Surgical treatment of pulsatile tinnitus related to the sigmoid sinus

Yuxuan Xing; Song Gao; Yuchen Zhou; Shenghua Song; Ling Lu; Jie Chen; Yanhong Dai

doi:10.1016/j.joto.2022.10.001

Surgical treatment of pulsatile tinnitus related to the sigmoid sinus

J Otol. 2023 Jan;18(1):21-25. doi: 10.1016/j.joto.2022.10.001. Epub 2022 Oct 13.

Authors

Yuxuan Xing^{1

2}, Song Gao^{1

2}, Yuchen Zhou^{1

2

3}, Shenghua Song^{1

2}, Ling Lu^{1

2}, Jie Chen^{1

2}, Yanhong Dai^{1

2}

Affiliations

¹ Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, 210008, People's Republic of China.
² Research Institute of Otolaryngology, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China.
³ Department of Otolaryngology Head and Neck Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, People's Republic of China.

Abstract

Objective: Tinnitus-a common clinical symptom-can be categorized into pulsatile tinnitus (PT) and non-PT. Among these, PT is usually associated with sigmoid sinus symptoms, such as sigmoid sinus wall defect or diverticulum, for which various surgical treatments are available. We have discussed the clinical efficacy of surgery for sigmoid sinus-associated PT via the transmastoid approach in this study.

Methods: We conducted a retrospective review of 4 patients who underwent surgery for sigmoid sinus-associated PT via the transmastoid approach at Nanjing Drum Tower Hospital from January to December 2020. Of these, 2 patients had sigmoid sinus wall defect and 2 had sigmoid sinus diverticulum. Post-operative tinnitus grading and surgical efficacy were determined.

Results: After surgery, PT dissolved in 3 patients, while tinnitus significantly decreased in 1 patient. During the follow-up period of 12-18 months, none of the 4 patients showed complications related to increased intracranial pressure or venous sinus thrombosis, and tinnitus symptoms disappeared in 3 patients without recurrence, although 1 patient occasionally developed tinnitus. Postoperative thin-slice CTA of the temporal bone indicated that the sigmoid sinus bone wall defect or diverticulum was completely repaired with a thick soft tissue coverage.

Conclusion: Surgical repair of sigmoid sinus-associated PT via the transmastoid approach deserves clinical promotion as it exhibited better efficiency while being relatively less invasive.

Keywords: Efficacy of surgery; PT, pulsatile tinnitus; Pulsatile tinnitus; SSWA, sigmoid sinus wall abnormality; Sigmoid sinus diverticulum; Sigmoid sinus wall defect; TEQ, tinnitus evaluation questionnaire; Transmastoid approach.