Why Not the Eighth Nerve? Neurovascular Compression—Probable Cause for Pulsatile Tinnitus

Lesinski, S. George; Chambers, A. Alan; Komray, Raymond; Keiser, Michael J.; Khodadad, G

doi:10.1177/019459987908700122

Cited by 29 publications

(17 citation statements)

References 12 publications

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“…Surgical repair and filling of the mastoid cavity with abdominal fat relieved the patient of the troublesome pulsatile tinnitus. (13,27) Brachiocephalic or external carotid artery stenosis (28,29) Otosclerosis (30) Paget's disease (31)(32)(33) Tortuous carotid or vertebral arteries (34) Increased cardiac output or aortic murmur (35)(36)(37) Vascular neoplasms (38)(39)(40)(41) Hypertension (30) latrogenic causes (12) Increased intracranial pressure (42) Jugular bulb anomalies (37,43) Pseudotumor cerebri syndrome (12,42,44) Other than vascular cause such as palatal myoclonus (21,37,45,46) Besides mastoidectomy (performed in the present case), revision craniotomy through the previous incision, filling the air cells with wax or muscle, might have had the same excellent result. Of course this approach carries a risk of cerebrospinal fluid leak or hematoma.…”

Section: Discussionmentioning

confidence: 99%

Pulsatile Tinnitus: A Review of the Literature and an Unusual Case of Iatrogenic Pneumocephalus Causing Pulsatile Tinnitus

Xenellis

Nikolopoulos²,

Felekis³

et al. 2005

Otology & Neurotology

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Otologists, neurosurgeons, and skull base surgeons should be aware of this surgical complication and be careful to identify any accidental opening to the air cell system of the temporal bone and meticulously close it when it happens. The review of the literature leads to the conclusion that pulsatile tinnitus should be thoroughly investigated, as it may be related to diseases that may have serious complications.

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Section: Discussionmentioning

confidence: 99%

Pulsatile Tinnitus: A Review of the Literature and an Unusual Case of Iatrogenic Pneumocephalus Causing Pulsatile Tinnitus

Xenellis

Nikolopoulos²,

Felekis³

et al. 2005

Otology & Neurotology

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“…Therefore the causes of pulsatile tinnitus are multiple. They include systemic disorders with high cardiac output (anaemia, thyrotoxicosis, valvular heart disease) [9, 111, circumscribed vascular variations [ 1,8,19,20,25,27,28,37,49], arteriovenous malformations, dural arteriovenous fistulas [2,3,10,12,13,23,24,34,38,42,55,58] or arterial wall diseases causing stenosis such as dissections, fibromuscular displasias or atherosclerosis [7, 16-18, 30, 33, 35, 44, 50, 56], skull base tumours [26,36,48, 511, intracranial hypertension [31,32,45,46] and rare diseases such as Paget's disease [14] or histiocytosis X of the petrous bone [5].…”

Section: Discussionmentioning

confidence: 99%

“…None of these investigations showed an abnormality that could explain pulsatile tinnitus. [58] Dural arteriovenous fistula [2,13,23,24,34,38,55] Carotid cavernous fistula [42] Aneurysm of the ICA [3,12] Fibromuscular dysplasia of the ICA [ 17,56] Dissection of the ICA [33,50] Atherosclerosis [7,16,30,44] Occlusion of the contralateral CCA [35] Vascular anomalies of the ear [8,20,28,49] Vascular compression of the VIII nerve [27,37] Migraine [52] Jugular bulb anomalies [1,391 Abnormal condylar and mastoid emissary veins [19,25] Glomus tumor [26,36,48] Paget's disease [14] Cavernous haemangioma [51] Histiocytosis X [5] Intracranial hypertenison of various causes [14,31,32,45,46] Anaemia, high cardiac output [9,11] Palatal myoclonus [4,22] Abnormally paten...…”

Section: Unknown Pathologymentioning

confidence: 99%

Pulsatile tinnitus —a review of 84 patients

et al. 1998

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Pulsatile tinnitus can be annoying for a patient and can also be the only clue to a potentially devastating and life-threatening disease. In order to understand its clinical spectrum and management better we analysed the files of 84 patients seen at our institution over a 10-year period. Noninvasive techniques (ultrasound, computed tomography, magnetic resonance imaging) and angiography were employed as investigations tailored to the individual patient. A vascular disorder [i.e. arteriovenous fistula, dissection of the internal carotid artery (ICA), fibromuscular dysplasia, aneurysm of the ICA and sinus thrombosis] was found in 36 patients (42%), most commonly a dural arteriovenous fistula or a carotid-cavernous sinus fistula. In 26 patients with a vascular abnormality, pulsatile tinnitus was the presenting symptom. In 12 patients (14%), nonvascular disorders such as glomus tumour or intracranial hypertension with a variety of causes explained the tinnitus. We conclude that patients with pulsatile tinnitus should be investigated with noninvasive techniques. If these are negative or to clarify abnormal findings of noninvasive techniques selective angiography is needed for diagnosis and to guide treatment.

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“…Of three MRA studies performed, all three were diagnostic of the underlying lesions. Vascular anomalies of ear 8 Vascular compression of the eighth nerve 9 Venous lesion Jugular bulb anomalies 10 Benign intracranial hypertension 11 Abnormal condylar/mastoid emissary veins 12 Skull base, temporal lesions Histiocytosis X 13…”

Section: Magnetic Resonance Imaging and Magnetic Resonance Angiographymentioning

confidence: 99%

Role of Angiography in the Evaluation of Patients With Pulsatile Tinnitus

2000

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Objectives/Hypothesis: Pulsatile tinnitus in the face of normal findings on otoscopy is a common otological diagnostic dilemma and can be due to serious vascular malformations such as transverse or sigmoid sinus dural arteriovenous fistula (transverse or sigmoid sinus [TS] DAVF). Left untreated, TS DAVF may result in significant morbidity and mortality. TS DAVF can be suspected or diagnosed with computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA), with the gold standard being angiography. Our objective was to assess the utility of these various diagnostic modalities in the diagnosis of dural arteriovenous fistula. Study Design: Retrospective clinical review. Methods: Between 1986 and 1996, 54 patients were evaluated and treated for TS DAVF. Between 1996 and 1999, an additional 33 patients underwent MRI combined with MRA for the evaluation of pulsatile tinnitus. A retrospective review of the medical records for both groups, with special attention to clinical presentation, diagnostic evaluation, therapy, and outcome, was performed. Results: All patients had pulsatile tinnitus with normal findings on otoscopy. CT scan was relatively insensitive in the detection of TS DAVF. MRI and MRI/MRA were significantly more sensitive than CT. In the evaluation of patients with subjective pulsatile tinnitus, MRI/MRA defined anatomical abnormalities that may contribute to pulsatile tinnitus in 63% of patients. Conclusions: In the absence of objective pulsatile tinnitus, MRI/MRA is an appropriate initial diagnostic step. When a patient has an objective bruit, the clinician may choose to proceed directly to angiography to make certain that a TS DAVF is not missed.

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Why Not the Eighth Nerve? Neurovascular Compression—Probable Cause for Pulsatile Tinnitus

Cited by 29 publications

References 12 publications

Pulsatile Tinnitus: A Review of the Literature and an Unusual Case of Iatrogenic Pneumocephalus Causing Pulsatile Tinnitus

Pulsatile Tinnitus: A Review of the Literature and an Unusual Case of Iatrogenic Pneumocephalus Causing Pulsatile Tinnitus

Pulsatile tinnitus —a review of 84 patients

Role of Angiography in the Evaluation of Patients With Pulsatile Tinnitus

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