Pulsatile Versus Non-Pulsatile Tinnitus in Idiopathic Intracranial Hypertension

[Frédéric]

I don't know where to post this article:

• Authors: Jonathan P. Funnell, Claudia L. Craven, Simon D. Thompson, Linda D'Antona, Aswin Chari, Lewis Thorne, Laurence D. Watkins, Ahmed K. Toma

Abstract
Introduction

Tinnitus is a symptom commonly associated with idiopathic intracranial hypertension (IIH) that can have a profound effect on quality of life. We aim to determine tinnitus symptom response after dural venous sinus stenting (DVSS) or CSF diversion with a shunt, in patients with both pulsatile (PT) and non-pulsatile tinnitus (NPT).

Methods
Single-centre cohort of IIH patients (2006–2016) who underwent 24-h ICP monitoring (ICPM). An un-paired t test compared ICP and pulse amplitude (PA) values in IIH patients with PT vs. NPT.

Results
We identified 59 patients with IIH (56 F:3 M), mean age 32.5 ± 9.49 years, 14 of whom suffered from tinnitus. Of these 14, seven reported PT and seven reported NPT. Patients with tinnitus had a mean 24-h ICP and PA of 9.09 ± 5.25 mmHg and 6.05 ± 1.07 mmHg respectively. All 7 patients with PT showed symptom improvement or resolution after DVSS (n = 4), secondary DVSS (n = 2) or shunting (n = 1). In contrast, of the 7 with NPT, only 1 improved post intervention (DVSS), despite 2 patients having shunts and 5 having DVSS.

Conclusions
NPT and PT were equally as common in our group of IIH patients. DVSS appears to be an effective management option for IIH patients with a clear history of pulsatile tinnitus. However, non-pulsatile tinnitus was more persistent and did not respond well to either DVSS or CSF diversion.

Keywords
Cerebrospinal fluid (CSF) Headache Hydrocephalus Tinnitus Dural venous sinus stenting (DVSS)

Source: https://link.springer.com/article/10.1007/s00701-018-3587-8

 

[Laurie1961]

Interesting approach. This has to do with the inability of the brain and sinuses to process and cleanse spinal fluid.

I am having good luck using mustard packs on my tail bone that would weep excess amounts of clear fluid when my tinnitus first began and was very severe. I also noticed that veins in hands and feet were often bloated and blue, not returning blood as they should until I started using home remedies on the skin that contain sulfur (mustard powder ). Mustard packs to the back of my neck recently have improved my twenty year bout with Bell's Palsy.

The drug alternative to the stenting approach was not well tolerated. It was a combination of NO and S (acetazalamide) or oxided niacin (converted B3) and sulfur as a simultaneous injection putting it into the veins, or swallowed all at once into the gut.

So doing surgery and placing a stent or valve is a miraculous idea. Stents are made of plastic that attracts fungus and mold and bacteria or stents are made of a metal that attracts heavy metals. Long term prognosis is a wait and see- and I am sitting on pins and needles waiting to see how long the clinical trial test subjects survive. Which is worse tinnitus or heart flutter?

 

[Frédéric]

Association of pulse synchronous tinnitus and sigmoid sinus wall abnormalities in patients with idiopathic intracranial hypertension

Purpose
Pulse synchronous tinnitus (PT) is common in patients with idiopathic intracranial hypertension (IIH) and in those with sigmoid sinus wall abnormalities (SSWAs). Although patients with SSWAs and IIH share many clinical features, the incidence of SSWAs in patients with IIH and its relationship to PT in this cohort is less well established. The purpose of this study is to assess the incidence of SSWAs in patients with IIH and PT, and to determine if there is an association between SSWAs and PT in this population.

Materials and methods
Prospective computed tomography (CT) study of adults with IIH. Subjective PT was correlated with presence or absence of SSWAs on CT.

Results
22 subjects were enrolled and 14 subsequently underwent CT. The incidence of SSWAs was significantly higher in subjects with PT than without (70% vs. 0%, p = 0.02). Mean age, BMI and opening pressures did not differ between those with and without SSWAs or PT.

Conclusions
There is a high incidence of SSWAs in subjects with IIH and PT. These findings support an association between SSWAs and PT, and implicate SSWAs as a possible cause of, or contributing factor to, PT in patients with IIH. Patients with IIH and PT that does not resolve with reducing intracranial pressure should undergo diagnostic CT and consider treatment of a SSWA if present.

Source: https://www.sciencedirect.com/science/article/abs/pii/S0196070920303690