Evidence of air‐conduction transmission pathway and strategized transtemporal operative techniques for venous pulsatile tinnitus: Combining water occlusion test and operative sensing applications

Abstract

Objectives:(1) To establish evidence of the transmission pathway of venous pulsatile tinnitus (PT) associated with sigmoid sinus wall anomalies (SSWAs) and (2) quantify the efficacy of transtemporal surgery.Methods: This retrospective study included 33 surgical cases of PT associated with SSWAs and 15 controls with venous PT without SSWAs. Quantitative water occlusion test (q-WOT) and imaging data were acquired for preoperative evaluation prior to strategized transtemporal osteovascular reconstruction surgery. A condenser microphone and hydrophone were intraoperatively deployed to assess and monitor in vivo amplitude variations of the PT in eight participants.Results: A total of 23 (69.6%) participants with SSWA responded to the q-WOT with a median solution volume of 1.3 (1.1/1.6), which significantly differed from that observed in controls (p < 0.01). The change in the operative peak amplitude of the acoustic data was statistically significant (p < 0.01), from a median of 57.6 (55.5/57.9) dB SPL to 34.3 (33.4/38.8) dB SPL. Conclusion:Intraoperative application of acoustic sensors revealed that PT associated with SSWAs is predominantly transmitted via the air-conduction pathway. If objective findings such as q-WOT and sensing applications suggest that the transmission of venous PT is involved in middle ear air conduction, the reconstruction technique should be prioritized; if less involvement of middle ear air-conduction is indicated, addressing flow pathologies may be imperative for resolving venous PT.

Time Series and Mel-frequency Cepstrum Coefficient Analyses of Venous Pulsatile Tinnitus Vascular Sound and Flow Velocity Sensed by Transcranial/Retroauricular Doppler Ultrasound Approaches

“…The diagnosis of venous PT strictly followed our previously established clinical protocols. (9) This study was designed using mathematical methods to analyze the vascular flow and acoustic display sensed by a LISENDO 880 ultrasound system (Hitachi Aloka Medical Ltd., Japan) with S121/L441 transducers. Additionally, 1) the acoustic sound was recorded using a microphone (VideoMicro, RODE, Sydney, Australia) oriented to the speakers of the ultrasound system, 2) the electrocardiogram was installed on the participant, and 3) to synchronize image and acoustic data, a camera was placed on a support facing the Doppler monitor.…”

“…(16) Nonetheless, the flow volume and/or flow velocity can be effectively redistributed or reduced locally after external compression, whereas local compression over the prominent transverse-sigmoid junction will not significantly impair bilateral flow dynamics in vivo. (9) Therefore, the degree of reduction of flow velocity and the patency of collateral sinuses should be carefully measured prior to surgical intervention. Since the surgical repair of dehiscence using robust biomaterials provides a therapeutic effect in alleviating PT, (15) the external compression technique can be performed as an additional or alternative method if addressing dehiscence alone fails to preclude PT.…”

“…(7,8) As the sigmoid plate becomes dehiscent, the sound of sigmoid sinus vascular wall displacement (vibroacoustic source) secondary to flow impingement and blood flow motion (hydroacoustic source) is transmitted to the inner ear via the air-conduction transmission route. (9) Although the clinical association among SSWAs, transverse sinus stenosis, and idiopathic intracranial hypertension has been increasingly investigated and identified by clinicians, (4) no conclusion has been drawn on the correlation between hemodynamics and the acoustic production of PT.…”

Intracranial pressure, lateral sinus patency, and jugular ultrasound hemodynamics in patients with venous pulsatile tinnitus

“…As a type of objective tinnitus, vascular PT is categorized into arterial, arteriovenous, and venous origins (4,5). Venous PT is the largest demographic in patients with vascular PT and is associated with a) anatomical anomalies, such as sigmoid sinus wall anomalies (SSWAs), transverse-sigmoid sinus enlargement, and transverse sinus (TS) stenosis, and b) intracranial hemodynamic abnormalities, such as increased cerebrospinal fluid pressure (CSFP), increased trans-stenotic pressure gradient of the TS, and dural venous sinus flow volume asymmetry (5)(6)(7)(8)(9). While these anatomical and hemodynamic anomalies synergistically produce and allow the transmittance of PT, SSWAs are recognized as the most deterministic factor that causes PT (7).…”

Influence of sigmoid plate and dura mater on vascular wall displacement, vibroacoustic/hydroacoustic sources characteristics, and frequency-loudness assessments of venous pulsatile tinnitus: A coupled-computational fluid dynamics study combining transcanal recording investigation

“…Although subcategorized under objective tinnitus, venous PT is the most common type of vascular PT ( Dong et al, 2015 ). The ipsilateral internal jugular vein (IJV) compression test helps indicate whence the pulse-synchronous noise arises, which this mechanistic characteristic has been used as a diagnostic criterion for indicating PT of venous etiologies ( Hsieh et al, 2021b ). In most cases with venous PT, sigmoid sinus wall anomalies (SSWAs), consisting of sigmoid sinus wall dehiscence and diverticulum, are the most common anatomical anomalies in patients with venous PT ( Dong et al, 2015 ; Kline et al, 2020 ).…”