Transmastoid Hydroxyapatite Resurfacing for Sigmoid Sinus Wall Anomalies Causing Pulsatile Tinnitus

Abstract

Objective: Comprising 4% of tinnitus, pulsatile tinnitus (PT) can be particularly difficult for affected patients as well as surgeons looking to address their symptoms. Often the cause is not identified but can be secondary to turbulent flow in or near the sigmoid sinus, particularly if there is an identifiable sigmoid sinus dehiscence (SSDe) and/or diverticulum (SSDi). These sigmoid sinus wall anomalies (SSWA) may be treated with transmastoid sigmoid sinus resurfacing; however, this intervention remains relatively novel and its technique, materials used, resolution success, and complications need to be continuously reviewed. Methods: A retrospective case series of patients with PT due to SSWA at a tertiary referral center was reviewed. A total of 6 patients (7 ears) treated by transmastoid resurfacing using hydroxyapatite (HA) were retrospectively assessed. Pre-operative demographics and symptoms, pre- and post-operative hearing results, and post-operative outcomes were reviewed. Results: All patients were female with an average BMI of 32.9 (±5.4) and a mean age of 45.5 years (±15.3). Mean follow-up was 648 days. Objective tinnitus was noted in all ears with SSDi (100%); however, no objective tinnitus was noted with purely SSDe. In 100% of ears, PT was diminished with ipsilateral jugular compression and was amplified with contralateral head turn. Pre-operative symptoms of PT resolved in all patients, but delayed recurrence (>1 year) occurred in 1 ear (14%). No patient had pre- or post-operative hearing loss. No major complications were encountered. Conclusions: Transmastoid resurfacing for SSWA with HA bone cement is a safe, reliable intervention in properly identified PT patients.

Surgical treatment of pulsatile tinnitus related to the sigmoid sinus

“…In addition, 1 patient's tinnitus was significantly alleviated after surgery, exhibiting occasional tinnitus, with the treatment effect being satisfactory. These results are basically consistent with those reported by domestic and foreign scholars ( Newberry et al., 2021 ).…”

Radiographic Sigmoid Sinus Wall Abnormalities and Pulsatile Tinnitus: A Case-Control Study

“…Correlation between PT and SSWAs An association between SSWA and PT has been well substantiated in the literature (2)(3)(4)(5)(6)(7)(8)(9)(10)24). Our work provides by far the largest case-control study of PT and incidence of associated radiographic anomalies, as previous studies have been limited by small sample size (15) and confounding control groups (13).…”

“…The latter point is further reinforced by the fact that despite nearly equal incidence of right-sided (n = 56) and left-sided (n = 58) PT, SSWA was more common on the right, which is consistent with previous literature (3,4,6,13,27). These points may also help explain why some patients with unilateral PT and ipsilateral SSWA fail to improve after surgical resurfacing, despite the historical success of this procedure, with improvements reported in more than 80% of patients (2–10).…”

“…Pulsatile tinnitus (PT) is an uncommon symptom, characterizing an estimated 4% of all tinnitus complaints (1). Sigmoid sinus wall abnormalities (SSWAs) are believed to contribute to PT in some patients, and surgical resurfacing often results in resolution or improvement (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Previous evaluations of patient cohorts with PT have found a 20 to 32% rate of coexistent SSWA (5,12,13).…”

Multiphysics Interaction Analysis of the Therapeutic Effects of the Sigmoid Sinus Wall Reconstruction in Patients with Venous Pulsatile Tinnitus

“…Particularly for patients with TS stenosis, the impingement of the blood flow on the temporal bone at the distal of the TS stenosis became stronger [ 11 , 14 , 27 ]. Therefore, firmer materials, such as bone cement or bone chips, may be better than an autogenous bone meal in terms of minimizing the recurrence of SSWR [ 25 , 28 , 29 ].…”