From the Department of Surgery, Section of Otolaryngology and the Department of Diagnostic Radiology, Section of Neuroradiology (C.V. and E.L.K.), Yale School of Medicine
1983 Eastern Section Triological Paper
Article first published online: 5 JAN 2009
Copyright © 1983 The Triological Society
Volume 93, Issue 12, pages 1534–1539, December 1983
How to Cite
Buckwalter, J. A., Sasaki, C. T., Virapongse, C., Kier, E. L. and Bauman, N. (1983), Pulsatile tinnitus arising from jugular megabulb deformity: A treatment rationale. The Laryngoscope, 93: 1534–1539. doi: 10.1288/00005537-198312000-00002
Presented at the Meeting of the Eastern Section of the American Laryngological, Rhinological and Otological Society, Inc., New York, NY, January 28, 1983
- Issue published online: 5 JAN 2009
- Article first published online: 5 JAN 2009
Pulsatile tinnitus is a rare presenting symptom in patients with enlarged jugular bulbs. We will describe three young women presenting with right pulsatile tinnitus associated with a megabulb deformity of the temporal bone. After extensive radiologic and audiologic evaluation, no vascular or bony abnormalities could be identified. All three patients demonstrated pulsatile bruits over the right temple. Pulsatile tinnitus disappeared with ipsilateral jugular compression suggesting flow rather than pressure to be responsible for abnormal auditory symptoms. This observation formed the basis of our treatment recommendations.
Because of progressively debilitating pulsatile tinnitus, two patients elected right internal jugular vein ligations under local anesthesia. Both patients were relieved of tinnitus.
We conclude that jugular vein ligation can be a safe and effective surgical treatment for pulsatile tinnitus resulting from a jugular megabulb deformity, provided two criteria are met: 1, The presence of an expanding tumor is ruled out. 2. The presence of contralateral venous drainage is established by angiography or brain scan. Anatomic and functional hemodynamic considerations of brain circulation will be emphasized in the discussion of our treatment rationale.