Retroauricular/Transcranial Color-Coded Doppler Ultrasound Approach in Junction With Ipsilateral Neck Compression on Real-Time Hydroacoustic Variation of Venous Pulsatile Tinnitus

Abstract

Alterations in dural venous sinus hemodynamics have recently been suggested as the major contributing factors in venous pulsatile tinnitus (PT). Nevertheless, little is known about the association between real-time alterations in hemodynamics and the subjective perception of venous PT. This study aimed to investigate the hydroacoustic correlations among diverticular vortices, mainstream sinus flow, and PT using various Doppler ultrasound techniques. Nineteen venous PT patients with protrusive diverticulum were recruited. The mainstream sinus and diverticular hemodynamics before and after ipsilateral internal jugular vein (IJV) compression were investigated using an innovative retroauricular color-coded Doppler (RCCD) method to examine the correlation between the disappearance of PT and hemodynamic alterations. To reveal the hydroacoustic characteristics of disparate segments of venous return, a computational fluid dynamics (CFD) technique combined with the transcranial color-coded Doppler method was performed. When the ipsilateral IJV was compressed, PT disappeared, as the mean velocity of mainstream sinus flow and diverticular vortex decreased by 51.2 and 50.6%, respectively. The vortex inside the diverticulum persisted in 18 of 19 subjects. The CFD simulation showed that the flow amplitude generated inside the transverse–sigmoid sinus was segmental, and the largest flow amplitude difference was 20.5 dB. The difference in flow amplitude between the mainstream sinus flow and the diverticular flow was less than 1 dB. In conclusion, the sensation of PT is closely associated with the flow of kinetic energy rather than the formation of a vortex, whereby the amplitude of PT is correlated to the magnitude of the flow velocity and pressure gradient. Additionally, the range of velocity reduction revealed by the RCCD method may serve as a presurgical individual baseline curative marker that may potentially optimize the surgical outcomes.

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

“…In addition to vascular stenosis, which has a positive correlation with the pressure gradient ( Zhao et al, 2021a ; Zhao et al, 2021b ; Ding et al, 2021 ), the entropic flow pattern of vortices generated in elbow-like regions may engender regional flow regurgitation that potentially compromises the patency of the sinus outflow ( Zhao et al, 2021a ), although the enigmatic correlation between the pressure gradient and vortex generation remains unraveled. Nevertheless, with growing evidence suggesting that the increased kinetic energy (sinus flow volume and velocity) is a primary contributing factor to PT rather than the occurrence of the vortex per se , it is postulated that the vortical structure of a flow contributes little or insignificantly to hydroacoustic noise production if the kinetic energy is relatively low ( Gao et al, 2022 ).…”

“… is . Hydroacoustic simulation has been previously described by our recent in detail ( Gao et al, 2022 ). The variational formulation of Lighthill’s analogy was integrated by parts and applied to the right-hand side, where the surface contribution was derived from an integral over Eq.…”

Resurfacing Dehiscence(s) Without Reducing Diverticulum Effectively Silences Pulsatile Tinnitus: Novel Surgical Techniques for Diverticulum and Intraoperative Microphone Monitoring

“…MR sequence parameters are provided in Supplementary Material 1, http:// links.lww.com/MAO/B790. To measure TS stenosis, the largest and smallest cross-sectional areas of the ipsilateral TS were normalized between the proximal end (5 mm distal to the TS and superior sagittal sinus/straight sinus intersection) and distal end (5 mm proximal to the transverse-sigmoid sinus junction) (8). Contralateral TS hypoplasia was defined as greater than 66% stenosis in greater than 40% of the TS length (8).…”

Case Report: Venous pulsatile tinnitus induced by enlarged oblique occipital sinus and resultant diverticulum/dehiscence of the sigmoid-jugular wall

“…Vascular pulsatile tinnitus (PT) or pulse-synchronous tinnitus is the auditory perception of vascular sounds in line with the cardiac rhythm (1). The most common type of vascular PT is venous PT (2), which is characterized by the reduction or elimination of PT sound when the ipsilateral internal jugular vein (IJV) is compressed (3).…”