High Jugular Bulb Research Articles

Prevalence of Jugular Bulb Abnormalities and Resultant Inner Ear Dehiscence: a Histopathologic and Radiologic Study

Objective: Jugular bulb (JB) abnormalities including high riding JB and JB diverticulum can erode inner ear structures and cause hearing loss, dizziness, and tinnitus. This study investigates 1) the prevalence of JB abnormalities, and 2) their erosion into inner ear structures using temporal bone histopathology and computed tomography (CT). Method: A total of 1579 temporal bones and 100 CT of the temporal bones (200 ears) were reviewed. The presence of a high JB was recorded as was its erosion into inner ear structures. Accompanying demographic and clinical information was reviewed. Results: High JB was noted in 8.2% (130/1579) of temporal bone specimens, and in 8.5% (17/200) of cases radiologically. Histologically, high JB were more common on the left side, in women, and in those greater than 40 years old. There was no significant increase in the prevalence of high JB over age 40 years. High JB eroded inner ear structures in 34% (44/130) of cases histologically and 18% (3/17) radiologically. The vestibular aqueduct was most frequently dehiscent histologically (n = 41) and radiologically (n = 3). Posterior semicircular canal and facial nerve were infrequently dehiscent. Only 2 out of 41 histological cases of vestibular aqueduct dehiscence had hydrops or a clinical history of Ménière’s disease. Conclusion: JB abnormalities are common. They are present in 8% to 9% of individuals and are acquired by age 40 years. In 1/3 of cases, high riding JB erodes the inner ear, most frequently involving the vestibular aqueduct. Contrary to expectation, dehiscence of the vestibular aqueduct is infrequently associated with endolymphatic hydrops clinically or histologically.

A Case of Inner Ear Anomaly with Normal Hearing Associated with High Jugular Bulb

A Case of Inner Ear Anomaly with Normal Hearing Associated with High Jugular Bulb

A case of high jugular bulb with abnormal intracranial and extracranial venous circulation

A case of high jugular bulb with abnormal intracranial and extracranial venous circulation

A Case Of High Jugular Bulb Accompanied With Cholesteatoma

A Case Of High Jugular Bulb Accompanied With Cholesteatoma

A Case of High Jugular Bulb Observed During Middle Ear Surgery

A Case of High Jugular Bulb Observed During Middle Ear Surgery

Medial High Jugular Bulb with Vestibular Disorder

Medial High Jugular Bulb with Vestibular Disorder

Unilateral Conductive Hearing Loss Secondary to an Ipsilateral High Jugular Bulb with Contralateral Agenesis of The Lateral Dural Sinuses in a Pediatric Patient

Unilateral Conductive Hearing Loss Secondary to an Ipsilateral High Jugular Bulb with Contralateral Agenesis of The Lateral Dural Sinuses in a Pediatric Patient

CT and MRI findings of temporal bone anomaly in patients with tinnitus

Objective To study high resolution CT (HRCT) and MRI findings of temporal bone anomaly in patients with tinnitus and identify the optimal examination method in the detection of the anomaly. Methods The HRCT and MRI data were analyzed retrospectively in 1015 patients including 145 patients with pulsatile tinnitus (PT) and 870 patients with nonpulsatile tinnitus (NPT). The positive rates of HRCT and MRI in the identification of temporal bone anomaly were analyzed and the efficiency of various examination methods was compared in revealing the anomaly. Data were tested by Chi-square test analysis. Results Among 1015 patients, anomaly was seen in 767 cases (75.57%). High jugular bulb was found in 414 patients, accounting for 40. 79%. Sigmoid sinus anomaly was detected in 387 patients (38. 13%), while otitis media was found in 148 cases (14. 58%), and low middle cranial fossa in 70 cases (6. 90%). The positive rate of HRCT in the detection of high jugular bulb was 54. 89% (365/665), which was significantly higher than those of other methods (P ＜ 0. 05). The positive rate of enhanced HRCT in showing sigmoid sinus anomaly was 73.68% (56/76), which was significantly higher than those of other methods(P ＜0. 05). Sigmoid sinus anomaly was the most frequent finding in patients with PT, accounting for 66. 21% (96/145). The incidence of sigmoid sinus anomaly was higher in PT than in NPT (291/870,33.45% ;χ2 =56. 537 ,P ＜0. 01). The fast imaging employing steady-state acquisition (FIESTA) sequence was the best examination method in displaying the vessel within the internal auditory canal (42/42,100%).Conclusions High jugular bulb and sigmoid sinus anomaly were the most frequent abnormal findings of temporal bone in patients with tinnitus. Enhanced HRCT was the choice of modality in patients with PT.Plain HRCT was recommended for NPT. FIESTA sequence was the best in the evaluation of the vessel within the internal auditory canal. Key words: Tinnitus; Temporal bone; Tomography, X-ray computed; Magnetic resonance imaging

Ear and Further Anatomic Anomalies in Children Undergoing Stapedotomy

Purpose: Aim of this study was to examine any stapes fixation-related clinical, intraoperative and high-resolution computed tomography (HRCT) findings in children undergoing stapedotomy. Procedures: Detailed diagnostic assessment was performed in 12 children (18 ears) who underwent stapedotomy within the period 2005–2008. Results: Ear malformations such as malleus-incus anomalies, malleus-epitympanum fixation and absence of the stapedius tendon, small external auditory canal and auricle malformations were clinically and/or intraoperatively diagnosed. HRCT identified a petrous high jugular bulb and malformed inner auditory canal in 4 ears; however, it failed to recognize ossicular fixation. Systemic anomalies, namely kyphoscoliosis, esophageal atresia and finger malformations were identified in 2 children. Summing up, additional anatomic anomalies were found in 8 patients (66.7%). Conclusions: Ear malformations may coexist in children with stapes fixation. Ossicular fixation is not easily recognized with HRCT, and therefore, ossicular mobility should always be tested intraoperatively. In a few cases, pediatric stapes fixation can coexist with systemic dysplasias; in such patients, additional referral to geneticists is recommended.

Operative Management of Posterior Semicircular Canal Dehiscence from a High Jugular Bulb

Operative Management of Posterior Semicircular Canal Dehiscence from a High Jugular Bulb

Saethre-Chotzen Syndrome, Pro136His TWIST Mutation, Hearing Loss, and External and Middle Ear Structural Anomalies: Report on a Brazilian Family

To describe the clinical, speech, hearing, and imaging findings in three members of a Brazilian family with Saethre-Chotzen syndrome (SCS) who presented some unusual characteristics within the spectrum of the syndrome. Clinical evaluation was performed by a multidisciplinary team. Direct sequencing of the polymerase chain reaction-amplified coding region of the TWIST1 gene, routine and electrophysiological hearing evaluation, speech evaluation, and imaging studies through computed tomography (CT) scan and magnetic resonance imaging (MRI) were performed. TWIST1 gene analysis revealed a Pro136His mutation in all patients. Hearing evaluation showed peripherial and mixed hearing loss in two of the patients, one of them with severe unilateral microtia. Computed tomography scan showed structural middle ear anomalies, and MRI showed distortion of the skull contour as well as some of the brain structures. We report a previously undescribed TWIST1 gene mutation in patients with SCS. There is evidence that indicates hearing loss (conductive and mixed) can be related both with middle ear (microtia, high jugular bulb, and enlarged vestibules) as well as with brain stem anomalies. Here we discuss the relationship between the gene mutation and the clinical, imaging, speech, and hearing findings.

Unilateral conductive hearing loss secondary to an ipsilateral high jugular bulb with contralateral agenesis of the lateral dural sinuses in a pediatric patient

We present a case of a 7-year-old boy with a left sided conductive hearing loss accompanied by pulsating tinnitus. Otomicroscopic examination of the left ear revealed a bluish, non-pulsating mass behind the posterior inferior quadrant of the tympanic membrane. The audiogram demonstrated a left conductive hearing loss and a type B tympanogram. A myringotomy with insertion of a pressure equalizing (PE) tube was performed with no change in symptoms and hearing. CT demonstrated a high jugular bulb (HJB) on the left side, intruding the middle ear space, in contact with the ossicular chain. Venous stage of magnetic resonance demonstrated a complete dominance of the dural sinuses on the left side, with a huge internal jugular vein diverticulum. In addition, a complete agenesis of the lateral dural sinuses was demonstrated on the contralateral side. The combination of pulsatile tinnitus and unilateral conductive hearing loss with a red or blue to purple mass behind the tympanic membrane should alert the physician. Assessment of the anatomy and blood flow by CT scan and MRI of the ear and head are advised to delineate the finding, before considering any type of intervention.

High Computed Tomographic Correlations between Carotid Canal Dehiscence and High Jugular Bulb in the Middle Ear

Both carotid canal dehiscence (CCD) and high jugular bulb (HJB) are thought to increase the potential for disastrous consequences during middle ear surgery. Clinical co-presentation of these two great vessel variants has not yet been described. This study aims to determine the relationship between CCD and HJB based on a computed tomographic (CT) temporal bone evaluation. High-resolution CT scans of 408 temporal bones obtained from 208 adults were recruited. Carotid canal integrity, jugular bulb position, petrous apex pneumatization and the minimal thickness of the carotid canal wall (TCW) facing the tympanic cavity were examined and measured for the incidence of CCD and/or HJB. Other variables including gender, age, laterality and the presence of otitis media or mastoiditis were also collected for analysis. CCD was found in 28 ears (6.9%); 19 of these were found to also have HJB (67.9%). The presence of CCD was significantly correlated with HJB presentation. The minimal TCW in HJB ears was significantly thinner than that of normally positioned jugular bulbs. Moreover, after controlling for other candidate variables, the independent factors of age (younger or older than 50 years) and jugular bulb position (high vs. normal) were found to predict the presence of CCD. In conclusion, HJB tends to coexist with a thinner carotid canal wall. This finding emphasizes the need to be watchful for the coexistence of these two great vessel anomalies when surgeons encounter an aged patient presenting either CCD or HJB during middle ear surgery.

High Mega Jugular Bulb Presenting with Facial Nerve Palsy and Severe Headache

We present a rare case of a 50-year-old female patient with symptomatic high mega jugular bulb requiring surgery. We review her medical file, preoperative and postoperative imaging, audiograms, and surgical report. High jugular bulb was diagnosed with computed tomography and magnetic resonance imaging. Symptoms of facial nerve palsy and headache were abolished after surgical procedure. Headache and facial nerve palsy can be caused by high mega jugular bulb. Surgery is indicated in such symptomatic cases and leads to relief of signs and symptoms of disease.

A novel surgical technique for management of tinnitus due to high dehiscent jugular bulb

Objectives To assess the effectiveness of middle ear floor reconstruction in management of vascular tinnitus due to high jugular bulb with dehiscent middle ear floor. Study Design Case series with chart review. Setting Tertiary academic medical center. Subjects and Methods We reviewed the medical records of seven patients with high dehiscent jugular bulb, presenting with incapacitating pulsatile roaring tinnitus that was abolished by digital compression of the ipsilateral jugular vein, from January 2002 to December 2006. The diagnosis was confirmed by CT scan of the temporal bone (bone window, coronal views). The seven patients were surgically explored, five under local anesthesia (to monitor the results with possible intraoperative revision) and two under general endotracheal anesthesia, for middle ear floor reconstruction that was done using bone dust, perichondrium, and tragal cartilage (mean follow-up 28 months). Results Of the seven patients, tinnitus disappeared in four (57%) and decreased in one. The overall improvement was five of seven (71%). One patient had postoperative increased intracranial pressure. Conclusion The preliminary results suggest that surgical reconstruction of the middle ear floor under local anesthesia offers valuable treatment for patients with incapacitating tinnitus due to dehiscent middle ear floor. However, the risk of sigmoid sinus thrombosis should be considered. To our knowledge, this is the first trial of multilayer reconstruction of the middle ear floor dehiscence to manage high jugular bulb causing tinnitus.

An anatomical and radiological study of the high jugular bulb on high-resolution CT scans and alcohol-fixed skulls of adults

Although many reports mention a “high jugular bulb” (HJB), it is often not clearly defined. We examined the relationship between the jugular bulb (JB) and the internal auditory canal (IAC) in 200 temporal bones on high resolution CT scans and alcohol-fixed skull bases of adults. The average distance (±standard deviation) between the IAC and the JB was 7.5 ± 2.3 mm (range, 1–16 mm). The JB was higher on the right side than its companion in 53.3% of patients (left side only in 22%; no side dominance in 23.7% of bases). When the JB reached or exceeded the floor of the IAC (16.5%), it was defined as a HJB; 61% of HJB were found in females. Bilateral HJB was found in 0.5% of patients. The HJB was not associated with a contralateral flat JB. Preoperative multiplanar high resolution CT reconstructions make the most detailed assessment of structural topography.

Beware the silent presentation of a high and dehiscent jugular bulb in the external ear canal

We report two rare cases of high and dehiscent jugular bulbs protruding into the external ear canal; one case was silent, the other symptomatic. The cases are presented and the relevant literature reviewed and discussed. A 52-year-old woman underwent mastoid exploration for suspected cholesteatoma. On raising the tympanomeatal flap, while still lateral to the annulus, brisk venous bleeding occurred from a high, dehiscent jugular bulb in the external ear canal. The second patient, a 42-year-old man, underwent imaging for suspected glomus tumour. A high, dehiscent jugular bulb was found protruding into the external ear canal and hypotympanum. High jugular bulbs in the middle ear have been reported many times. To our knowledge, there has only been one previous report of a high jugular bulb in the external ear. These cases illustrate the importance of full, accurate assessment of high resolution computed tomography images, and of appropriate, immediate management of bleeding.

Surgical management of tinnitus due to high jugular bulb

Surgical management of tinnitus due to high jugular bulb

Anatomical delineation of a safety zone for drilling the internal acoustic meatus during surgery for vestibular schwanomma by retrosigmoid suboccipital approach

Drilling the internal acoustic meatus (IAM) is an important step during surgical removal of vestibular schwanommas. During this maneuver, the proximity of the jugular bulb and the saccus endolymphaticus to the IAM makes these structures prone to injury. There have been studies in the past on the relationship between a high jugular bulb (HJB) and the IAM, but there is no description of a safety area available for drilling the meatus. In the present study, measurements were made between the IAM and the nearest points on the top of the jugular bulb, the saccus endolymphaticus and the petrous ridge. The incidence of a HJB was also calculated. It was found that about 5 mm of bone could be safely drilled away from the posterior lip of the IAM without damaging either the jugular bulb or the saccus endolymphaticus in most of the cases. The incidence of HJB was found to be 38.6% with 18.1% having a very high bulb. Thus, a significant proportion of patients are likely to have a HJB. Since there are significant individual variations, a preoperative radiological study for delineation of important bony landmarks is necessary in all patients undergoing surgery for vestibular schwanommas.

Management of high jugular bulb with tinnitus: Transvenous stent-assisted coil embolization

Management of high jugular bulb with tinnitus: Transvenous stent-assisted coil embolization