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BACKGROUND: Sigmoid sinus wall dehiscence can lead to pulsatile tinnitus with a significant decrease in quality of life, occasionally leading to psychiatric disorders. Several surgical and endovascular procedures have been described for resolving dehiscence. Within endovascular procedures, the sagittal sinus approach could be a technical alternative for tracking and accurate stent positioning within the sigmoid sinus when the jugular bulb anatomy is unfavorable. CASE PRESENTATION: A retrospective case series of three patients with pulsatile tinnitus due to sigmoid sinus wall dehiscence without intracranial hypertension was reviewed from January 2018 to January 2022. From the participants enrolled, the median age was 50.3 years (range 43-63), with 67% self-identifying as female and 33% as male. They self-identified as Hispanic. Sigmoid sinus dehiscence was diagnosed using angiotomography, and contralateral transverse sinus stenosis was observed in all patients. Patients underwent surgery via a navigated endovascular sagittal sinus approach for sigmoid sinus stenting. No neurological complications were associated with the procedure. Pulsatile tinnitus improved after the procedure in all patients. CONCLUSIONS: Superior sagittal sinus resection for sigmoid sinus wall stenting is a safe and effective technique. Pulsatile tinnitus due to sigmoid sinus wall dehiscence could be treated using the endovascular resurfacing stenting technique. However, further research is needed to evaluate the potential benefit of contralateral stenting for removing sinus dehiscence when venous stenosis is detected. However, resurfacing sigmoid sinus wall dehiscence results in symptomatic improvement.
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Procedimientos Endovasculares , Stents , Acúfeno , Humanos , Femenino , Masculino , Acúfeno/cirugía , Acúfeno/etiología , Adulto , Persona de Mediana Edad , Procedimientos Endovasculares/métodos , Estudios Retrospectivos , Senos Craneales/cirugía , Seno Sagital Superior/cirugía , Resultado del Tratamiento , Constricción Patológica/cirugíaRESUMEN
INTRODUCTION: Sigmoid sinus diverticulum has been considered the most common cause of pulsatile tinnitus; the mechanism underlying sigmoid sinus diverticulum formation is unclear. To the best of our knowledge, no previous studies have assessed whether the formation of sigmoid sinus diverticulum is related to compression of the internal jugular vein by the styloid process. OBJECTIVE: To discuss the relationship between the styloid process and the formation of sigmoid sinus diverticulum. METHODS: The medical records of nine patients diagnosed with venous pulsatile tinnitus caused by sigmoid sinus diverticulum were reviewed between April 2009 and May 2019. All patients underwent high-resolution computed tomography of the temporal bones, computed tomography venogram of the head and neck, magnetic resonance venography, and brain magnetic resonance imaging. The length and medial angulation of the styloid process were measured, and compression of the internal jugular vein was recorded. RESULTS: The study population consisted of nine female right-sided pulsatile tinnitus patients with a mean age of 53.8±4.6 years. The mean lengths of the styloid process were 3.9±0.6cm on the right side and 4.1±0.7cm on the left side. The mean medial angulation of the styloid process was significantly smaller on the right side than the left side (65.3°±1.2° vs. 67.8°±1.7°, p<0.05). In addition, computed tomography venogram of the head and neck demonstrated the left internal jugular vein was compressed by the styloid process in eight of the nine patients. CONCLUSION: The formation of sigmoid sinus diverticulum with venous pulsatile tinnitus may be related to compression of the contralateral internal jugular vein by the styloid process. However, accumulation of data in additional cases is required to verify this suggestion.
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Divertículo , Acúfeno , Senos Craneales/diagnóstico por imagen , Divertículo/complicaciones , Divertículo/diagnóstico por imagen , Femenino , Humanos , Venas Yugulares/diagnóstico por imagen , Persona de Mediana Edad , Acúfeno/diagnóstico por imagen , Acúfeno/etiología , Tomografía Computarizada por Rayos XRESUMEN
Resumen El acúfeno es un síntoma relativamente frecuente en una consulta de otorrinolaringología. Se han descrito interacciones en las células ciliadas externas o internas, desequilibrios en el balance de las fibras aferentes y fenómenos de reorganización cortical tras lesiones periféricas que están involucrados en un 90%-95% de las causas del acúfeno. El restante 5%-10% está constituido por un tipo de acúfenos llamados objetivos, que no comparten estos mecanismos fisiopatológicos, sino que se originan en alguna estructura del organismo generalmente ajena a la vía auditiva y estimulan el aparato auditivo igual que lo haría un sonido del exterior. Presentamos el caso de un varón de 52 años remitido al Servicio de Otorrinolaringología de nuestro hospital por acúfeno pulsátil de meses de evolución, sin asociar hipoacusia, ni vértigo, ni otra sintomatología.
Abstract Tinnitus is a relatively frequent symptom in an otolaryngology consultation. Interactions in external or internal hair cells, imbalances in the afferent fiber balance and cortical reorganization phenomena after peripheral injuries have been described in 90%-95% of the causes of tinnitus. The remaining 5%-10% is comprised of a type of tinnitus called objective, which do not share these pathophysiological mechanisms, but originate from some structure of the body generally external to the auditory pathway and stimulate the auditory apparatus just as a sound from the exterior. We present the case of a 52-year-old man referred to the Otolaryngology service at our hospital for pulsatile tinnitus of months of evolution, with no hearing loss, vertigo, or other symptoms associated.
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Humanos , Masculino , Persona de Mediana Edad , Acúfeno/diagnóstico , Acúfeno/etiología , Enfermedades Vasculares/complicaciones , Acúfeno/fisiopatología , Acúfeno/epidemiologíaRESUMEN
Changes in course of the internal carotid artery (ICA) are uncommon, and dehiscence of the carotid canal with cochlea may occur. A 48-year-old female individual with pulsatile tinnitus. No other otologic symptoms observed. Otolaryngologic examination and audiometric test with normal results. Computed tomography (CT) scan of the mastoid bones showed dehiscence of cochlea with ICA on the right side. An option for monitored observation was made after analysis of the risks and undefined results of surgery. Patient maintained clinical and audiometric profile. Carotid-artery cochlear dehiscence is a condition that must be known, remembered and investigated, because it may mimic other otologic pathologies. Knowledge about it prevents serious complications that can be difficult to reverse.
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RESUMEN El tinnitus pulsátil es un síntoma otológico infrecuente pero requiere un estudio acabado. Una historia y examen físico detallados, son primordiales para orientar el estudio imagenológico posterior, con lo que se llega al diagnóstico en gran parte de los casos. El tratamiento debe ser dirigido a corregir la causa subyacente. En este trabajo, se presenta un caso clínico de tinnitus pulsátil, revisión del tema y orientación al enfoque diagnóstico.
ABSTRACT Pulsatile tinnitus is an infrequent otologic symptom but requires a thorough study. A detailed history and physical examination are essential to guide the subsequent imaging study, with which the diagnosis is reached in a large number of cases. The treatment should be aimed at correcting the underlying cause. In this study, a clinical case of pulsatile tinnitus, review of the subject and orientation to the diagnostic approach is presented.
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Humanos , Femenino , Adulto , Acúfeno/etiología , Acúfeno/terapia , Acúfeno/diagnóstico por imagen , Tomografía Computarizada por Rayos X , OtoscopíaRESUMEN
Se presenta el caso de una paciente de sexo femenino, de 69 años, que refiere tinnitus pulsátil de dos meses de evolución percibido en la región retroauricular derecha. Se presentan los hallazgos en estudios de imágenes, diagnóstico y se presenta una corta revisión del tema.
We present the case of a female patient, 69 years old, who reported pulsatile tinnitus since two months ago perceived in the right retroauricular region. We present the findings in image studies, diagnosis and a short review about the topic.