Pulsatile Tinnitus Caused by Internal Jugular Phlebectasia

Jugular Bulb Abnormalities Associated with Phlebectasia in Patients with Meniere’s Disease: Novel Surgical Approach

Internal Jugular Phlebectasia (IJP) is a rare entity in which there is a fusiform dilatation of internal jugular vein, usually presenting with a neck mass or tinnitus. The Jugular Bulb (JB) is an enlarged confluence connecting the sigmoid sinus and the Internal Jugular Vein (IJV). It has been suggested that JBA (Jugular Bulb Abnormalities) might also cause hearing loss, vertigo, and pulsatile tinnitus. Meniere’s Disease (MD) is a disorder characterized by recurrent vertigo attacks, fluctuating hearing loss, and tinnitus. We report Meniere’s disease-like symptoms in two cases (52 and 38-year-old) with a history of pulsatile tinnitus, vertigo and lateral neck swelling that appeared only on straining, coughing, or during a Valsalva maneuver. Diagnosis of IJP in the two cases, had been approved preoperatively by CTA. Intraoperative venography in the course of exploration showed the High Jugular Bulb (HJB) along with the Jugular Bulb Diverticulum (JBD) and sigmoid sinus diverticulum. Polytetrafluoroethylene tube graft PTFE (6 mm) was inserted into the dilated segment extending from sternoclavicular joint up to the beginning of sigmoid sinus. A-One- year follow up duplex ultrasound revealed patency of the synthetic graft without any dynamic flow abnormalities. Because of diagnosis rarity, this entity is frequently ignored or misdiagnosed. These two cases displayed how the importance of associated IJP and JBA as a differential diagnosis of lateral neck swelling associated with Meniere’s disease-like symptoms to avoid inappropriate treatment. Surgical management offers a safe, effective and convenient outcome especially in young patients in whom endovascular therapy may not be durable or cost-effective.