Venous sinus stenting for intractable pulsatile tinnitus: A review of indications and outcomes

Abstract

Background: Pulsatile tinnitus presents as a unique variation of tinnitus in which a conscious perception of the heartbeat is localized to the ears in either unilateral or bilateral fashion. The sensation is typically caused by an increase in turbulent blood flow in the affected ear, in most cases, due to a structural abnormality of the venous sinuses – the most common of which being stenosis. Herein, we discuss the etiology of pulsatile tinnitus followed by indications for treatment of various pathologies which have been successfully treated with venous sinus stenting and have led to resolution of auditory symptoms. Methods: The authors queried PubMed database using combinations of the keywords “venous sinus stenting,” “endovascular treatment,” and “pulsatile tinnitus” to identify relevant studies published in English after 2001 and before December 1, 2020 and verified selected. Results: Our results corroborate those published in prior reviews reporting a high rate of pulsatile tinnitus resolution with venous sinus stenting. Conclusion: The success of venous sinus stenting is clinically relevant as an effective treatment option for patients suffering from pulsatile tinnitus. Future applications and studies are needed and are currently being developed to further demonstrate the effectiveness of stents in the treatment of pulsatile tinnitus.

The role of noninvasive imaging in the diagnostic workup for pulsatile tinnitus

“…Increased utilization of MRV based on clinical suspicion of pulsatile tinnitus with venous etiology may lead to early detection of venous stenosis, which can be treated with venous sinus stenting that has been shown to lead to symptom resolution. [13][14][15] Additionally, we found that age on presentation, age at pulsatile tinnitus onset, and BMI were associated with the use of DSA to achieve a final clinical diagnosis. Specifically, while higher age was associated with increased odds of diagnosis by DSA, higher BMI was associated with reduced odds.…”

“…Increased utilization of MRV based on clinical suspicion of pulsatile tinnitus with venous etiology may lead to early detection of venous stenosis, which can be treated with venous sinus stenting that has been shown to lead to symptom resolution. 13–15…”

Arachnoid Granulation Causing Unilateral Pulsatile Tinnitus Treated With Dural Venous Sinus Stenting

“…Tinnitus is the persistent perception of sound in the absence of an external source that can significantly affect patients' quality of life (1)(2)(3). Approximately 4% of all tinnitus patients have a pulsatile component where a rhythmical sound coincides with a patient's heartbeat and is in reality the perception of accelerated/turbulent flow of blood or cerebrospinal fluid within vessels proximal to the middle ear (4,5). These structural abnormalities can be nonvascular, i.e., bone erosions/dehiscence, pneumatization, or neoplasms of the temporal bone or vascular, including aneurysms, dissections, arteriovenous malformations, fistulas, and venous sinus anomalies (5)(6)(7).…”