Zhou Yongqing, Chen Xuzhen, Cui Bao, Sun Xingwang, DU Yuping, Sun Yajing, Wang Ling, Li Zhen
Department of Otorhinolaryngology Head and Neck Surgery，the 980th Hospital of Joint Logistics Support Force of PLA，Shijiazhuang，050082，China.
Department of Radiology，the 980th Hospital of Joint Logistics Support Force of PLA.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May;35(5):410-415. doi: 10.13201/j.issn.2096-7993.2021.05.006.
To probe the clinical characteristics of diagnosis and therapy of vascular pulsatile tinnitus（PT） associated with sigmoid sinus-mastoid. Retrospectively analyzed the clinical data of the hospitalized 45 PT patients of an ear surgeon in one hospital between January 2013 to January 2020, and observed the effectiveness with surgery and non-surgery therapy. Surgical procedures include reconstruction the bone wall of sigmoid sinus by transmastoid approach and ligation of mastoid emissary vein. Non-surgery therapy includes anti-anemia therapy and observation. All patients have been followed-up in ENT outpatient. Results: Of 45 cases, female：male was 43：2, the mean age was 42.7 years old. The other PT patients were the subjective tinnitus except two females were the objective tinnitus. Of 40 cases, 38 patients underwent transmastoid approach to reconstructed sigmoid sinus bone wall, including 6 patients with the ligated mastoid emissary vein at the same period.The other 2 cases with the ligated mastoid emissary vein only.Five cases were treated by non-surgery therapies, including 2 cases anti-anemia therapy and 3 cases observation. The longest follow-up period was seven and a half years, the shortest was six months. One case was lost to follow up. The total cure rate was 80.0%（36/45），the surgery cure rate was 82.5%（33/40）, the non-surgery cure rate was 60.0% （3/5）. The pathophysiologic mechanism of the PT is still complex and unclear until now. However, the following conditions probably play an important role in the etiology: female, common features of anatomy anomalies, hemodynamic variations. It is a key point to confirm the responsible site or the main cause of the PT . Although the surgery is relatively simple, the effect is remarkable and no major postoperative complications，surgery could not be a only choice.
探讨乙状窦-乳突相关的血管搏动性耳鸣（PT）的诊断及治疗临床特点。回顾性分析某医院一名耳科医生在2013年1月至2020年1月期间收治的45例PT患者的临床资料，观察手术及非手术治疗的效果。手术方式包括经乳突入路重建乙状窦骨壁及结扎乳突导血管。非手术治疗包括抗贫血治疗及观察。所有患者均在耳鼻喉科门诊随访。结果：45例患者中，女性∶男性为43∶2，平均年龄42.7岁。除2例女性为客观性耳鸣外，其余PT患者均为主观性耳鸣。40例患者中，38例行经乳突入路重建乙状窦骨壁，其中6例同期结扎乳突导血管；另2例仅结扎乳突导血管。5例行非手术治疗，其中2例抗贫血治疗，3例观察。随访时间最长7年半，最短6个月，1例失访。总治愈率为80.0%（36/45），手术治愈率为82.5%（33/40），非手术治愈率为60.0%（3/5）。目前PT的病理生理机制仍复杂不明。然而，以下情况可能在病因中起重要作用：女性、解剖结构异常的常见特征、血流动力学改变。明确PT的责任部位或主要病因是关键。虽然手术相对简单，效果显著且术后无重大并发症，但手术并非唯一选择。
