Koo Young Hoon, Lee Ji Ye, Lee Jong Dae, Hong Hyun Sook
Department of Radiology Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Wonmi-gu, Bucheon, Korea.
Medicine (Baltimore). 2018 Jun;97(26):e11067. doi: 10.1097/MD.0000000000011067.
Jugular bulb anomalies are asymptomatic lesions commonly seen in routine practice. However, some patients with jugular bulb anomalies may present with symptoms such as tinnitus or conductive hearing loss (CHL).
A 9 year old boy complained right sided hearing disturbance without any vestibular symptoms. Pure tone audiometry (PTA) revealed a mild right sided conductive hearing loss. Otoscopy showed a red-purplish mass like lesion in his right middle ear cavity, which was regarded as hypervascular tumor.
Based on otoscopic findings, preliminary differential diagnoses included jugular bulb anomaly, hemotympanum, cholesterol granuloma and paraganglioma.
We performed contrast enhanced computed tomography of the temporal bone (TBCT).
CT scan showed and enhancing lesion which was bulging from his right jugular foramen to the middle ear with dehiscent jugular bulb. The lesion showed the same degree of contrast enhancement with the venous vasculature. This lesion contacted with the tympanic membrane, incudostapedial joint and round window, which might be attributable to interruption of sound transmission mechanics. Otherwise there was no evidence of mass or trauma related lesions in the temporal bone.
Although most of jugular bulb anomalies are asymptomatic, patients may present with conductive hearing loss due to the interference of sound transmission mechanics.
颈静脉球异常是在常规检查中常见的无症状病变。然而，一些患有颈静脉球异常的患者可能会出现耳鸣或传导性听力损失（CHL）等症状。
一名9岁男孩主诉右侧听力障碍，无任何前庭症状。纯音听力测试（PTA）显示右侧轻度传导性听力损失。耳镜检查显示其右中耳腔内有一个红紫色肿块样病变，被认为是血管丰富的肿瘤。
根据耳镜检查结果，初步鉴别诊断包括颈静脉球异常、血鼓室、胆固醇肉芽肿和副神经节瘤。
我们进行了颞骨增强计算机断层扫描（TBCT）。
CT扫描显示一个强化病变，从右侧颈静脉孔膨出至中耳，颈静脉球有骨质缺损。该病变与静脉血管系统的强化程度相同。此病变与鼓膜、砧镫关节和圆窗接触，这可能归因于声音传导机制的中断。此外，颞骨内没有肿块或创伤相关病变的证据。
虽然大多数颈静脉球异常是无症状的，但由于声音传导机制受到干扰，患者可能会出现传导性听力损失。
