Li L, Han Y C, Sun P C, Hu N, Mao Y Y, Hou Z Q, Wang H B, Fan Z M
Department of Otology Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan 250021, China.
Department of Medical Imaging Center, Shandong Provincial ENT Hospital, Jinan 250021, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 Aug 7;59(8):792-796. doi: 10.3760/cma.j.cn115330-20231220-00316.
To analyze the disease characteristics, diagnosis and treatment methods of venous pulsatile tinnitus treated by intervention of sigmoid sinus. Fifty patients (from Shandong Provincial ENT Hospital, Shandong University between February 2014 and July 2020) with venous pulsatile tinnitus treated by sigmoid sinus surgery were analyzed retrospectively. The tinnitus characteristics, imaging findings, surgical methods, intraoperative findings and postoperative tinnitus changes were recorded. The patients were followed up for 6-12 months. The sign rank sum test was used to analyze the difference in tinnitus grading before and after surgery. There were 50 patients with unilateral venous pulsatile tinnitus, including 49 females and 1 male. The age ranged from 17 to 67 years, with a median age of 44 years. There were 45 cases of right tinnitus and 5 cases of left tinnitus. The degree of tinnitus before operation was grade Ⅱ or above, including 4 cases of gradeⅡ, 11 cases of grade Ⅲ, 22 cases of grade Ⅳ and 13 cases of grade Ⅴ. Thirty-seven cases were cured, 8 cases were ineffective (no change in tinnitus), 3 cases were markedly effective (tinnitus grade decreased by 3 in 2 cases, 4 in 1 case), and 2 cases were effective (tinnitus grade decreased by 1). The difference of tinnitus grade before and after operation was statistically significant (=-5.70,<0.05). Temporal bone CT showed 36 cases of sigmoid diverticulum (including 17 cases with sigmoid sinus dehiscence), 12 cases of sigmoid sinus dehiscence and 2 cases of absence of the temporal bone cortex abutting to sigmoid sinus. Thirty-five cases were performed with closure of sigmoid sinus diverticulum, 4 cases were performed with resurfacing of the sigmoid plate, 5 cases were performed with narrowing of sigmoid sinus, 4 cases were performed with simple opening of pre sigmoid mastoid air chamber, 1 case of opening was performed with pre sigmoid mastoid air chamber combined with narrowing of sigmoid sinus, and 1 case was performed with opening of pre sigmoid mastoid air chamber combined with closure of sigmoid sinus diverticulum. Venous pulsatile tinnitus is common in women. The common causes may be sigmoid sinus wall abnormalities such as sigmoid sinus diverticulum and perisigmoid bone defect. Imaging examinations are helpful for diagnosis. Venous pulsatile tinnitus can be treated with surgery.
分析经乙状窦干预治疗的静脉搏动性耳鸣的疾病特征、诊断及治疗方法。回顾性分析2014年2月至2020年7月间在山东大学山东省耳鼻喉医院接受乙状窦手术治疗的50例静脉搏动性耳鸣患者。记录耳鸣特征、影像学表现、手术方法、术中所见及术后耳鸣变化。对患者进行6 - 12个月的随访。采用符号秩和检验分析手术前后耳鸣分级的差异。50例患者均为单侧静脉搏动性耳鸣，其中女性49例，男性1例。年龄范围为17至67岁，中位年龄44岁。右侧耳鸣45例，左侧耳鸣5例。术前耳鸣程度为Ⅱ级及以上，其中Ⅱ级4例，Ⅲ级11例，Ⅳ级22例，Ⅴ级13例。治愈37例，无效（耳鸣无变化）8例，显效（2例耳鸣分级下降3级，1例下降4级）3例，有效（耳鸣分级下降1级）2例。手术前后耳鸣分级差异有统计学意义（=-5.70，<0.05）。颞骨CT显示乙状窦憩室36例（其中乙状窦骨壁缺损17例），乙状窦骨壁缺损12例，乙状窦旁颞骨皮质缺如2例。35例行乙状窦憩室封闭术，4例行乙状窦壁重建术，5例行乙状窦缩窄术，4例行单纯乙状窦前乳突气房开放术，1例行乙状窦前乳突气房开放术联合乙状窦缩窄术，1例行乙状窦前乳突气房开放术联合乙状窦憩室封闭术。静脉搏动性耳鸣在女性中常见。常见病因可能为乙状窦壁异常，如乙状窦憩室和乙状窦周围骨质缺损。影像学检查有助于诊断。静脉搏动性耳鸣可通过手术治疗。
