A Convenient Sonographic Technique for Diagnosis of Pulsatile Tinnitus Induced by a High Jugular Bulb

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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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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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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