Clin Exp Otorhinolaryngol.  2015 Jun;8(2):111-116. 10.3342/ceo.2015.8.2.111.

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

• Guo P
• Wang WQ

• KMID: 2360780
• DOI: http://doi.org/10.3342/ceo.2015.8.2.111

Abstract

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.

Keyword

Pulsatile Tinnitus; Angiography; Cranial Venous Sinuses

MeSH Terms

Angiography
Colon, Sigmoid*
Cranial Sinuses
Deception
Diverticulum
Head
Hearing Loss, Sensorineural
Humans
Hyperacusis
Magnetic Resonance Angiography*
Medical Records
Operating Tables
Phlebography
Recurrence
Tinnitus*

Figure

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  Fig. 1 About 1.5×1.0-cm2 area of the prominent sigmoid sinus was exposed under local anesthesia.

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  Fig. 2 The prominent sigmoid sinus was being compressed and meanwhile the subject was asked whether tinnitus disappeared or not.

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  Fig. 3 After application of auricular cartilage, temporalis muscle fascia and octyl-cyanoacrylate/N-butyl-cyanoacrylate.

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  Fig. 4 Preoperative temporal bone computed tomography (A, arrow) and magnetic resonance venography (B, arrow) showing an enlargement of right sigmoid sinus. Postoperative magnetic resonance venography demonstrating 56% surgical compression of sigmoid sinus (C, arrow).

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