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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.
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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
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Cass ND, Lindquist NR, Patro A, Smetak MR, Perkins EL, O'Malley MR, Bennett ML, Haynes DS, Tawfik KO. Radiographic Sigmoid Sinus Wall Abnormalities and Pulsatile Tinnitus: A Case-Control Study. Otol Neurotol 2023; 44:353-359. [PMID: 36843071 DOI: 10.1097/mao.0000000000003842] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE Compare incidence of sigmoid sinus wall abnormalities (SSWAs) and other radiographic abnormalities in patients with pulsatile tinnitus (PT) versus controls. STUDY DESIGN Retrospective case-control. SETTING Tertiary referral center. PATIENTS Adults with PT and high-resolution computed tomography imaging were compared with adults undergoing cochlear implant workup including high-resolution computed tomography imaging. MAIN OUTCOME MEASURES Incidence of SSWA in PT cohort (n = 141) compared with control (n = 149, n = 298 ears). Secondary outcome measures included differences in demographics and in other radiographic abnormalities between cohorts. RESULTS Patients with PT had a higher incidence of SSWA (34% versus 9%, p < 0.001) and superior canal dehiscence (23% versus 12%, p = 0.017) than controls. Spearman product component correlations demonstrated that ipsilateral PT was weakly associated with SSWA ( r = 0.354, p < 0.001). When SSWA was present in the PT cohort (n = 48 patients, n = 59 ears), in 31 cases (64.6%), the SSWA correlated with PT laterality (e.g., left SSWA, left PT); in 12 (25.0%), SSWA partially correlated with PT laterality (e.g., bilateral SSWA, right PT); and in 5 (10.4%), the SSWA did not correlate with PT laterality (e.g., right SSWA, left PT). CONCLUSIONS For our patients with both PT and SSWA, the SSWA is likely a contributing factor in approximately 65% of cases. For a third of patients with PT and concomitant SSWA, the association between the two is either not causative or not solely causative. Surgeons counseling patients with PT and SSWA may be optimistic overall regarding sigmoid resurfacing procedures but must appreciate the possibility of treatment failure, likely because of untreated comorbid conditions.
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Affiliation(s)
| | - Nathan R Lindquist
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ankita Patro
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Miriam R Smetak
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth L Perkins
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew R O'Malley
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marc L Bennett
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David S Haynes
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kareem O Tawfik
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
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Xing Y, Gao S, Zhou Y, Song S, Lu L, Chen J, Dai Y. Surgical treatment of pulsatile tinnitus related to the sigmoid sinus. J Otol 2023; 18:21-25. [PMID: 36820162 PMCID: PMC9937817 DOI: 10.1016/j.joto.2022.10.001] [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: 06/28/2022] [Revised: 09/27/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022] Open
Abstract
Objective Tinnitus-a common clinical symptom-can be categorized into pulsatile tinnitus (PT) and non-PT. Among these, PT is usually associated with sigmoid sinus symptoms, such as sigmoid sinus wall defect or diverticulum, for which various surgical treatments are available. We have discussed the clinical efficacy of surgery for sigmoid sinus-associated PT via the transmastoid approach in this study. Methods We conducted a retrospective review of 4 patients who underwent surgery for sigmoid sinus-associated PT via the transmastoid approach at Nanjing Drum Tower Hospital from January to December 2020. Of these, 2 patients had sigmoid sinus wall defect and 2 had sigmoid sinus diverticulum. Post-operative tinnitus grading and surgical efficacy were determined. Results After surgery, PT dissolved in 3 patients, while tinnitus significantly decreased in 1 patient. During the follow-up period of 12-18 months, none of the 4 patients showed complications related to increased intracranial pressure or venous sinus thrombosis, and tinnitus symptoms disappeared in 3 patients without recurrence, although 1 patient occasionally developed tinnitus. Postoperative thin-slice CTA of the temporal bone indicated that the sigmoid sinus bone wall defect or diverticulum was completely repaired with a thick soft tissue coverage. Conclusion Surgical repair of sigmoid sinus-associated PT via the transmastoid approach deserves clinical promotion as it exhibited better efficiency while being relatively less invasive.
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Affiliation(s)
- Yuxuan Xing
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China
- Research Institute of Otolaryngology, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Song Gao
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China
- Research Institute of Otolaryngology, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Yuchen Zhou
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China
- Research Institute of Otolaryngology, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
- Department of Otolaryngology Head and Neck Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, People's Republic of China
| | - Shenghua Song
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China
- Research Institute of Otolaryngology, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Ling Lu
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China
- Research Institute of Otolaryngology, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Jie Chen
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China
- Research Institute of Otolaryngology, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
- Corresponding author. Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China.
| | - Yanhong Dai
- Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China
- Research Institute of Otolaryngology, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
- Corresponding author. Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China.
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Hsieh Y, Xu X, Wu Y, Wang W. Evidence of air-conduction transmission pathway and strategized transtemporal operative techniques for venous pulsatile tinnitus: Combining water occlusion test and operative sensing applications. Laryngoscope Investig Otolaryngol 2021; 6:1436-1448. [PMID: 34938885 PMCID: PMC8665428 DOI: 10.1002/lio2.699] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/20/2021] [Accepted: 11/02/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES (1) To establish evidence of the transmission pathway of venous pulsatile tinnitus (PT) associated with sigmoid sinus wall anomalies (SSWAs) and (2) quantify the efficacy of transtemporal surgery. METHODS This retrospective study included 33 surgical cases of PT associated with SSWAs and 15 controls with venous PT without SSWAs. Quantitative water occlusion test (q-WOT) and imaging data were acquired for preoperative evaluation prior to strategized transtemporal osteovascular reconstruction surgery. A condenser microphone and hydrophone were intraoperatively deployed to assess and monitor in vivo amplitude variations of the PT in eight participants. RESULTS A total of 23 (69.6%) participants with SSWA responded to the q-WOT with a median solution volume of 1.3 (1.1/1.6), which significantly differed from that observed in controls (p < 0.01). The change in the operative peak amplitude of the acoustic data was statistically significant (p < 0.01), from a median of 57.6 (55.5/57.9) dB SPL to 34.3 (33.4/38.8) dB SPL. CONCLUSION Intraoperative application of acoustic sensors revealed that PT associated with SSWAs is predominantly transmitted via the air-conduction pathway. If objective findings such as q-WOT and sensing applications suggest that the transmission of venous PT is involved in middle ear air conduction, the reconstruction technique should be prioritized; if less involvement of middle ear air-conduction is indicated, addressing flow pathologies may be imperative for resolving venous PT. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Yue‐Lin Hsieh
- Department of Otology and Skull Base SurgeryEye Ear Nose & Throat Hospital, Fudan UniversityShanghaiChina
- Department of Otolaryngology‐Head and Neck SurgeryNHC Key Laboratory of Hearing MedicineShanghaiChina
| | - Xiaobing Xu
- Department of Otolaryngology‐Head and Neck SurgeryNHC Key Laboratory of Hearing MedicineShanghaiChina
- Department of RadiologyEye Ear Nose & Throat Hospital, Fudan UniversityShanghaiChina
| | - Yongzhen Wu
- Department of Otology and Skull Base SurgeryEye Ear Nose & Throat Hospital, Fudan UniversityShanghaiChina
- Department of Otolaryngology‐Head and Neck SurgeryNHC Key Laboratory of Hearing MedicineShanghaiChina
| | - Wuqing Wang
- Department of Otology and Skull Base SurgeryEye Ear Nose & Throat Hospital, Fudan UniversityShanghaiChina
- Department of Otolaryngology‐Head and Neck SurgeryNHC Key Laboratory of Hearing MedicineShanghaiChina
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