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CT evaluation of unilateral pulsatile tinnitus with jugular bulb wall dehiscence

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Abstract

Objectives

To investigate the imaging features of unilateral pulsatile tinnitus (PT) with jugular bulb wall dehiscence (JBWD).

Methods

Computerized tomography angiography images of unilateral PT patients were reviewed between 2019 and 2021. Thirty-one symptomatic JBWD patients without sigmoid sinus wall dehiscence (SSWD) were included. Thirty-eight patients with SSWD were used as the control group. The prevalence of JBWD was calculated. The area and height of the jugular bulb, the extent of dehiscence, the presence of jugular bulb diverticulum, posterior condylar emissary vein (PCEV), oblique occipital sinus (OOS), venous outflow laterality (VOL), the degree of transverse sinus stenosis (TSS), and the pituitary height to sella turcica ratio were compared between the two groups.

Results

The prevalence of JBWD was 12.1%, and JBWD was established as a causative diagnosis in 5.0% of unilateral PT patients. There were no statistical differences in the gender, symptomatic side, or VOL between the two groups. The area of the jugular bulb was larger and the height was higher (parea < 0.001, pheight = 0.005). The prevalence of jugular bulb diverticulum was higher in the JBWD group (p = 0.002). The degree of symptomatic TSS was less severe (p < 0.001), and the prevalence of bilateral TSS was lower in the JBWD group (p < 0.001). The pituitary height to sella turcica ratio was greater (p = 0.004), the prevalence of PCEV (p = 0.014) was lower, and OOS (p = 0.015) was greater in the JBWD group.

Conclusions

The correlating factors of PT with JBWD and PT with SSWD are significantly different. These findings can further facilitate early and efficient PT treatment.

Key Points

• The incidence of jugular bulb dehiscence (JBWD) accounted for approximately 12.1% in pulsatile tinnitus (PT) patients, and JBWD was established as a causative diagnosis in 5.0% of PT patients.

• PT required large blood flows and abnormal flow patterns, whether in JBWD or sigmoid sinus wall dehiscence groups.

• JBWD causing PT has some unique characteristic findings on CT.

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Abbreviations

CT:

Computerized tomography

ICP:

Intracranial pressure

JBWD:

Jugular bulb wall dehiscence

OSS:

Oblique occipital sinus

PCEV:

Posterior condylar emissary vein

PT:

Pulsatile tinnitus

SSWD:

Sigmoid sinus wall dehiscence

TTS:

Transverse sinus stenosis

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Funding

National Natural Science Foundation of China No. 61931013 (Zhenchang Wang), No. 82171886 (Pengfei Zhao), and No. 62171297 (Han Lv). Natural Science Foundation of Beijing Municipality, 7222301(Pengfei Zhao). Beijing Scholars Program No. [2015] 160 (Zhenchang Wang). Beijing Key Clinical Discipline Funding No. 2021-135 (ZhenchangWang).

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Authors and Affiliations

  1. Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, 100050, China

    Chihang Dai, Pengfei Zhao, Heyu Ding, Han Lv, Xiaoyu Qiu, Xiaoshuai Li, Ning Xu, Xuxu Meng, Zhenghan Yang & Zhenchang Wang

  2. Department of Otorhinolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, 100050, China

    Guopeng Wang, Jing Xie & Shusheng Gong

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  1. Chihang Dai
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Correspondence to Pengfei Zhao or Zhenchang Wang.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained (2020-P2-202-02).

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• performed at one institution

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Dai, C., Zhao, P., Ding, H. et al. CT evaluation of unilateral pulsatile tinnitus with jugular bulb wall dehiscence. Eur Radiol 33, 4464–4471 (2023). https://doi.org/10.1007/s00330-022-09352-8

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