Jugular bulb abnormalities in patients with Meniere’s disease using high-resolution computed tomography

Abstract

Temporal bone abnormalities such as hypoplasia of the vestibular aqueduct or hypopneumatization of the mastoid have been described in Meniere's disease (MD). Jugular bulb abnormalities (JBA) are one of the most common temporal bone abnormalities. The aim of this study was to evaluate the frequency of JBA in MD. Radiological data obtained by temporal bone high-resolution computed tomography of 200 ears of 167 MD patients (MD group) and 218 ears of 109 patients with normal inner ear function (control group) were analyzed retrospectively. The frequencies of high jugular bulb (HJB), jugular bulb diverticulum (JBD), inner ear adjacent jugular bulb (IAJB) and jugular bulb related inner ear dehiscence (JBID) were evaluated and compared between MD group and control group. IAJB was differentiated into vestibular aqueduct adjacent jugular bulb (VAAJB), cochlear aqueduct adjacent jugular bulb and posterior semicircular canal adjacent jugular bulb. JBID was further analyzed by differentiating into jugular bulb related vestibular aqueduct dehiscence (JBVAD), jugular bulb related cochlear aqueduct dehiscence and jugular bulb related posterior semicircular canal dehiscence. The frequencies of HJB, JBD and IAJB were higher in MD group compared to control group (21, 13.3 %, p = 0.036; 8.5, 3.7 %, p = 0.037; 13.5, 4.6 %, p = 0.001). No differences between both groups were seen in JBID (4.0, 2.3 %, p = 0.315). Most IAJB and JBID were seen in VAAJB and JBVAD. There is a higher frequency of JBA in patients with MD than in patients without inner ear symptoms. Temporal bones of MD patients might be constituted anatomically different, carrying predisposing factors for the development of clinically apparent MD.

Endovascular treatment of jugular bulb diverticula causing debilitating pulsatile tinnitus

“…The prevalence of jugular bulb abnormalities increases during the first four decades of life and stabilizes thereafter 9. While it is not possible accurately to identify what percentage of diverticula are symptomatic (and it is recognized that many will be asymptomatic6), they have been described in association with pulsatile tinnitus and other symptoms such as vertigo and hearing loss in a number of case series 1 2 6 10–12. Patients tend to be >50 years of age at presentation 10 11…”

“…Diagnosis can be made with MR venography, but the optimal imaging tool is probably a combination of CT venography and skull base CT, allowing identification of the relationship to adjacent structures 2 10. The surgical treatment of JBD involves mastoidectomy and impaction of bone wax 4.…”

“…Jugular bulb abnormalities may be identified in association with a number of symptoms including pulsatile tinnitus and vertigo 1 2. These symptoms can be debilitating and have a significant impact on quality of life 3.…”

Chronic cerebro-spinal insufficiency in multiple sclerosis and meniere disease: same background, different patterns?

“…19 Several studies analyzing the temporal bone imaging 20 or anatomy in MD patients have found consistent alterations in the arrangement of the sigmoid sinus, anteriorly or medially displaced, and jugular bulb abnormalities. According to Redfern et al 21 and Park et al 22 there is a higher frequency of jugular bulb abnormalities in patients with MD than in patients without inner ear symptoms, particularly, the mediolateral and anteroposterior position of the jugular bulb determines encroachment of the surrounding structures. Authors postulated that abnormal position contributes to MD development and that temporal bones of MD patients might be constituted anatomically different, carrying predisposing factors for the development of clinically apparent MD.…”

High jugular bulb in a cohort of patients with definite Ménière's disease

“…Both studies show an increase of jugular bulb abnormalities in Ménière's disease compared with the asymptomatic side 1 or a control group. 2 This approach provides a new means to understand Ménière's disease physiopathology. In addition, the findings have clinical consequences that are worth knowing by the surgeon.…”