Left dehiscent jugular bulb

[chamferman]

Hello Dr. Nagler,
First & for mostly I would like to thank you for the wonderful work you are doing on this forum.


I am a 46 year old generally fit & healthy male with no major health problems, who has had Tinnitus in my left ear for just under a year.
The onset of my Tinnitus happened a couple of weeks after Suffering with mild Bell Palsy also on the left hand side of my face. The facial paralysis lasted for a month, minor facial twitching went on for a further 7 months. In the first week of the Bells Palsy I developed Hyperacusis this went on for 8 months and has now dissapeared.
Within a day of getting Bells Palsy I presented myself to ENT & was prescribed Prednisone.

The closest match I have heard to my Tinnitus is White Noise at 6k,
The level of my tinnitus varies daily, I can change the pitch of the Tinnitus by clenching my jaw
Occasionally when I hear certain every day noises such as locking a door and I hear a sound of metal hitting metal it creates a ping sound in my Tinnitus ear, which lasts for a few minutes

Because I had Bells Palsy & Tinnitus, it is routine in England for the NHS to give you a CT with contrast scan to check for a Acoustic Neuroma. I was given the all clear regarding the Acoustic Neuroma, but told I had a Left dehiscent jugular bulb projecting into the posteroinferior aspect of the middle ear cavity through dehiscent sigmoid plate.
The ENT put it into laymen's terms & explained to me I had a enlarged artery protuding into my lefthand ear and it was nothing to worry about, I asked him whether this could be the cause of my Tinnitus & he said no.

Well obviously like most people when your told you have a certain condition the first thing you do is Google it. Having now Googled a Left dehiscent jugular bulb, I am coming up with results that indicate Pulsating Tinnitus, only difference is they Mention HIGH Riding jugular bulb.



Could I have your thoughts please?

Thanks in advance


Simon

 

[Dr. Nagler]

@chamferman posted:

First & for mostly I would like to thank you for the wonderful work you are doing on this forum.

.............

You are welcome. Glad to help.

................
I am a 46 year old generally fit & healthy male with no major health problems, who has had Tinnitus in my left ear for just under a year.
The onset of my Tinnitus happened a couple of weeks after Suffering with mild Bell Palsy also on the left hand side of my face. The facial paralysis lasted for a month, minor facial twitching went on for a further 7 months. In the first week of the Bells Palsy I developed Hyperacusis this went on for 8 months and has now dissapeared.
Within a day of getting Bells Palsy I presented myself to ENT & was prescribed Prednisone.

The closest match I have heard to my Tinnitus is White Noise at 6k,
The level of my tinnitus varies daily, I can change the pitch of the Tinnitus by clenching my jaw
Occasionally when I hear certain every day noises such as locking a door and I hear a sound of metal hitting metal it creates a ping sound in my Tinnitus ear, which lasts for a few minutes

Because I had Bells Palsy & Tinnitus, it is routine in England for the NHS to give you a CT with contrast scan to check for a Acoustic Neuroma. I was given the all clear regarding the Acoustic Neuroma, but told I had a Left dehiscent jugular bulb projecting into the posteroinferior aspect of the middle ear cavity through dehiscent sigmoid plate.
The ENT put it into laymen's terms & explained to me I had a enlarged artery protuding into my lefthand ear and it was nothing to worry about, I asked him whether this could be the cause of my Tinnitus & he said no.

Well obviously like most people when your told you have a certain condition the first thing you do is Google it. Having now Googled a Left dehiscent jugular bulb, I am coming up with results that indicate Pulsating Tinnitus, only difference is they Mention HIGH Riding jugular bulb.

Could I have your thoughts please?

................

OK.

So first of all, jugular bulbs cannot be dehiscent unless they are high riding. Most radiologists will include the words "high riding" in their reports when they describe a dehiscent jugular bulb, but in point of fact it is redundant to do so. Not all high riding jugular bulbs are dehiscent, but all dehiscent jugular bulbs are high riding. Hope that makes sense.

Second, jugular bulbs are veins, not arteries.

Third, most dehiscent jugular bulbs are asymptomatic, but sometimes they can look like a tumor when a doctor examines your ear with an otoscope. That's important to keep in mind if a doctor ever suggests biopsying the "tumor" in your middle ear, because the results of doing such a biopsy can be catastrophic.

Fourth, when dehiscent jugular bulbs do present as tinnitus, the tinnitus is pulsatile and is predominantly located on the same side as the dehiscent jugular bulb.

Fifth, if you have left sided pulsatile tinnitus and a left dehiscent jugular bulb, that still doesn't mean the tinnitus is necessarily caused by the dehiscent jugular bulb. That diagnosis is made during examination of the neck by disappearance of the pulsatile tinnitus upon selective manual compression of the jugular vein while not disturbing blood flow through the carotid artery.

Sixth, even if all of the above criteria are satisfied, whether or not you should have surgery to depends upon a number of factors, one of which is the degree to which your tinnitus bothers you.

There, no need for you to go to medical school now. Just sit for the exams and hang out your shingle!

Dr. Stephen Nagler