Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam.
Department of Otorhinolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, Seoul, Korea.
Otol Neurotol. 2019 Feb;40(2):192-199. doi: 10.1097/MAO.0000000000002093.
To discuss the possible pathophysiologic mechanism of pulsatile tinnitus (PT) perception due to high jugular bulb with bony dehiscence (HJBD) and its improvement after the dehiscent jugular bulb (JB) resurfacing using bone cement, and to describe the efficacy of an objective measure of PT using transcanal sound recording and spectro-temporal analysis (TSR/STA).
Retrospective case series study.
A university-based, tertiary care cancer center.
Three PT patients with HJBD.
MAIN OUTCOME MEASURE(S): All patients underwent transtympanic resurfacing after the source of PT was confirmed by temporal bone imaging and TSR/STA. Improvement of symptom and the changes in the TSR/STA were analyzed.
In the first case, a revision operation was performed due to slightly improved but persistent PT after initial resurfacing with bone pate and a piece of conchal cartilage. Revision transtympanic JB resurfacing was performed in this case using bone cement, and PT resolved immediately after the surgery. In the second and third cases, PT resolved completely, or was much abated, immediately after transtympanic resurfacing with bone cement. The TSR/STA also revealed improvement of PT. The median follow-up duration was 28 months, and all three patients remained asymptomatic or much improved compared with their preoperative status.
Transtympanic resurfacing with bone cement, reinforcing the dehiscent JB to reduce focal turbulent flow, is a simple and effective surgical treatment option in patients with PT due to HJBD. In patients with HJBD, the objective measurement of PT by TSR/STA may be of help in selecting appropriate surgical candidates and objective evaluation of the treatment outcome.
探讨由于颈静脉球高位伴骨窗（HJBD）导致搏动性耳鸣（PT）感知的可能病理生理机制，以及使用骨水泥修复开放的颈静脉球后对其改善情况，并描述使用经耳道声音记录和时频分析（TSR/STA）客观测量 PT 的效果。
回顾性病例系列研究。
大学附属三级癌症中心。
3 例 HJBD 伴 PT 患者。
所有患者均通过颞骨影像学和 TSR/STA 确认 PT 来源后，行经鼓室表面重建。分析症状改善情况和 TSR/STA 的变化。
在首例患者中，初次使用骨片和耳甲软骨进行表面重建后，PT 略有改善但仍持续存在，因此进行了修正手术。在这种情况下，使用骨水泥进行了修正性经鼓室 JB 表面重建，手术完成后 PT 立即消失。在第二例和第三例患者中，PT 完全消失或明显减轻，在使用骨水泥进行经鼓室表面重建后立即消失。TSR/STA 也显示出 PT 的改善。中位随访时间为 28 个月，与术前相比，所有 3 例患者均无症状或明显改善。
使用骨水泥进行经鼓室表面重建，强化开放的颈静脉球，减少局灶性湍流，是治疗 HJBD 所致 PT 的简单有效手术方法。在 HJBD 患者中，通过 TSR/STA 客观测量 PT 可能有助于选择合适的手术候选者，并客观评估治疗效果。
