Inner Ear Conductive Hearing Loss and Unilateral Pulsatile Tinnitus Associated with a Dural Arteriovenous Fistula: Case Based Review and Analysis of Relationship between Intracranial Vascular Abnormalities and Inner Ear Fluids.

Ettore Cassandro,Claudia Cassandro,Giuliano Sequino,Giuseppe Chiarella,Alfonso Scarpa,Claudio Petrolo

doi:10.1155/2015/817313

Ettore Cassandro, Claudia Cassandro + Show 4 more

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https://doi.org/10.1155/2015/817313

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Abstract

While pulsatile tinnitus (PT) and dural arteriovenous fistula (DAVF) are not rarely associated, the finding of a conductive hearing loss (CHL) in this clinical picture is unusual. Starting from a case of CHL and PT, diagnosed to be due to a DAVF, we analyzed relationship between intracranial vascular abnormalities and inner ear fluids. DAVF was treated with endovascular embolization. Following this, there was a dramatic recovery of PT and of CHL, confirming their cause-effect link with DAVF. We critically evaluated the papers reporting this association. This is the first case of CHL associated with PT and DAVF. We describe the most significant experiences and theories reported in literature, with a personal analysis about the possible relationship between vascular intracranial system and labyrinthine fluids. In conclusion, we believe that this association may be a challenge for otolaryngologists. So we suggest to consider the possibility of a DAVF or other AVMs when PT is associated with CHL, without alterations of tympanic membrane and middle ear tests.

Highlights

IntroductionConductive hearing loss (CHL) and pulsatile tinnitus (PT) with normal otoscopic examination and normal systemic findings often offer a diagnostic challenge to the otolaryngologist
Conductive hearing loss (CHL) and pulsatile tinnitus (PT) with normal otoscopic examination and normal systemic findings often offer a diagnostic challenge to the otolaryngologist.conductive hearing loss (CHL) usually indicates external or middle ear pathologies, such as fixation of the ossicular chain, tympanic membrane perforation, and cholesteatoma
The counter-evidence of the connections between the intracranial and labyrinthine fluids comes from previous studies that described that, in animal models, when the cochlear and vestibular aqueducts were closed there are no modifications within inner ear fluids [32, 33]

Summary

Introduction

Conductive hearing loss (CHL) and pulsatile tinnitus (PT) with normal otoscopic examination and normal systemic findings often offer a diagnostic challenge to the otolaryngologist. PT is a clinical condition frequently resulting from altered blood flow or increased blood turbulence near the ear or from idiopathic intracranial hypertension. It is often described as a sound synchronous with the heartbeat. The most common local causes of PT include atherosclerotic carotid artery disease, dural arteriovenous fistulas (DAVFs) and AVMs, glomus tumours of the jugular foramen and middle ear, fibromuscular dysplasia, tortuous internal carotid artery, jugular bulb abnormalities, transverse-sigmoid sinus stenosis and aneurysms, myoclonic contractions of the tensor veli palatini, Paget disease, otosclerosis, superior semicircular canal dehiscence, and idiopathic intracranial hypertension syndrome [3]. We analyze and discuss the most significant experiences and theories reported in literature about the possible relationship between vascular intracranial system and labyrinthine fluids

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