The relationship between jugular bulb position and jugular bulb related inner ear dehiscence: a retrospective analysis

Park, Jonas J.-H.; Shen, Anmin; Loberg, Christina; Westhofen, Martin

doi:10.1016/j.amjoto.2014.12.006

Cited by 35 publications

(26 citation statements)

References 15 publications

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“…Both Buckwalter et al (1983) and Chandler (1983) promoted jugular vein ligation as a treatment for PT, which has since been determined ineffective (Jin and Wang, 2015). Additionally, the presence of a HJB alone is not itself predictive of PT; Marsot-Dupuch (2001) determined that only 4.5% of patients with an enlarged jugular bulb ever develop PT, while Park et al (2015) found a 35% prevalence of HJB in patients with hearing loss. The ambiguity of the role of abnormal jugular vein geometries and flow rate in PT pathology suggests the link between flow, shape, and sound, if it exists, must be complex; simply observing the flow rate and bulb shape is not enough to identify the origin of venous PT.…”

Section: Introductionmentioning

confidence: 99%

Flow patterns in the jugular veins of pulsatile tinnitus patients

Kao

Kefayati²,

Amans³

et al. 2017

Journal of Biomechanics

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Pulsatile Tinnitus (PT) is a pulse-synchronous sound heard in the absence of an external source. PT is often related to abnormal flow in vascular structures near the cochlea. One vascular territory implicated in PT is the internal jugular vein (IJV). Using computational fluid dynamics (CFD) based on patient-specific Magnetic Resonance Imaging (MRI), we investigated the flow within the IJV of seven subjects, four symptomatic and three asymptomatic of PT. We found that there were two extreme anatomic types classified by the shape and position of the jugular bulbs: elevated and rounded. PT patients had elevated jugular bulbs that led to a distinctive helical flow pattern within the proximal internal jugular vein. Asymptomatic subjects generally had rounded jugular bulbs that neatly redirected flow from the sigmoid sinus directly into the jugular vein. These two flow patterns were quantified by calculating the length-averaged streamline curvature of the flow within the proximal jugular vein: 130.3 ± 8.1 m-1 for geometries with rounded bulbs, 260.7 ± 29.4 m-1 for those with elevated bulbs (P < 0.005). Our results suggest that variations in the jugular bulb geometry lead to distinct flow patterns that are linked to PT, but further investigation is needed to determine if the vortex pattern is causal to sound generation.

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Section: Introductionmentioning

confidence: 99%

Flow patterns in the jugular veins of pulsatile tinnitus patients

Kao

Kefayati²,

Amans³

et al. 2017

Journal of Biomechanics

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“…We have suggested that the term SSCDS be replaced with otic capsule dehiscence syndrome (OCDS) or third window syndrome (TWS) because SSCD symptoms and diagnostic findings can occur with posterior semicircular canal dehiscence, internal carotid arterycochlea dehiscence, posterior semicircular canal-jugular bulb dehiscence, wide vestibular aqueduct in children (personal communication, Dr. Soumit Dasgupta, March 3, 2017), posttraumatic hypermobile stapes footplate (personal communication, Dr. Arun Gadre, August 1, 2015) and in patients with CT-TWS. 2,3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][30][31][32][33][34][35][36][37][38][39] We have reported the development of CT-TWS developing in a delayed manner after surgical plugging and resurfacing of CT1 SSCD TWS. 2,3 John Carey's group has also noted that in a series of near-SSCD patients undergoing plugging and resurfacing procedures all patients noted initial improvement in at least one presenting TWS symptom; however, 5 subjects (45%) had persistence or recurrence of at least 1 TWS symptom at greater than 1 month after surgery.…”

Section: Introductionmentioning

confidence: 99%

Comorbidities confounding the outcomes of surgery for third window syndrome: Outlier analysis

Wackym

Mackay-Promitas

Demirel

et al. 2017

Laryngoscope Investig Oto

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ObjectivePatients with third window syndrome and superior semicircular canal dehiscence (SSCD) symptoms whose surgical outcomes placed them as outliers were systematically studied to determine comorbidities that were responsible for their poor outcomes due to these confounding factors.Study DesignObservational analytic case‐control study in a tertiary referral center.MethodsTwelve adult patients with clinical SSCD syndrome underwent surgical management and had outcomes that did not resolve all of their subjective symptoms. In addition to one of the neurotologists, 2 neurologists (one specializing in migraine and the other a neuro‐ophthalmologist), and a psychologist clinician‐investigator completed comprehensive evaluations. Neuropsychology test batteries included: the Millon Behavioral Medicine Diagnostic; Patient Health Questionnaire (PHQ‐9) and Generalized Anxiety Disorder Screener (GAD‐7); Adverse Childhood Experiences Scale; the Wide Range Assessment of Memory and Learning, including the 3 domains of verbal memory, visual memory, and attention/concentration; Wechsler Adult Intelligence Scale; and the Delis‐Kaplan Executive Function System. The control cohort was comprised of 17 participants who previously underwent surgery for third window syndrome that resulted in the expected outcomes of resolution of their third window syndrome symptoms and cognitive dysfunction.ResultsThere was a high rate of psychological comorbidity (n = 6) in the outlier cohort; multiple traumatic brain injuries were also a confounding element (n = 10). One patient had elevated cerebrospinal fluid (CSF) pressure requiring ventriculoperitoneal shunting to control the recurrence of dehiscence and one patient with a drug‐induced Parkinson‐like syndrome and idiopathic progressive neurological degenerative process.ConclusionsComponents of the Millon Behavioral Medicine Diagnostic, PHQ‐9 and GAD‐7 results suggest that these instruments would be useful as screening tools preoperatively to identify psychological comorbidities that could confound outcomes. The identification of these comorbid psychological as well as other neurological degenerative disease processes led to alternate clinical management pathways for these patients.Level of Evidence2b.

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“…Park et al subclassified HRJB into two types based on axial CT images: type 1, in which the bulb dome reaches above the inferior part of the round window; and type 2, when the dome is higher than the inferior edge of the IAC. 28,29 It is apparent that there is no consensus on the exact definition of HRJB, and multiplanar structures that define the critical microsurgical boundaries (SCC, IAC, round window, and endolymphatic sac) of the skull base cannot often be analyzed based only on limited standard axial CT sections of temporal bone, without reconstruction.…”

mentioning

confidence: 99%

Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications

Manjila

Bazil

Kay

et al. 2018

Neurosurgical Focus

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OBJECTIVEThere is no definitive or consensus classification system for the jugular bulb position that can be uniformly communicated between a radiologist, neurootologist, and neurosurgeon. A high-riding jugular bulb (HRJB) has been variably defined as a jugular bulb that rises to or above the level of the basal turn of the cochlea, within 2 mm of the internal auditory canal (IAC), or to the level of the superior tympanic annulus. Overall, there is a seeming lack of consensus, especially when MRI and/or CT are used for jugular bulb evaluation without a dedicated imaging study of the venous anatomy such as digital subtraction angiography or CT or MR venography.METHODSA PubMed analysis of “jugular bulb” comprised of 1264 relevant articles were selected and analyzed specifically for an HRJB. A novel classification system based on preliminary skull base imaging using CT is proposed by the authors for conveying the anatomical location of the jugular bulb. This new classification includes the following types: type 1, no bulb; type 2, below the inferior margin of the posterior semicircular canal (SCC), subclassified as type 2a (without dehiscence into the middle ear) or type 2b (with dehiscence into the middle ear); type 3, between the inferior margin of the posterior SCC and the inferior margin of the IAC, subclassified as type 3a (without dehiscence into the middle ear) and type 3b (with dehiscence into the middle ear); type 4, above the inferior margin of the IAC, subclassified as type 4a (without dehiscence into the IAC) and type 4b (with dehiscence into the IAC); and type 5, combination of dehiscences. Appropriate CT and MR images of the skull base were selected to validate the criteria and further demonstrated using 3D reconstruction of DICOM files. The microsurgical significance of the proposed classification is evaluated with reference to specific skull base/posterior fossa pathologies.RESULTSThe authors validated the role of a novel classification of jugular bulb location that can help effective communication between providers treating skull base lesions. Effective utilization of the above grading system can help plan surgical procedures and anticipate complications.CONCLUSIONSThe authors have proposed a novel anatomical/radiological classification system for jugular bulb location with respect to surgical implications. This classification can help surgeons in complication avoidance and management when addressing HRJBs.

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The relationship between jugular bulb position and jugular bulb related inner ear dehiscence: a retrospective analysis

Cited by 35 publications

References 15 publications

Flow patterns in the jugular veins of pulsatile tinnitus patients

Flow patterns in the jugular veins of pulsatile tinnitus patients

Comorbidities confounding the outcomes of surgery for third window syndrome: Outlier analysis

Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications

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