Temporal Bone–Resurfacing Techniques for Pulsatile Tinnitus Associated with Vascular Wall Anomalies

Systematic Review of Temporal Bone–Resurfacing Techniques for Pulsatile Tinnitus Associated with Vascular Wall Anomalies

George S. Liu, Brian C. Boursiquot, Nikolas H. Blevins, MD, ...
First Published January 22, 2019
https://doi.org/10.1177/0194599818823205

Abstract
Objective
To systematically review literature evidence on temporal bone–resurfacing techniques for pulsatile tinnitus (PT) associated with vascular wall anomalies.

Data Sources
We searched PubMed, Embase, and the Cochrane Database. The period covered was from 1962 to 2018.

Review Methods
We included studies in all languages that reported resurfacing outcomes for patients with PT and radiographic evidence or direct visualization of sigmoid sinus wall anomaly, jugular bulb wall anomaly, or dehiscent or aberrant internal carotid artery.

Results
Of 954 citations retrieved in database searches and 5 citations retrieved from reference lists, 20 studies with a total of 141 resurfacing cases involving 138 patients were included. Resurfacing outcomes for arterial sources of PT showed 3 of 5 cases (60%) with complete resolution and 2 (40%) with partial resolution. Jugular bulb sources of PT showed 11 of 14 cases (79%) with complete resolution and 1 (7%) with partial resolution. Sigmoid sinus sources of PT showed 91 of 121 cases (75%) with complete resolution and 12 (10%) with partial resolution. Symptoms occurred more in females and on the right side. Most cases (94%) used hard-density materials for resurfacing. Material density did not appear to be associated with resurfacing outcomes. Use of autologous materials was associated with improved outcomes for arterial sources resurfacing. Major complications involving sigmoid sinus thrombosis or compression were reported in 4% of cases without long-term morbidity or mortality.

Conclusions
Resurfacing surgery is likely effective and well tolerated for select patients with PT associated with various vascular wall anomalies.

 

Patterns of audiometric threshold shifts from pulsatile tinnitus due to sigmoid sinus wall anomalies

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.

Source: https://www.sciencedirect.com/science/article/abs/pii/S0196070920303410

 

I am currently waiting to have this surgery done. According to my scan, the sigmoid sinus bone is missing.

I also have normal tinnitus as well as pulsatile tinnitus. My pulsatile tinnitus started first.

I have to admit though, I'm scared the operation might make my normal tinnitus worse.