A case of jugular bulb diverticulum causing pulsatile tinnitus

Pulsatile tinnitus (PT) caused by a high-riding dehiscence jugular bulb (HDJB) is a rare but treatable otology disease. There are several managements include transcatheter endovascular coil embolization, transvenous stent–assisted coil embolization, or resurfacing the dehiscent bony wall of high jugular bulb under the use of microscope. Among those options, surgical resurfacing of HDJB might be an effective and safe choice with less destruction. However, previous studies approached middle ear cavity via microscope can only provide a lateral, indirect view, while resurfacing the vessel through a transcanal endoscopic ear surgery (TEES) approach may give surgeon a direct and easy way to manage HDJB. In this report, we presented a case of 40-year-old woman with HDJB and shared our clinical consideration and reasoning of the surgical management of PT via a transtympanic approach by TEES rather than a transmastoid approach.

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Jugular Bulb Resurfacing With Bone Cement for Patients With High Dehiscent Jugular Bulb and Ipsilateral Pulsatile Tinnitus

Otology & Neurotology ◽

10.1097/mao.0000000000002093 ◽

2019 ◽

Vol 40 (2) ◽

pp. 192-199 ◽

Cited By ~ 3

Author(s):

Sang-Yeon Lee ◽

Seul-Ki Song ◽

Sung Joon Park ◽

Han Gyeol Park ◽

Byung Yoon Choi ◽

...

Keyword(s):

Bone Cement ◽

Jugular Bulb ◽

Pulsatile Tinnitus

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Hypotympanic Sound Baffle for Amelioration of Pulsatile Tinnitus due to Carotid and Jugular Bulb Dehiscence

Otology & Neurotology ◽

10.1097/mao.0000000000002293 ◽

2019 ◽

Vol 40 (7) ◽

pp. 920-926

Author(s):

George S. Liu ◽

Nikolas H. Blevins ◽

Yona Vaisbuch

Keyword(s):

Jugular Bulb ◽

Pulsatile Tinnitus

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Surgical treatment of the high jugular bulb in patients with M�ni�re's disease and pulsatile tinnitus

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s004050050146 ◽

1999 ◽

Vol 256 (5) ◽

pp. 224-229 ◽

Cited By ~ 43

Author(s):

V. Couloigner ◽

A. Bozorg Grayeli ◽

D. Bouccara ◽

N. Julien ◽

O. Sterkers

Keyword(s):

Surgical Treatment ◽

Jugular Bulb ◽

Pulsatile Tinnitus ◽

High Jugular Bulb

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Endovascular treatment of two concomitant causes of pulsatile tinnitus: sigmoid sinus stenosis and ipsilateral jugular bulb diverticulum. Case report and literature review

Acta Neurochirurgica ◽

10.1007/s00701-011-1202-3 ◽

2011 ◽

Vol 154 (1) ◽

pp. 89-92 ◽

Cited By ~ 25

Author(s):

Francesco Signorelli ◽

Kalid Mahla ◽

Francis Turjman

Keyword(s):

Case Report ◽

Literature Review ◽

Endovascular Treatment ◽

Jugular Bulb ◽

Sigmoid Sinus ◽

Pulsatile Tinnitus ◽

Sinus Stenosis

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Aberrant internal carotid artery in the middle ear with dehiscent high jugular bulb

The Journal of Laryngology & Otology ◽

10.1017/s0022215112000564 ◽

2012 ◽

Vol 126 (6) ◽

pp. 645-647 ◽

Cited By ~ 9

Author(s):

Y-Y Lin ◽

C-H Wang ◽

S-C Liu ◽

H-C Chen

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Ear ◽

Internal Carotid ◽

Jugular Bulb ◽

Bleeding Complications ◽

Pulsatile Tinnitus ◽

High Jugular Bulb ◽

Aberrant Internal Carotid Artery ◽

The Right

AbstractObjective:We report an extremely rare case of an aberrant internal carotid artery in the middle ear, together with a dehiscent high jugular bulb, a combination never previously reported.Methods:Case report with a review of the literature.Results:A 24-year-old man presented with a five-year history of aural fullness, pulsatile tinnitus and mild hearing impairment in his right ear. Otoscopy revealed a retro-tympanic mass. Computed tomography of the temporal bone revealed protrusion of the right internal carotid artery into the middle-ear cavity, with a dehiscent high jugular bulb. Magnetic resonance angiography showed a reduced diameter and lateralisation of the right internal carotid artery. A diagnosis of an aberrant internal carotid artery with a dehiscent high jugular bulb was made, and the patient was managed with conservative treatment.Conclusion:The otologist should be aware of the possibility of an aberrant internal carotid artery when the patient presents with a retro-tympanic mass, hearing loss and pulsatile tinnitus. Radiological investigation is required to make the differential diagnosis. When an aberrant internal carotid artery presents with a dehiscent high jugular bulb, the risk of serious bleeding is elevated. We recommend a conservative approach for cases presenting without bleeding complications.

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Pulsatile tinnitus due to an aneurysmatic diverticulum of the jugular bulb treated with the Woven EndoBridge device

Interventional Neuroradiology ◽

10.1177/1591019919881582 ◽

2019 ◽

Vol 26 (2) ◽

pp. 235-238

Author(s):

F Drescher ◽

V Maus ◽

W Weber ◽

S Fischer

Keyword(s):

Layer Structure ◽

Single Layer ◽

Flow Diverter ◽

Jugular Foramen ◽

Jugular Bulb ◽

Common Symptom ◽

Pulsatile Tinnitus ◽

Glomus Tumors ◽

Woven Endobridge ◽

The Web

Tinnitus is a common symptom with an incidence of 4–20%. Pulsatile tinnitus represents a minor subgroup of less than 10% of all patients suffering from tinnitus. Pulsatile tinnitus – different from permanent mostly idiopathic tinnitus is mainly caused by physical sources related to vascular pathologies resulting in a change in blood volume and pressure or an alteration of the vessel lumen. Differential diagnosis for pulsatile tinnitus include dural arteriovenous fistulas, glomus tumors of the jugular foramen and the middle ear or atherosclerotic diseases of the carotid artery in the petrous or cavernous segment. Anomalies of the dural sinuses and the jugular bulb have been described as rare sources of synchronized tinnitus. The Woven EndoBridge (WEB, Microvention, Tustin, CA) is an intraaneurysmal flow diverter for the treatment of broad-based arterial aneurysms with a high safety and effectiveness profile. The initial version of the WEB with a dual layer structure evolved to a single layer structure in two different versions (WEB SL, WEB SLS). The WEB system does not require a concomitant antiplatelet therapy compared to other intraluminal devices as extra-aneurysmal flow-diverters or intracranial stents. Here we describe a case of an aneurysmatic diverticulum of the jugular bulb in a patient with ipsilateral pulsatile tinnitus treated with a WEB device.

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

Otolaryngology ◽

10.1177/0194599818823205 ◽

2019 ◽

Vol 160 (5) ◽

pp. 749-761 ◽

Cited By ~ 4

Author(s):

George S. Liu ◽

Brian C. Boursiquot ◽

Nikolas H. Blevins ◽

Yona Vaisbuch

Keyword(s):

Temporal Bone ◽

Complete Resolution ◽

Sinus Thrombosis ◽

Vascular Wall ◽

Jugular Bulb ◽

Review Literature ◽

Sigmoid Sinus ◽

Pulsatile Tinnitus ◽

Partial Resolution ◽

Sinus Wall

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.

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A Rare Cause of Red Tympanic Membrane: Jugular Bulb Diverticulum

Ear Nose & Throat Journal ◽

10.1177/01455613211031384 ◽

2021 ◽

pp. 014556132110313

Author(s):

Boon Chin Te ◽

Kai Ping Ong ◽

Izny Hafiz Zainon

Keyword(s):

Carotid Artery ◽

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Tympanic Membrane ◽

Open Surgery ◽

Dural Arteriovenous Fistula ◽

Imaging Study ◽

Jugular Bulb ◽

Pulsatile Tinnitus ◽

Glomus Tympanicum

Significance Statement Pulsatile tinnitus with erythematous tympanic membrane mass suggests vascular pathologies such as dural arteriovenous fistula, glomus tympanicum, or aberrant carotid artery. Jugular bulb aneurysmatic diverticulum is rare but should be suspected in a case with the presence of aneurysm in other organs. An imaging study is mandatory to confirm the diagnosis. Patient must avoid digging ear as it can cause profuse bleeding. Treatment option can be open surgery or endovascular treatment.

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