Almutairi Homood M, Alkhalifah Khalid M, Alhujaili Hareth Nasir, AlAmry Saleh
Department of Otolaryngology-Head & Neck Surgery (ORL-H&N), Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia.
College of Medicine, Qassim University, Unaizah, Saudi Arabia.
Eur Arch Otorhinolaryngol. 2025 Feb;282(2):1095-1101. doi: 10.1007/s00405-024-08974-6. Epub 2024 Sep 21.
Sigmoid sinus anomalies such as dehiscence or diverticula may present with pulsatile tinnitus (PT) and low-frequency hearing loss. Occasionally, these symptoms are severe, necessitating resurfacing of the affected area to restore a normal-appearing sinus wall. This study describes three cases wherein we managed PT attributed to sigmoid sinus anomalies using polymethylmethacrylate (PMMA) bone cement, a novel material.
Three patients with PT without any history of illnesses initially underwent cortical mastoidectomy to expose the affected area and resurface the sinus wall. Subsequently, PMMA bone cement was used to reconstruct any bony defects causing PT symptoms. Viscosity of the bone cement was altered based on specific characteristics and causes of the affected area. Additionally, we performed the water occlusion test (WOT), audiological assessment, the Tinnitus Handicap Inventory score (THI), and temporal computed tomography, both pre- and postoperatively, to assess the extent of PT.
Preoperatively, all three patients had tinnitus that dissipated with pressure on the neck and the water occlusion test (WOT), with no reported vertigo, trauma, or ear infections. Moreover, all three cases had a severe handicap according to the THI. In contrast, all cases had reduced PT and a significantly decreased THI score postoperatively, as well as no recurrence or complications and no instances of increased intracranial hypertension at the 12-month follow-up.
All cases showed promising results, emphasizing the sustained benefits of this novel intervention for the management of PT.
乙状窦异常，如裂开或憩室，可能表现为搏动性耳鸣（PT）和低频听力损失。偶尔，这些症状较为严重，需要对受影响区域进行修复，以恢复外观正常的窦壁。本研究描述了三例我们使用新型材料聚甲基丙烯酸甲酯（PMMA）骨水泥治疗因乙状窦异常导致的搏动性耳鸣的病例。
三名无任何疾病史的搏动性耳鸣患者最初接受了皮质乳突切除术，以暴露受影响区域并修复窦壁。随后，使用PMMA骨水泥修复任何导致搏动性耳鸣症状的骨缺损。根据受影响区域的具体特征和病因改变骨水泥的粘度。此外，我们在术前和术后均进行了水堵塞试验（WOT）、听力评估、耳鸣障碍量表评分（THI）以及颞部计算机断层扫描，以评估搏动性耳鸣的程度。
术前，所有三名患者的耳鸣在颈部受压和水堵塞试验（WOT）时均会消失，未报告有眩晕、外伤或耳部感染。此外，根据耳鸣障碍量表（THI），所有三例患者均有严重的功能障碍。相比之下，所有病例术后搏动性耳鸣均减轻，耳鸣障碍量表（THI）评分显著降低，且在12个月的随访中无复发或并发症，也无颅内压升高的情况。
所有病例均显示出良好的效果，强调了这种新型干预措施在治疗搏动性耳鸣方面的持续益处。
