scholarly journals A Transcanal Endoscopic Approach for Management of Pulsatile Tinnitus due to High-Riding Dehiscent Jugular Bulb

2021 ◽  
pp. 014556132110436
Author(s):  
David Shang-Yu Hung ◽  
Wei-Ting Lee ◽  
Yi-Lu Li ◽  
Jiunn-Liang Wu

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.

1994 ◽  
Vol 108 (9) ◽  
pp. 772-775 ◽  
Author(s):  
Philip J. Moore

AbstractEncounters with the jugular bulb in ear surgery are uncommon. This communication relates three cases where the author was confronted with the bulb in middle ear surgery – one in relation to the external auditory canal when raising a tympanomeatal flap and two in the hypotympanum when entering the middle ear. The anatomy of the jugular bulb is considered, particularly in regard to its quite variable placement within the temporal bone. The manner of clinical presentation of the high jugular bulb and previous cases in the literature where the jugular bulb has been discovered in juxtaposition to the surgical approach are discussed. Implications of surgical management are considered.


2012 ◽  
Vol 126 (6) ◽  
pp. 645-647 ◽  
Author(s):  
Y-Y Lin ◽  
C-H Wang ◽  
S-C Liu ◽  
H-C Chen

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.


2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Natasha Pollak ◽  
Roya Azadarmaki ◽  
Sidrah Ahmad

Stapedius and tensor tympani tenotomy is a relatively simple surgical procedure commonly performed to control pulsatile tinnitus due to middle ear myoclonus and for several other indications. We designed a cadaveric study to assess the feasibility of an entirely endoscopic approach to stapedius and tensor tympani tenotomy. We performed this endoscopic ear surgery in 10 cadaveric temporal bones and summarized our experience. Endoscopic stapedius and tensor tympani section is a new, minimally invasive treatment option for middle ear myoclonus that should be considered as the first line surgical approach in patients who fail medical therapy. The use of an endoscopic approach allows for easier access and vastly superior visualization of the relevant anatomy, which in turn allows the surgeon to minimize tissue dissection. The entire operation, including raising the tympanomeatal flap and tendon section, can be safely completed under visualization with a rigid endoscope.


2021 ◽  
pp. 014556132110091
Author(s):  
Yusuke Takata ◽  
Takashi Anzai ◽  
Satoshi Hara ◽  
Hiroko Okada ◽  
Fumihiko Matsumoto ◽  
...  

A dehiscent high jugular bulb would be a pitfall in middle ear surgery especially for cholesteatoma. We report a case of cholesteatoma attached to a dehiscent high jugular bulb successfully treated with surgery assisted with underwater endoscopy. To the best of our knowledge, no previous study has reported a case of cholesteatoma with dehiscent high jugular bulb treated with surgery assisted with underwater endoscopy. Owing to the risk of jugular bulb injury, underwater endoscopy is a good indication for middle ear cases with a dehiscent high jugular bulb to obtain a clear operative field and avoid an unexpected air embolism.


2008 ◽  
Vol 27 (1) ◽  
pp. 139-140 ◽  
Author(s):  
Minoru Nakagawa ◽  
Norimitsu Miyachi ◽  
Kenjiro Fujiwara

2011 ◽  
Vol 16 (2) ◽  
pp. 106-112 ◽  
Author(s):  
Chih-Hung Wang ◽  
Zheng-Ping Shi ◽  
Dai-Wei Liu ◽  
Hsing-Won Wang ◽  
Bor-Rong Huang ◽  
...  

2019 ◽  
Vol 133 (12) ◽  
pp. 1033-1037 ◽  
Author(s):  
A Das ◽  
S Mitra ◽  
D Ghosh ◽  
S Kumar ◽  
A Sengupta

AbstractObjectiveTo assess the effect of tranexamic acid on intra-operative bleeding and surgical field visualisation.MethodsFifty patients undergoing various endoscopic ear surgical procedures, including endoscopic tympanoplasty, endoscopic atticotomy or mastoidectomy, endoscopic ossiculoplasty, and endoscopic stapedotomy, were randomly assigned to: a study group that received tranexamic acid or a control group which received normal saline. The intra-operative bleeding and operative field visualisation was graded using the Das and Mitra endoscopic ear surgery bleeding and field visibility score, which was separately analysed for the external auditory canal and the middle ear.ResultsThe Das and Mitra score was better (p < 0.05) in the group that received tranexamic acid as a haemostat when working in the external auditory canal; with respect to the middle ear, no statistically significant difference was found between the two agents. Mean values for mean arterial pressure, heart rate and surgical time were comparable in both groups, with no statistically significant differences.ConclusionTranexamic acid appears to be an effective haemostat in endoscopic ear surgery, thus improving surgical field visualisation, especially during manipulation of the external auditory canal soft tissues.


2019 ◽  
Vol 80 (06) ◽  
pp. 608-611 ◽  
Author(s):  
Gaetano Ferri ◽  
Matteo Fermi ◽  
Matteo Alicandri-Ciufelli ◽  
Domenico Villari ◽  
Livio Presutti

Objectives The main objective of this article is to describe endoscopic management of intraoperative massive bleeding from jugular bulb injury during exclusively transcanal endoscopic procedures for middle ear pathologies. Design Case series with chart review. Setting Tertiary referral center. Participants We retrospectively reviewed two patients who experienced jugular bulb injury during endoscopic transcanal approach for glomus tympanicum and chronic otitis media. The surgical videos and charts were carefully investigated and analyzed. Main Outcome Measures Feasibility and suitability of exclusive endoscopic management of jugular bulb bleeding and description of surgical maneuvers that should be performed to obtain safe and effective hemostasis. Results In both patients, jugular bulb bleeding was progressively controlled by means of exclusive endoscopic approach with no need to convert to microscopic approach. None of the cases required a second surgeon helping in keeping the endoscope during hemostatic maneuvers. Both patients had a normal postoperative period with no recurrence of hemorrhage. Conclusions Endoscopic management of jugular bulb bleeding is feasible by using the technique described with reasonable efficacy and with no additional risk or morbidity to the procedure. Knowledge of anatomy and its variants, preoperative evaluation of imaging, and the ability of the surgeon to adapt the surgical technique to the specific case are recommended to prevent vascular complications during endoscopic ear surgery.


2020 ◽  
Vol 41 (9) ◽  
pp. e1122-e1127 ◽  
Author(s):  
Marco Bonali ◽  
Matteo Fermi ◽  
Matteo Alicandri-Ciufelli ◽  
Francesco Mattioli ◽  
Domenico Villari ◽  
...  

1989 ◽  
Vol 103 (1) ◽  
pp. 101-106 ◽  
Author(s):  
J. C. Shotton ◽  
H. Ludman ◽  
T.C.S. Cox

AbstractVariability in the size of the dural sinuses and jugular bulb is not uncommon and usually manifests as a high jugular bulb encroaching upon the floor of the middle ear. A rarer entity is the superior and medial extension of the jugular bulb into the bone of the posterior wall of the internal auditory meatus. We report a case where this anomaly was encountered during acoustic neuroma surgery making exposure of the fundus of the internal auditory meatus technically impossible. The possibility of a communication with the superior petrosal sinus is discussed.


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