Endolymphatic Duct Obstruction from a Jugular Bulb Diverticulum

Abstract

Herniation of the jugular bulb into the middle ear is uncommon. Extension of a jugular bulb diverticulum into the petrous pyramid is rare. In ten previously reported cases in the literature, only the radiographic appearance of the lesion was stressed. Of interest to otolaryn gologists is the fact that in seven of the cases there was an ipsilateral sensorineural hearing loss. Other symptoms included tinnitus and ver tigo. One patient had been diagnosed as having Meniere's disease. We document an additional case (a patient who had "classical Meniere's disease") and report the first known surgical exploration of this venous anomaly. The diverticulum extended high into the petrous bone and was found to obliterate the distal segment of the endolymphatic duct. To our knowledge, this is the first time that a cause and effect rela tionship has been recognized between endolymphatic hydrops and a jugular bulb diverticulum. We propose that the diverticulum, by ob structing the endolymphatic duct, was directly responsible for the Meniere's-like symptoms.

High Mega Jugular Bulb Presenting with Facial Nerve Palsy and Severe Headache

“…10 Jahrsdoerfer et al, in the review of literature on jugular bulb diverticula, mentioned one patient with facial twitching. 8 Pappas et al reported a case of a young woman with a history of recurrent facial paralysis since age 16 years and episodic hemifacial spasm between episodes of paralysis. 9 Like our patient, she also suffered from frequent parietal headaches, and the facial paralysis was also limited to the lower face.…”

“…6 So far, three patients were described in the literature who had various forms of facial nerve involvement ranging from facial twitching and recurrent facial paralysis to episodic hemifacial spasm. [7][8][9] In regard to this rare clinical entity, we add a fourth case and evaluate the presentation and management considerations.…”

Jugular Bulb Diverticula

“…Medial extensions of the jugular bulb diverticula, also involving the inner ear and/or the internal auditory canal, are very rarely observed [4,[15][16][17][18][19], Symptoms are represented by tinnitus, sensorineural hearing loss, ver tigo and auricular pain.…”

Temporal Bone High-Resolution Computed Tomography in Non-Syndromic Unilateral Hearing Loss in Children

“…Dehiscence between the JB and VA was defined as absence of bony coverage separating the two structures [24] . A JB diverticulum is defined as an irregular outpouching of the JB [25] .…”