乙状窦还纳及窦壁重建术治疗搏动性耳鸣的疗效分析

目的 观察乙状窦还纳术及窦壁重建术治疗乙状窦憩室及骨壁缺损引起的血管搏动性耳鸣的手术疗效。方法 回顾性分析2019年1月—2021年9月威海市立第二医院耳鼻咽喉头颈外科收治的7例血管搏动性耳鸣患者的临床资料，观察术后当天、1个月、6个月、1年耳鸣变化情况。结果 7例患者均为女性，右侧发病6例，左侧发病1例。根据临床表现及颞骨薄层CT及颅脑MRA、MRV检查确诊为乙状窦源性血管搏动性耳鸣，耳鸣致残量化表（THI）评分分级，均为3级以上，7例患者均在全麻下手术，其中6例乙状窦憩室伴发乙状窦骨质缺损患者接受乙状窦憩室回纳及窦壁重建术治疗，1例合并横窦憩室患者接受乙状窦、横窦憩室回纳+窦壁重建术治疗。术后1年随访，痊愈5例、显效1例、有效1例。结论 对乙状窦憩室或骨壁缺损引起的搏动性耳鸣进行乙状窦还纳术及窦壁重建术疗效确切，值得临床借鉴。     

经乳突径路乙状窦骨壁加固术治疗搏动性耳鸣的研究

目的探讨分析乙状窦骨壁菲薄所致搏动性耳鸣的手术方法及疗效。方法 2017年6月-2018年10月我科诊断为乙状窦骨壁菲薄导致的搏动性耳鸣患者13例,所有患者采用耳后乳突径路行乙状窦骨壁加固术,术中磨除乙状窦周围气房,充分显露乙状窦骨壁后用骨蜡加固乙状窦壁。对其临床资料和短期手术疗效进行回顾性总结和分析。结果 13例患者均为女性,单耳发病,左耳3例,右耳10例,术前颞骨CT检查及术中发现证实乙状窦骨壁存在局灶性菲薄。11例患者术后第一天搏动性耳鸣即完全消失,2例患者术后第二天开始改善,术后第六天诉耳鸣完全消失。随访2-18月,13例患者搏动性耳鸣无复发,无其他并发症。结论本文短期疗效观察表明,乙状窦骨壁局灶性菲薄是部分搏动性耳鸣患者的致病原因;用骨蜡行乳突径路乙状窦骨壁加固术是治疗这类搏动性耳鸣的简单易行、疗效可靠的方法。     

手术治疗乙状窦骨壁缺损引起搏动性耳鸣的临床疗效分析

目的研究经乳突径路手术治疗乙状窦骨壁缺损引起的搏动性耳鸣的临床疗效。方法收集2014年3月—2018年6月诊断为乙状窦骨壁缺损引起的搏动性耳鸣并接受手术治疗的患者6例,其中男2例,女4例;年龄29~58岁,平均年龄38.5岁;左侧 1例,右侧5例。术前行颞骨高分辨率CT（HRCT）检查,6例患者中均有不同程度乙状窦骨壁缺损,术前结合颅内血管数字减影血管造影（DSA）及颅内血管CT动静脉造影（CTA+CTV）等综合检查,排除引起搏动性耳鸣的其他疾患。全部患者均行乙状窦骨壁缺损修复术。结果6例患者术后均无眩晕、恶心、呕吐及脑脊液漏等并发症。随访6～29个月,6例患者搏动性耳鸣分级0级4例（痊愈）、1级1例（显效）、2级1例（有效）,与术前比较差异均具有统计学意义（P<0.05）,均无复发。结论通过手术治疗乙状窦骨壁缺损所致搏动性耳鸣的风险较小,疗效显著,是一种有效的治疗手段,值得临床推广应用。     

乙状窦缩窄术治疗搏动性耳鸣

目的 探讨乙状窦缩窄术治疗搏动性耳鸣的疗效.方法 选取中国人民解放军联勤保障部队第九四○医院2014年8月—2019年8月收治的11例患者,用耳鸣致残量化表(THI)均评估为重度搏动性耳鸣,所有患者均为单耳发病,其中右耳9例,左耳2例,均为客观性搏动性耳鸣.术前行颞骨薄层CT检查提示9例右耳乙状窦憩室;1例左耳乙状窦憩...     

耳后肌骨膜瓣乙状窦窦壁修补术治疗搏动性耳鸣

目的:探讨耳后肌骨膜瓣乙状窦窦壁修补术治疗搏动性耳鸣效果。方法通过对2010.1—2016.10在我科住院的25例V级搏动性耳鸣患者,查颞骨薄层CT提示乙状窦壁与乳突气房间隔薄弱、或者乙状窦外壁菲薄、缺损,入院后均行耳后肌骨膜瓣乙状窦窦壁修补术治疗,评价耳后肌骨膜瓣乙状窦窦壁修补术治疗搏动性耳鸣效果。结果 25例患者中21例耳鸣患者均为女性,4例为男性;其中右侧18例,左侧7例;年龄25-60岁,中位数42岁,病史6月-6年,有2年以上高血压病史7例,腔隙性脑梗塞病史5年1例,施行耳后肌骨膜瓣乙状窦窦壁修补术后,23例术后即刻治愈,搏动性耳鸣完全消失,2例耳鸣响度明显减弱,术后6月、12月电话随访此2例病人耳鸣时有时无,响度≤II级,全部病例随访2年以上,没有复发或加重病例。结论耳后肌骨膜瓣修补乙状窦窦壁治疗搏动性耳鸣简单有效,对患者身体条件要求小,创伤小;可以在临床推广使用,但需术前仔细评估。     

乙状窦憩室致搏动性耳鸣手术治疗的疗效分析

目的　探讨乙状窦憩室引起的搏动性耳鸣手术治疗的效果。方法　通过对2010年3月～2014年6月期间在我院诊断为乙状窦憩室引起的搏动性耳鸣并接受手术治疗 的32例患者的临床资料进行回顾性总结和分析,评价乙状窦憩室回纳术对搏动性耳鸣的治疗效果。结果　32例患者中女性29例,年龄30～62岁,男性3例,年龄32～47岁;左侧4例,右侧28例。术前颞骨高分辨率CT检查,32例患者中均有不同程度乙状窦憩室。术前综合检查排除患耳中耳炎及肿瘤,患耳无手术、外伤史,无高血压病、甲状腺疾病及糖尿病等基础病病史。全部患者均行乙状窦憩室回纳术,术后均无眩晕、恶心呕吐、脑脊液漏等并发症,1例患者因鼓室积血引起短期的低调耳鸣,经对症处理后症状消失,7例耳鸣明显减轻,24例患者耳鸣消失。随访6～36个月,32例患者搏动性耳鸣均完全消失,无反复。结论　乙状窦憩室致搏动性耳鸣的手术治疗风险较小,疗效显著,是一种有效的治疗手段,值得临床推广、应用。     

乙状窦憩室致搏动性耳鸣手术治疗的疗效分析CSCD

目的探讨乙状窦憩室引起的搏动性耳鸣手术治疗的效果。方法通过对2010年3月~2014年6月期间在我院诊断为乙状窦憩室引起的搏动性耳鸣并接受手术治疗的32例患者的临床资料进行回顾性总结和分析,评价乙状窦憩室回纳术对搏动性耳鸣的治疗效果。结果 32例患者中女性29例,年龄30~62岁,男性3例,年龄32~47岁;左侧4例,右侧28例。术前颞骨高分辨率CT检查,32例患者中均有不同程度乙状窦憩室。术前综合检查排除患耳中耳炎及肿瘤,患耳无手术、外伤史,无高血压病、甲状腺疾病及糖尿病等基础病病史。全部患者均行乙状窦憩室回纳术,术后均无眩晕、恶心呕吐、脑脊液漏等并发症,1例患者因鼓室积血引起短期的低调耳鸣,经对症处理后症状消失,7例耳鸣明显减轻,24例患者耳鸣消失。随访6~36个月,32例患者搏动性耳鸣均完全消失,无反复。结论乙状窦憩室致搏动性耳鸣的手术治疗风险较小,疗效显著,是一种有效的治疗手段,值得临床推广、应用。     

乙状窦憩室一例

1临床资料
　　患者,女,27岁,因右侧搏动性耳鸣1个月,于2014年3月13日入院。患者自述一月前无明显诱因出现右耳“咚咚”声低调耳鸣,其频率与心脏跳动一致,压迫右颈侧区耳鸣可消失,剧烈运动及夜间睡眠差时耳鸣加重;无耳痛、头痛,无耳流脓、眩晕及面瘫,无明显听力下降。曾就诊于当地医院,诊断为“神经性耳鸣（右）”,行静脉输液（药物不详）等治疗,耳鸣症状无任何改善。入院诊断为“搏动性耳鸣（右）”。患者平素身体健康,家族中无类似病史者。体检：全身体检无特殊异常,外耳道及鼓膜正常,耳周听诊未闻及明显血管杂音。纯音测听示双耳听力正常,双耳鼓室导抗图均为A型,双侧声反射可引出。颞骨CT血管造影（CT angiography ,CTA ）示：右侧乙状窦沟深大,右侧乙状窦上曲段前外壁菲薄,局部骨质缺失,可见囊袋状软组织密度影突入右侧乳突蜂房内,相应部位乙状窦与前方乳突气房相通,缺失范围约5 mm×3 mm ,左侧乙状窦骨壁完整（图1、2）。术前数字减影血管造影（digital subtraction angiography ,DSA）检查：静脉期静脉窦显影,右侧横窦、乙状窦为优势回流静脉窦,静脉回流畅,于右侧乙状窦部可见一囊状突起,突向乳突蜂房内（图3）。根据影像学检查结果,拟诊断为“右侧搏动性耳鸣”,考虑为右侧乙状窦憩室,于2014年3月16日在全身麻醉下行右侧乙状窦骨壁缺损修补术,采用右耳后发际前弧形切口,分离皮肤及皮下组织至乳突骨膜及部分颞肌筋膜,留取颞肌筋膜晾干备用;平行皮肤切口前方约0．5 cm切开颞肌骨膜,向前后分离,暴露乳突骨皮质;沿乙状窦表面投影区磨除乳突皮质及气房,留取骨粉备用;暴露乙状窦前壁、外侧壁,见前壁部分骨质缺损（图4）。冲洗术腔,颞肌筋膜覆盖乙状窦球部表面（图5）,骨粉塑形后覆盖（图6）,对位缝合耳后皮肤切口,加压包扎。术后患者搏动性耳鸣消失,无听力下降及其他不适。术后随访至2014年9月,耳鸣无复发。     

耳源性乙状窦血栓性静脉炎CT及MRI表现

目的　探讨中耳乳突炎引起的乙状窦血栓性静脉炎及周围脓肿的特征性影像征象。方法　回顾分析11例中耳乳突炎导致的乙状窦血栓性静脉炎的影像学表现。 11例患者均行颞骨高分辨CT检查和MRI平扫及增强,5例行磁共振静脉血管成像（magnetic resonance venography,MRV）检查,4例行颅脑CT检查。结果　CT主要表现为10例乙状窦前壁骨质明显破坏,1例无明显破坏;4例乙状窦内或周围有积气,手术证实3例为乙状窦脓肿和周围脓肿,1例为单纯乙状窦周围脓肿。MRI表现为11例患者以乙状窦为中心的侧窦系统流空信号均消失,窦壁增厚有强化;T1WI表现为等信号6例、略低信号2例、稍高信号3例,T1WI增强可见窦壁增厚强化、腔内软组织影不同程度强化;T2WI均为高信号。5例MRV均显示患侧乙状窦和颈内静脉充盈缺损;2例横窦亦见充盈缺损,3例横窦局部变细。结合MRI和MRV检查,11例病变均累及乙状窦,同时累及颈静脉球及颈静脉上段,有9例同时累及横窦。结论　CT所显示的乙状窦前壁骨质缺损高度提示乙状窦血栓性静脉炎的可能性,窦周围或窦内积气提示乙状窦周围脓肿或窦内脓肿。MRI和MRV可准确显示乙状窦血栓位置和周围结构受累情况,也可推测血栓的成份。     

乙状窦憩室临床特征分析

目的　分析8例乙状窦憩室患者的临床特征,提高诊治水平。方法　对耳鸣患者详细询问病史、常规行听力检查（纯音听阈测试、声阻抗测听、耳声发射检查及脑干听觉诱发电位等）、颞骨薄层CT/HRCT平扫,8例患者被诊断为乙状窦憩室。其中6例患者选择行乙状窦憩室还纳填塞术,2例拒绝手术而选择保守治疗。结果　6例患者经 手术证实诊断正确,术中乙状窦沟壁重建后搏动性耳鸣症状消失,随访2～16个月,无复发。2例保守治疗患者症状较前无明显好转。结论　根据临床表现、听力检查、颞骨CT/HRCT、头颅CTA/CTV可诊断乙状窦憩室。乙状窦憩室还纳填塞术是较好治疗方案。     

Degree of Sigmoid Sinus Compression and the Symptom Relief Using Magnetic Resonance Angiography in Venous Pulsating Tinnitus

Objectives

To show that mechanical compression of sigmoid sinus is effective for treatment of pulsatile tinnitus caused by sigmoid sinus enlargement, and to evaluate the relationship between the compression degree of sigmoid sinus and the tinnitus symptom relief using magnetic resonance angiography.

Methods

Medical records of twenty-four patients who were diagnosed with venous tinnitus caused by sigmoid sinus enlargement and underwent mechanical compression of sigmoid sinus were reviewed between April 2009 and May 2013. All these patients received computed tomography and magnetic resonance venography study before undergoing surgery and were followed for at least 4 months.

Results

Twenty-three patients felt relief from tinnitus three months after the surgery, and the cross-sectional area of the sigmoid sinus on the tinnitus side was compressed approximately by half (46%-69%) after the surgery. There were 4 patients whose tinnitus suddenly disappeared while lying on the operating table before operation, which may be a result of the patient''s emotional tension or postural changes from standing. One of the four patients felt no relief from tinnitus after the surgery, with the cross-sectional area of the sigmoid sinus only compressed by 30%. And two patients of them had a recurrence of tinnitus about 6 months after the surgery. Seven patients had sigmoid sinus diverticula, and tinnitus would not disappear merely by eliminating the diverticulum until by compressing the sigmoid sinus to certain degree. There were 3 minor complications, including aural fullness, head fullness and hyperacusis. The preoperative low frequency conductive and sensorineural hearing loss of 7 subjects subsided.

Conclusion

Mechanical compression of sigmoid sinus is an effective treatment for pulsatile tinnitus caused by sigmoid sinus enlargement, even if it might be accompanied by sigmoid sinus diverticulum. A compression degree of sigmoid sinus about 54% is adequate for the relief of tinnitus symptom. Cases in which patients'' tinnitus suddenly disappeared before the surgery might be excluded to improve the efficacy of surgery.     

Surgical management of pulsatile tinnitus secondary to jugular bulb or sigmoid sinus diverticulum with review of literature

Introduction

Jugular bulb and sigmoid sinus anomalies are well-known causes of vascular pulsatile tinnitus. Common anomalies reported in the literature include high-riding and/or dehiscent jugular bulb, and sigmoid sinus dehiscence. However, cases of pulsatile tinnitus due to diverticulosis of the jugular bulb or sigmoid sinus are less commonly encountered, with the best management option yet to be established. In particular, reports on surgical management of pulsatile tinnitus caused by jugular bulb diverticulum have been lacking in the literature.

Sandwich technique for sigmoid sinus wall reconstruction for treatment of pulsatile tinnitus caused by sigmoid sinus diverticulum/dehiscence

Abstract

Background: If the pulsatile tinnitus caused by sigmoid sinus diverticulum/dehiscence cannot be diagnosed and treated, it can lead to significant morbidity and mortality.

Aim: To assess the sandwich surgical technique for sigmoid sinus wall reconstruction for the treatment of pulsatile tinnitus caused by sigmoid sinus diverticulum/dehiscence.

Methods: A chart review was conducted with 17 patients suffering from pulsatile tinnitus caused by sigmoid sinus diverticulum/dehiscence who underwent sinus wall reconstruction surgery between January 2014 and July 2019.

Results: Of the total patients studied, 16 were female, and one was male. The procedure was performed on the right ear of 15 patients and on the left ear of 2 patients. The pulsatile tinnitus disappeared in all patients following the sinus wall reconstruction surgery using the sandwich technique. The mean follow-up time was 25?months (a range of 8-55?months). In the follow-up period, no recurrence of pulsatile tinnitus was found. None of the patients experienced major complications such as thrombosis.

Conclusions: The sandwich surgical technique for sinus wall reconstruction as a treatment for pulsatile tinnitus caused by sigmoid sinus diverticulum is safe and effective.     

The styloid process and the formation of sigmoid sinus diverticulum: is there a link?

IntroductionSigmoid 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.ObjectiveTo discuss the relationship between the styloid process and the formation of sigmoid sinus diverticulum.MethodsThe 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.ResultsThe 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 ± 0.6 cm on the right side and 4.1 ± 0.7 cm 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.ConclusionThe 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.     

Sigmoid sinus diverticulum: a new surgical approach to the correction of pulsatile tinnitus.

OBJECTIVE: Tinnitus represents a bothersome symptom not infrequently encountered in an otology practice. Tinnitus can be the harbinger of identifiable middle or inner ear abnormality; but more frequently, tinnitus stands alone as a subjective symptom with no easy treatment. When a patient complains of tinnitus that is pulsatile in nature, a thorough workup is indicated to rule out vascular abnormality. We report of a new diagnostic finding and method of surgical correction for select patients with pulsatile tinnitus. STUDY DESIGN: Retrospective case series. SETTING: Tertiary care, academic referral center. PATIENTS: Among patients seen for complaints of unilateral or bilateral pulsatile tinnitus, five were identified with diverticula of the sigmoid sinus. All patients had normal in-office otoscopic, tympanometric, and audiometric evaluations. Patients with paragangliomas or benign intracranial hypertension were excluded. Auscultation of the pinna or mastoid revealed an audible bruit in most patients. All patients underwent computed tomographic angiography of the temporal bone. In all cases, this finding was on the side coincident with the tinnitus. INTERVENTION: Three of five patients underwent transmastoid reconstruction of the sigmoid sinus. MAIN OUTCOME MEASURE: Patients were evaluated clinically for presence or absence of pulsatile tinnitus after reconstructive surgery. RESULTS: All patients electing surgical reconstruction had immediate and lasting resolution of the tinnitus. CONCLUSION: Surgical reconstruction can provide lasting symptom relief for patients with pulsatile tinnitus and computed tomographic evidence of a sigmoid sinus diverticulum.     

Pulsatile tinnitus in perimenopausal period

Sigmoid sinus diverticulum-induced pulsatile tinnitus is a rare medical problem. Here we report a case where pulsatile tinnitus occurred in the perimenopause with evidence of sigmoid sinus diverticulum. The tinnitus disappeared with the restoration of hearing after surgery. While diagnosis is critical for the treatment, this disorder can be diagnosed relatively easily, and a satisfactory therapeutic outcome can be achieved using a simple surgical approach. The sigmoid sinus diverticulum may be a clinical manifestation of osteoporosis occurring in the perimenopausal period.