| ObjectiveTo investigate the clinical features,imaging characteristics and pathophysiological mechanisms of pulsatile tinnitus(PT)caused by sigmoid sinus diverticulum(SSD),and to analyze the clinical efficacy of the transmastoid sigmoid sinus diverticulum closure surgery.MethodsIn this study,the clinical data and follow-up information of 24 cases with unilateral SSD were collected and analyzed retrospectively,and all patients were diagnosed and treated by the Department of Otology from December,2011 to June,2017,in Shandong Provincial Hospital(West Campus).Before surgery,all patients had undergone physical examinations,related audiological detections and imaging measurements including temporal bone high-resolution CT(HRCT)and CT Angiography/Venography(CTA/CTV).In addition,pre-operative tinnitus grading had been made based on each case's degree of PT.After excluding surgical contraindications,all patients had received the operation called transmastoid sigmoid sinus diverticulum closure under local anesthesia.Post-operative tinnitus grading and imaging review had been done before each patient was discharged from hospital.After a 3 to 69 months follow-up,we collected useful information including recurrence of PT,possible complications or adverse reactions,etc.Then we statistically analyzed the differences in pre-operative and post-operative grading of PT,and analyzed the recurrence rate of PT after operation as well as possible factors.Relative clinical experiences were summarized and the curative efficacy of the surgery was evaluated.ResultsIn 24 cases,age was ranged from 28 to 63 years old,with the median age of 44.5.The number of female was much more than male,with 22 to 2.The follow-up time horizon was 3 to 69 months and the median time was 37 months.We found that in all cases,the side of PT and SSD was in accordance with that of the dominant venous sinus side,with 22 in the right and 2 in the left,and the ratio of right to left was 11:1.Before surgery,they all presented a tinnitus degree of no less than grade 2,including grade 2 in 2 cases(8.33%),grade 3 in 7 cases(29.17%),grade 4 in 9 cases(37.50%),grade 5 in 5 cases(20.83%),and grade 6 in 1 case(4.17%).After surgery,there were 2 patients whose PT remained the same grade,and the rest patients' PT grades were lower than their pre-operative ones(6 grades lower in 1 case,5 grades lower in 3 cases,4 grades lower in 5 cases,3 grades lower in 10 cases,2 grades lower in 2 cases,and 1 grade lower in 1 cases).According to further analysis,the comparison between pre-operative and post-operative tinnitus grading was statistically significant(P<0.05).23 out of 24 patients experienced total disappearance or remission of PT during the surgery.Among them,1 patient's PT reappeared immediately after surgery,17 patients' symptom almost didn't reappear during follow-up,and recurrence of PT was found in 5 cases,whose recurrence time were respectively 2 weeks,half a month,2 months,6 months and 3 years after operation.There also existed 1 patient who showed no change in the degree of tinnitus during and after surgery,and no improvement after a 64-months follow-up.All cases in the study presented no serious complications such as tympanic hemorrhage,cerebrospinal fluid leakage,increased intracranial pressure,and venous sinus thrombosis.Only one patient experienced persistent periauricular numbness and dizziness,which didn't affect surgical efficacy and postoperative recovery.Conclusions1.Sigmoid sinus diverticulum(SSD)is an important cause of venous PT.2.SSD mostly appears in the dominant venous side.3.The clinical efficacy of transmastoid sigmoid sinus diverticulum closure surgery for the treatment of PT caused by SSD is definite,and it is a relatively simple,safe and effective clinical method. |
PDF Full Text Request