Abstract
A dominant sigmoid sinus with either diverticulum or dehiscence (SS-Div/SS-Deh) is a common cause of pulsatile tinnitus (PT). For PT originating from SS-Div/SS-Deh, an etiology-specific and secure reconstruction using firm materials is vital for optimal outcomes. As a follow-up to our previous reports on transmastoid SS resurfacing or reshaping for SS-Div/SS-Deh, this study aimed to evaluate the long-term results of transmastoid resurfacing/reshaping. We retrospectively reviewed 20 PT patients who were diagnosed with SS-Div/SS-Deh, underwent transmastoid resurfacing/reshaping, and were followed up for more than 1 year postoperatively. For PT, immediate and long-term changes (> 1 year) in loudness and annoyance were analyzed using the visual analog scale (VAS). Additionally, pre and postoperative objective measurements of PT using transcanal sound recording and spectro-temporal analysis (TSR-STA), imaging results, and audiological findings were comprehensively analyzed. Significant improvements in PT were sustained or enhanced for > 1 year (median follow-up period: 37 months, range: 12–54 months). On TSR-STA, both peak and root mean square amplitudes decreased after surgery. Also, the average pure-tone threshold at 250 Hz improved after surgery. Thus, our long-term follow-up data confirmed that the surgical management of PT originating from SS-Div/SS-Deh is successful with regard to both objective and subjective measures.
Highlights
A dominant sigmoid sinus with either diverticulum or dehiscence (SS-Div/SS-Deh) is a common cause of pulsatile tinnitus (PT)
While non-pulsatile tinnitus is thought to be a consequence of functional changes in the auditory and the non-auditory cortices[3,4], PT is due to major vascular wall anomalies in the temporal bones[5,6]
By reviewing the results of objective assessments, including transcanal sound recording with spectro-temporal analysis (TSR-STA) and pure-tone audiometry (PTA), and correlating these with subjective symptom improvements, we suggest possible pathophysiological mechanisms of PT perception and its long-term improvement after surgical managements
Summary
A dominant sigmoid sinus with either diverticulum or dehiscence (SS-Div/SS-Deh) is a common cause of pulsatile tinnitus (PT). Our long-term follow-up data confirmed that the surgical management of PT originating from SS-Div/SS-Deh is successful with regard to both objective and subjective measures. Tinnitus, characterized by a conscious auditory perception in the absence of an external stimulus, is a common otological condition[1]. As a follow-up study to our aforementioned initial studies, we evaluate the long-term efficacy of SS resurfacing/reshaping techniques in a relatively large cohort with SS-Div/SS-Deh. By reviewing the results of objective assessments, including transcanal sound recording with spectro-temporal analysis (TSR-STA) and pure-tone audiometry (PTA), and correlating these with subjective symptom improvements, we suggest possible pathophysiological mechanisms of PT perception and its long-term improvement after surgical managements. Our results provide a novel insight into the effect of stringent selection of surgical candidates among PT patients with SS-Div/SS-Deh and patient-tailored surgical approaches on successful treatment
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