High Jugular Bulb Research Articles

When the Jugular Bulb Contacts the Facial Nerve.

Dehiscences of the intrapetrous canal of the facial nerve (FN) and those of a high jugular bulb (HJB) have various incidences. However, the HJB-FN common dehiscent osseous wall is a scarce finding and rarely reported. Thus, this work aimed to study this peculiar intrapetrous morphology on computed tomograms (CTs). A batch of 60 archived CTs was used. In 28.33% of cases, no HJBs were found; in 51.67% of cases, there were unilateral HJBs, and in 20% of cases, bilateral HJBs were found. 83.87% of the unilateral HJBs were on the right side, and the rest on the left side. In 3 cases with right-sided HJBs, 1 male and 2 females, FNs were found directly contacting the HJB. Therefore, the contact HJB-FN occurred in 5% of cases and 2.5% of the petrous bones/sides. HJBs' dehiscences to the retrotympanum or the posterior cranial fossa were also found in those cases. A dehiscent posterior semicircular canal to the HJB was found in one of these. Incidences for the HJB and the HJB-FN contacts seem higher than in previous studies. However, as only a 60-case batch of study was used, an overestimation may have resulted. Although scarce, the HJB-FN contact could determine specific symptoms and must be documented before specific surgical procedures involving the mastoid, retrotympanum, and posterior cranial fossa.

Anatomical Variations of the Jugular Bulb: A Critical and Comprehensive Review.

Background and Objectives: The jugular bulb (JB) is the uppermost part of the internal jugular vein receiving the sigmoid sinus. The aim of the present research is to aid the comprehension of the JB, its abnormalities, and surrounding structures for improving both academic and surgical awareness. Materials and Methods: Various studies on this topic were critically reviewed. Cone-beam CT scans and CT and MR angiograms were used to demonstrate each type of the discussed variations. Results: Variations in the JB anatomy were thoroughly documented: high JB, dehiscent JB, hypoplasia and hyperplasia, and diverticula of the JB, as they have significant clinical implications, particularly in the context of otological and neuro-otological surgery, skull base pathology, and diagnostic imaging. Definitions and critical arguments were also specified to clarify existing literature. Additionally, we present a case report illustrating a high and dehiscent JB, an anatomical variation of clinical interest due to its potential for misdiagnosis as a glomus tumor. Another case describes a dehiscent JB with a hypotympanic air cell protruding into it, further highlighting the variability of this condition. Conclusions: It is necessary to proceed with caution when observing abnormal morphological characteristics of the JB. Preoperative assessment of each case is essential for optimal outcomes.

Clinical evaluation of temporal bone anatomical abnormalities and surgical method selection in patients with congenital aural atresia

ObjectivesTo analyze anatomic variations of the temporal bone in congenital aural atresia (CAA) and their correlation with the Jahrsdoerfer score, in order to guide clinical selection of surgical treatment methods. Material and methodsWe retrospectively studied 53 patients (72 ears) with unilateral or bilateral CAA, including 34 ears with normal hearing as controls. Audiological and imaging data were collected and analyzed. We evaluated the Jahrsdoerfer score and anatomical variations, including tegmen mastoideum position, anterior sigmoid sinus displacement, and elevated jugular bulb. ResultsThe average air conduction hearing threshold (PTA4) ranged from 0.5 to 4 kHz was 65.48 ± 8.19 dBHL, with an average Jahrsdoerfer score of 4.93 ± 2.78. In CAA group, there was a higher prevalence and severity of anterior sigmoid sinus and low position of the tegmen mastoideum (P < 0.01). However, there was no significant difference in incidence rates among groups with high jugular bulb (P > 0.05). Anterior sigmoid sinus and high jugular bulb showed no correlation with the Jahrsdoerfer score, while the low position of the tegmen mastoideum had a weak correlation. The Jahrsdoerfer score did not adequately predict temporal bone anatomical abnormalities in CAA patients. ConclusionCAA exhibit a higher incidence and greater severity of temporal bone anatomical abnormalities compared to the control group, and the Jahrsdoerfer score inadequately assesses these abnormalities. Anomalies like low position of the tegmen mastoideum, anterior sigmoid sinus, and high jugular bulb should also be considered as independent factors influencing surgical decisions for atresiaplasty.

A Clinicopathological Study of Aural Polyps: A Retrospective Analysis in a Tertiary Care Hospital.

Introduction Aural polyps are a misnomer. Any lesion can present as a mass in the external auditory canal. Aural polyps are proliferation of the granulation tissue due to long standing inflammatory process with associated otalgia and otorrhea. Objectives To document the clinicoradiological presentations, intraoperative findings, and histopathological diagnosis of aural polyp, correlating them. Methods In our study 81 patients underwent treatment for aural polyps in the department of Ear, Nose, and Throat (ENT) from April 1997 to April 2022. Results were tabulated, a simple descriptive analysis was done using the Statistical Package Social Sciences software, and the results obtained were represented as percentages and presented in tables. Results The majority (38) of the patients presenting with aural polyps were diagnosed with mucosal and squamous type of CSOM, and 22 with simple granulation polyps. There were also 5 patients with malignant otitis externa, 3 patients had glomus tumors, 2 patients with retained foreign bodies, and 3 patients with brain herniation. We also identified aberrant internal carotid artery, high jugular bulb, one patient had facial nerve neuroma, one patient had polyp from the tragus diagnosed with tuberculosis, one patient with keratosis obturans, and one with exostosis. Conclusion A thorough detailed examination and mastoid exploration with radiological and histopathological evaluation is mandatory for better defining the definitive treatment. Utmost care and meticulousness are advised for the surgeons while dealing with aural polyps to avoid any complications.

Topographic Radioanatomical Analysis of the Singular Canal: Computed Tomography Study

Purpose: The singular canal (SC) is where the singular nerve, a branch of the inferior vestibular nerve, which carries afferent information from the posterior semicircular canal (PSCC), passes and is important in the surgical approach of the presigmoid retrolabyrinthine. This study was carried out to evaluate the visibility of the SC on standard computed tomography (CT) images, its distance to the surrounding structures, and to investigate the variations of its anatomy and its relationship with the meatus acusticus internus. Materials and Methods: The study was carried out retrospectively using images of 194 temporal bones on temporal bone CT scans of 44 men and 53 women aged 18–65. In the study, various measurements were made, especially the presence of the SC, its length, its angle with the internal acoustic canal (IAC), and the distance between the internal acoustic pore (IAP) and the singular foramen. In addition, the presence of the high jugular bulb and PSCC dehiscence images were investigated. Results: The SC was detected in 85.1% of the analyzed images. The mean canal length was 3.93 ± 1.22 mm, the angle between the SC and the IAC was 22.68° ±3.60°, and the distance between the SC and the IAP was 7.70 ± 0.83 mm. While no difference was found between the sides, it was determined that the length and diameter of the SC did not differ according to gender. Conclusion: Detailed morphometric analysis of the SC and a thorough understanding of its relationship with the IAC, vestibulum, and PSCC will help to accurately define the posterior and lateral borders of the dissection for this region.

The association between high jugular bulb and mastoid pneumatization in adults.

The purpose of this study was to analyze the relationship between the degree of high jugular bulb (HJB) and mastoid pneumatization using high-resolution computed tomography (HRCT). Between April 2019 and June 2022, HRCT of the temporal bone was retrospectively analyzed in 1,025 patients. By excluding the other coexistent pathologies, 113 patients with HJBs were recruited for the study. The degree of the HJBs were defined as follows: Grade I, JB situated between inferior annulus of tympanic membrane and cochlear basal turn (CBT). Grade II, JB situated between CBT and lateral semicircular canal (LSC). Grade III, JB situated above LSC. The volume of mastoid pneumatization was based on HRCT images using a 3D reconstruction. There were 32 male and 81 female subjects (mean age, 41.2 ± 14.0 years; age range, 18-80 years). The male group included 16 Grade I, 28 Grade II and 6 Group III HJB subjects. The female group included 38 Grade I, 62 Grade II and 31 Group III HJB cases. In the different groups of HJB, the mastoid cell volume differences were also not statistically significant (p = 0.165). In the classification, Grade II was most common (90/181, 49.7%). This study found no correlation between mastoid air cell volume and HJB, suggesting that HJB may not affect the mastoid air cell development and disease occurrence. These data must be considered exploratory, requiring more extensive cross-sectional studies.

Wave In in auditory brainstem response suggests a high possibility of a high jugular bulb.

Wave In, which refers to the negativity between waves I and II in auditory brainstem response (ABR), is an electrophysiological phenomenon observed in previous studies. The term "high jugular bulb" (HJB) describes a jugular bulb that is located in a high position in the posterior aspect of the internal acoustic canal. The present study aimed to explore the correlation between wave In and the possibility of a HJB. This retrospective study included a cohort of pediatric patients diagnosed with profound hearing loss who were enrolled in a government-sponsored cochlear implantation program at an academic medical center between January 2019 and December 2022. The analysis involved examining the results obtained from the ABR test and high-resolution computed tomography (HRCT) of the temporal bone in the patients. The position of the jugular bulb was classified according to the Manjila and Semaan classification. A total of 221 pediatric patients were included in the study. Twenty-four patients, with a median age of 3 years and a range of 1-7 years, showed significant bilateral (n = 21) or unilateral (n = 3) wave In (mean latency: right ear, 2.16 ms ± 0.22 ms; left ear, 2.20 ms ± 0.22 ms). The remaining 197 patients showed an absence of ABR. The HRCT images revealed that 18 of the 24 patients (75%) had HJB, but only 41 of the 197 patients who lacked ABR (20.8%) showed signs of HJB. The ratio difference was considered statistically significant based on the chi-squared test (χ2 = 32.10, p < 0.01). More than 50% of the HJBs were categorized as type 4 jugular bulbs, which are located above the inferior margin of the internal auditory canal. ABR wave In in pediatric patients with profound hearing loss suggests a high possibility of HJB. The physiological mechanism underlying this correlation needs further investigation.

High jugular bulb in patients with non-thrombotic internal jugular venous and transverse sinus stenosis: Clues to pathogenesis.

Conventional theories for jugular bulb (JB) formation are insufficient to explain the high proportion of high JB in adult patients. We aimed to study features of high JB in patients with non-thrombotic internal jugular venous stenosis (IJVS) and/or transverse sinus stenosis (TSS) to explore the pathogenesis of high JB formation. We retrospectively enrolled consecutive patients with the diagnosis of non-thrombotic IJVS and/or TSS. The relationship between IJVS and/or TSS and high JB was explored. Logistic regression analysis was performed to identify potential independent risk factors for high JB. A total of 228 patients were included in the final analyses. The proportions of IJVS, dominant-side IJVS, and non-TSS in dominant-side high JB subgroup were higher than those in nondominant-side high JB subgroup (83.3% vs. 62.5%, p < 0.001; 72.2% vs. 18.3%, p < 0.001; 43.5% vs. 29.2%, p = 0.02). Heights of JBs on dominant sides in IJVS subgroup and non-TSS subgroup were higher than those in non-IJVS subgroup and TSS subgroup (12.93 ± 2.57 mm vs. 11.21 ± 2.76 mm, p < 0.001; 12.66 ± 2.71 mm vs. 11.34 ± 2.73 mm, p = 0.003). Multivariate logistic regression indicated an independent association between dominant-side IJVS and dominant-side high JB (odds ratio, 29.40; 95% confidence interval, 11.04-78.30; p < 0.001). IJVS and asymmetric transverse sinus were independently and positively associated with high JB, especially dominant-side IJVS with dominant-side high JB, indicating a potential hemodynamic relationship between IJVS and high JB formation. Conversely, TTS might impede high JB formation.

Pre-Operative Evaluation of Petrous Temporal Bone Pathologies by CT and MRI in Cochlear Implant Candidates

Aim: To evaluate pathologies of the petrous temporal bone in cochlear implant candidates on CT and MRI preoperatively. Methods: A cross-sectional study was conducted at Combined Military Hospital Lahore from Jan 2014 to April 2016. 163 candidates were evaluated on CT and 149 were evaluated on MRI. All patients belonged to pediatric age group. Pathologies were grouped using classification of Sennaroglu &amp; Saatci and every pathology was sought in all the cases ensuring that the pathologiesare not missed. Results: High-resolution CT scan temporal bone revealed 69.9% normal studies. Chronic otitis media with mastoiditis was major abnormality observed in 16.6% of cases. Unilateral mastoiditis was seen in 6.1% of patients. Bilateral CSOM without mastoiditis was seen bilaterally in 1.8% of cases. While unilateral CSOM was observed 0.6 % of patients. Among inner ear malformations, Mondini malformation was seen in 4 cases (2.5%). A high jugular bulb was seen in 2 cases (1.2%).93.3% of cases were labeled as normal study on MRI. Four cases showed Mondini malformation. Infective process of middle ear showed a cumulative frequency of 2.7%. Inner ear aplasia was found in one patient. Sclerosing labyrinthitis was also found in one case. Conclusion: Both CT and MRI have substantial role in pre-operative evaluation of petrous temporal bone in cochlear implant candidates. Preoperative evaluation of petrous temporal bone by CT scan and MRI successfully identifies pathologies which can be absolute or relative contraindications of the cochlear implant as well as conditions in which surgical procedure needs to be modified. Keywords: Cochlear implants, HRCT temporal bone, MRI cochlea, Mastoiditis, Mondini malformation

Assessment of the distribution and volume of air chambers around the inner auditory canal on high-resolution computed tomography scans of the temporal bone.

Assessment of the distribution and volume of air chambers around the inner auditory canal on high-resolution computed tomography scans of the temporal bone.

Influence of pneumatization on morphology of temporal bone-related vasculatures and their morphometric relationship with ear regions: a computed tomography study

Anatomical variations in the location and position of temporal bone-related vasculature are routinely encountered in clinical practice, contributing to clinical syndromes and complexities in ear-related and neurological surgeries. Pneumatization of the temporal bone (TB) is one of several factors that have been hypothesized to influence the variabilities and variations of these vessels. This study aimed to investigate the association between the degree of pneumatization and the morphologies of some TB-related vessels, as well as their morphometrical relationship with ear regions. Observational retrospective chart review of 496 TBs computed tomographic scans were examined. Different degrees of pneumatization were observed, with hyper-pneumatization being the most common and hypo-pneumatization being the least. Various anatomical variants of the sigmoid sinus (SS), jugular bulb (JB), and internal carotid artery (ICA) were observed. Distances of SS and JB to ear regions were observed to have significant differences (p < 0.05) in laterality. These distances increased relative to increased air cells, showing a significant association (p < 0.05). A significant association (p < 0.001) was also observed between the degree of pneumatization and variants of JB and ICA. High JB, JB dehiscence, and ICA dehiscence were significantly associated with increased pneumatization, while flat JB was significantly associated with decreasing pneumatization. However, no significant association (p = 0.070, p = 0.645) was observed between the degree of pneumatization and morphologies of SS. This study concludes that the degree of pneumatization influences only the jugular bulb variants and ICA dehiscence, as well as the distances of SS and JB to ear regions.

Analysis of Etiology, Diagnosis, and Treatment Strategy and Efficacy of Pulsatile Tinnitus Caused by Abnormal Vascular Anatomy.

To investigate the etiology, clinical characteristics, diagnosis, and treatment strategies and efficacy of pulsatile tinnitus (PT) caused by vascular anatomy abnormality. The clinical data of 45 patients with PT in our hospital from 2012 to 2019 were collected and retrospectively analyzed. All 45 patients had vascular anatomical abnormalities. The patients were divided into 10 categories according to the different locations of vascular abnormalities: sigmoid sinus diverticulum (SSD), sigmoid sinus wall dehiscence (SSWD), SSWD with high jugular bulb, pure dilated mastoid emissary vein, aberrant internal carotid artery (ICA) in the middle ear, transverse-sigmoid sinus (TSS) transition stenosis, TSS transition stenosis with SSD, persistent occipital sinus stenosis, petrous segment stenosis of ICA, and dural arteriovenous fistula. All patients complained of PT synchronous with heartbeat rhythm. Endovascular interventional therapy and extravascular open surgery were used according to the location of the vascular lesions. Tinnitus disappeared in 41 patients, was significantly relieved in 3 patients, and was unchanged in 1 patient postoperatively. Except for one patient with transient headache postoperatively, no obvious complications occurred. PT caused by vascular anatomy abnormalities can be identified by detailed medical history and physical and imaging examination. PT can be relieved or even completely alleviated after appropriate surgical treatments.

Imaging Study &amp; Surgical Perspective Of Cochlear Implantees

Introduction: A cross-sectional prospective clinical study was done to evaluate the inner ear anomalies in candidates undergoing cochlear implantation. Materials and Methods: Study was carried out over a period of 07 years (Jan 2013 to Dec 2019) at Cochlear Implant Centre, Combined Military Hospital Dhaka. A total 206 deaf candidates, both pre and post lingual, were included in convenient sampling method. Result: The sample consisted of 206 candidates, of whom 117 (56.80%) were female and 89 (43.20%) were male. All candidates had severe to profound bilateral deafness. 182 (88.35%) of them were pre and 24 (11.65%) were in post lingual group. All patients diagnosed audiologically as profound deafness underwent HRCT scan of temporal bone with 3D reconstruction of cochlea and MRI of internal auditory canal &amp; brain. Radiological examination revealed that 36 (17.47%) candidates had ear anomalies. Mondini deformity 14 (06.80%), cochlear ossification 11 (5.34%), large vestibular aqueduct 04 (1.94%), high jugular bulb 04 (1.94%) and anteriorly placed sigmoid sinus 03 (1.45%) were noted. During intervention, 42 (20.39%) candidates had anomalous intra operative findings. Among them CSF gusher 19 (9.23%), ossification of basal turn 12 (5.83%), isolated rotated Cochlea 02 (0.97%), high jugular bulb 04 (1.94%), anteriorly placed sigmoid sinus 03 (1.45%), and very high facial nerve 02 (0.97%) were observed. During surgery, electrode insertion difficulty due to high CSF gusher was experienced in19 (9.23%) cases, full length of electrode insertion was not possible due to ossified basal turn 12 (5.83%), difficult to find out round window membrane due to rotated cochlea 02 (0.97%), prevented direct visualization of the round window due to high jugular bulb 04 (1.94%), difficult to approach round window due to very high facial nerve 02 (0.97%). and approach to round window membrane was compromised due to anteriorly placed sigmoid sinus 03 (1.45%). Most of these difficulties were effectively managed during surgery. Conclusions: This study highlights the importance of preoperative radiological scanning in the assessment of patients undergoing cochlear implantation. It provides vital information on cochlear status and in ruling out non cochlear causes where cochlear implantation is not feasible. Detection of anatomical abnormalities with appropriate evaluation, specially imaging should be mandatory in every patient undergoing cochlear implantation. J Dhaka Med Coll. 2021; 30(2) : 167-175

Surgical Fixation of Jugular Bulb Abnormalities Associated With Phelebectasia in Patients With Vascular Tinnitus.

Internal jugular phlebectasia is a rare entity in which there is a fusiform dilatation of the internal jugular vein (IJV), usually presenting as a neck mass or tinnitus. The jugular bulb (JB) is an enlarged confluence connecting the sigmoid sinus and the IJV. It has been suggested that JB abnormality might also cause vertigo and pulsatile tinnitus. This prospective interventional study involved 15 patients with pulsatile tinnitus associated with internal jugular phlebectasia. Four patients presented with recurrent vertigo attacks. IJV diameter at rest ranged from 11 to 18 mm. Eight patients have had inner ear bone dehiscence, and 40% had high JB. All cases were treated by surgical fixation using a ringed polytetrafluoroethylene graft extending from the costoclavicular joint to the sigmoid sinus under fluoroscopic guidance. Tinnitus disappeared immediately postoperatively in all cases, followed by the disappearance of vertigo on the fourth day. Two cases reported thrombosis of the graft in the sixth and seventh months but maintained symptomatic improvement. Recurrence was reported in 2 cases while the grafts were patent. Surgical fixation by replacing the jugular vein and bulb with a synthetic graft may offer an excellent surgical option for relieving vascular tinnitus, especially in these young patients in whom endovascular therapy may not be a durable treatment.

A study to evaluate the change in management plan of chronic otitis media (mucosal) after cone beam computed tomography

: Imaging of temporal bone helps the Otologists in preoperative surgical planning in ear surgery. Cone Beam Computed Tomography (CBCT) has much higher spatial resolution and clarity as compared to conventional X-Ray and much lower radiation exposure as compared to HRCT Temporal Bones. : To evaluate the change in management plan of Chronic Otitis Media (Mucosal) after CBCT. Also to determine the sensitivity and specificity of the CBCT findings by comparing with intra operative findings in the study participants. We conducted an observational descriptive study in the ENT Department of an academic Tertiary care hospital from October 2017 to October 2019. We included 95 patients whose management plan before CBCT was compared with the plan after CBCT and the percentage of cases undergoing a change in the management after CBCT was determined. The correlation of CBCT findings and intra operative findings in terms of specificity and sensitivity was also statistically calculated. : Subsequent to imaging, the management plan was changed in only 4 patients which was statistically non-significant. CBCT showed a 100% sensitivity, specificity, positive predictive value and negative predictive value to detect pneumatisation of the Mastoid, high jugular bulb and low-lying dura. The sensitivity to detect ossicular erosion was 98.9%. : Thorough clinical examination is the most important factor in decision making in patients with Chronic Otitis Media (Mucosal) and management plan remains unchanged after imaging. Though thorough clinical examination remains the gold standard in making a management plan of patients with Chronic Otitis Media (Mucosal), CBCT with its available details and minimal radiation helped to minimise intraoperative inadvertent injuries which might result due to normal anatomic variations like low lying dura, forward lying sinus, contracted mastoid cavity etc.

Hemangioma of temporal bone: clinical case

Vascular tumors often localized in the region of head and neck. Intraosseous hemangiomas localized mainly in the vertebrae and in the skull bones, but they are rarely found in the temporal bone. More often, intratemporal hemangiomas are localized in the internal auditory canal or in the area of the geniculate ganglion and Scarpas ganglion, due to the abundant blood supply of these areas. In other areas of the temporal bone, hemangioma is extremely rare. The symptoms depend on the localization and size of the tumor. The main clinical manifestations of the disease: facial nerve palsy, hemifacial spasm, cochleovestibular symptoms. The data of computed tomography (CT) and magnetic resonance imaging (MRI) are non-specific. Angiography is recommended to identify the anatomical features of the vessels like aberrant internal carotid artery, high jugular bulb), the blood supply of the tumor and the possibility of embolization, which significantly reduces the risk of bleeding and damage to important anatomical structures of the temporal bone during surgery. Differential diagnosis is carried out with many diseases of the temporal bone: cholesteatoma, glomus tumor, shwannoma of the VII and VIII cranial nerves, Langerhans cell histiocytosis, rhabdomyosarcoma, etc. Surgical treatment is the method of choice and allows to completely resect the tumor. The article presents a clinical case of intratemporal hemangioma in a patient with a long term symptom of hearing loss.

전정신경초종수술을 위한 경미로접근법에서 컴퓨터 단층촬영 3차원영상합성의 유용성

Background : The purpose of this study was to evaluate the clinical utility of preoperative three-dimensional temporal bone reconstruction in patients for translabyrinthine removal of vestibular schwannoma. Materials and Methods : Prior to commencement of the translabyrinthine approach, critical anatomical structures were traced and three-dimensionally reconstructed using computed tomography (CT) scans of the normal temporal bone. Two patients diagnosed with vestibular schwannoma via magnetic resonance imaging were evaluated in this study. Results : Anatomical reconstruction allowed sequential planning of the translabyrinthine approach. The patient-tailored, preoperative image-guided approach prevented iatrogenic damage by predicting a high jugular bulb or a narrow sinodural angle. Conclusions : Three-dimensional reconstruction illuminates the translabyrinthine approach and identifies difficulties that may be encountered at each step, thus preventing confusion.

Commentary: Resection of a Vestibular Schwannoma Using the Retrosigmoid Approach in a Patient With a High Jugular Bulb: 2-Dimensional Operative Video.

Commentary: Resection of a Vestibular Schwannoma Using the Retrosigmoid Approach in a Patient With a High Jugular Bulb: 2-Dimensional Operative Video.

A Case of Dural Arteriovenous Fistula in the High Jugular Bulb Diagnosed by Pulsating Tinnitus

A Case of Dural Arteriovenous Fistula in the High Jugular Bulb Diagnosed by Pulsating Tinnitus

High And Dehiscent Jugular Bulb in External Ear Canal: A Case Report

The high jugular bulb is the common anatomical variation of the jugular bulb in the temporal bone. Encounters with jugular bulb abnormalities during ear surgery are a rare but recognized problem. The case of a 60-year-old male with a subtotal dry eardrum perforation who underwent and elective tympanoplasty and unexpected brisk hemorrhage in external acoustic canal incisions is presented.