh is successful with regard to both objective and subjective measures.
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Huh G, Bae YJ, Woo HJ, Park JH, Koo JW, Song JJ. Vestibulocochlear Symptoms Caused by Vertebrobasilar Dolichoectasia. Clin Exp Otorhinolaryngol 2020; 13:123-132. [PMID: 31522490 PMCID: PMC7248613 DOI: 10.21053/ceo.2019.00780] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/15/2019] [Accepted: 08/04/2019] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Vertebrobasilar dolichoectasia (VBD), an elongation and distension of vertebrobasilar artery, may present with cranial nerve symptoms due to nerve root compression. The objectives of this study are to summarize vestibulocochlear manifestations in subjects with VBD through a case series and to discuss the needs of thorough oto-neurotologic evaluation in VBD subjects before selecting treatment modalities. METHODS Four VBD subjects with vestibulocochlear manifestations were reviewed retrospectively. VBD was confirmed by either brain or internal auditory canal magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). Patient information, medical history, MRI/MRA findings, and audiometry or vestibular function tests were reviewed according to patient's specific symptom. RESULTS Of the four subjects, three presented with ipsilesional sensorineural hearing loss (SNHL), three with paroxysmal recurrent vertigo, and two with typewriter tinnitus. The MRI/MRA of the four subjects revealed unilateral VBD with neurovascular compression of cisternal segment or the brainstem causing displacement, angulation, or deformity of the cranial nerve VII or VIII that corresponded to the symptoms. CONCLUSION Vestibulocochlear symptoms such as SNHL, recurrent paroxysmal vertigo, or typewriter tinnitus can be precipitated from a neurovascular compression of the vestibulocochlear nerve by VBD. Because proper medical or surgical treatments may stop the disease progression or improve audio-vestibular symptoms in subjects with VBD, a high index of suspicion and meticulous radiologic evaluation are needed when vestibulocochlear symptoms are not otherwise explainable, and if VBD is confirmed to cause audiovestibular manifestation, a thorough oto-neurotologic evaluation should be performed before initial treatment.
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Affiliation(s)
- Gene Huh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Jun Woo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Hyun Park
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Ja-Won Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Korea
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Jugular Bulb Resurfacing With Bone Cement for Patients With High Dehiscent Jugular Bulb and Ipsilateral Pulsatile Tinnitus. Otol Neurotol 2019; 40:192-199. [DOI: 10.1097/mao.0000000000002093] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Tinnitus is the sensation of hearing a sound with no external auditory stimulus present. It is a public health issue correlated with multiple comorbidities and precipitating factors such as noise exposure, military service, and traumatic brain injury, migraine, insomnia, small vessel disease, smoking history, stress exposure, anxiety, depression, and socioeconomic status. Clinical experience and a recent literature review point at tinnitus as a neuropsychiatric condition involving both auditory and nonauditory cortical areas of the brain and affecting brain-auditory circuitry. In fact, brain-ear connections have been highlighted in different models. Forward management of this disorder should take this body of research into consideration as tinnitus remains a challenging condition to evaluate and treat with current management protocols still symptomatic at best. With a better understanding of the etiologic factors and comorbidities of tinnitus, additional research trials and new therapeutic approaches could see the light to tackle this public health disability bringing hope to patients and doctors.
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Affiliation(s)
- Zeina Chemali
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
| | - R Nehmé
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Gregory Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Differentiation Between Intralabyrinthine Schwannoma and Contrast-enhancing Labyrinthitis on MRI: Quantitative Analysis of Signal Intensity Characteristics. Otol Neurotol 2018; 39:1045-1052. [DOI: 10.1097/mao.0000000000001901] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dural arteriovenous fistula masquerading as pulsatile tinnitus: radiologic assessment and clinical implications. Sci Rep 2016; 6:36601. [PMID: 27812001 PMCID: PMC5095646 DOI: 10.1038/srep36601] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/17/2016] [Indexed: 11/16/2022] Open
Abstract
Pulsatile tinnitus (PT) is often an initial presenting symptom of dural arteriovenous fistula (dAVF), but it may be overlooked or diagnosed late if not suspected on initial diagnostic work-up. Here, we assess anatomical features, treatment outcomes, and clinical implications of patients with PT due to dAVF. Of 220 patients who were diagnosed with dAVF between 2003 and 2014, 30 (13.6%) presented with only PT as their initial symptom. The transverse-sigmoid sinus (70.0%) was the most common site, followed by the hypoglossal canal (10.0%) and the middle cranial fossa (6.7%) on radiologic evaluation. Regarding venous drainage patterns, sinus or meningeal venous drainage pattern was the most common type (73.3%), followed by sinus drainage with a cortical venous reflux (26.7%). PT disappeared completely in 21 (80.8%) of 26 patients who underwent therapeutic intervention with transarterial embolization of the fistula, improved markedly in 3 (11.5%), and remained the same in 2 (7.7%). In conclusion, considering that PT may be the only initial symptom in more than 10% of dAVF, not only otolaryngologists but also neurologists and neurosurgeons should meticulously evaluate patients with PT. In most cases, PT originating from dAVF can be cured with transarterial embolization regardless of location and venous drainage pattern.
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