Systematic Review of Temporal Bone–Resurfacing Techniques for Pulsatile Tinnitus Associated with Vascular Wall Anomalies

Abstract

Objective To systematically review literature evidence on temporal bone–resurfacing techniques for pulsatile tinnitus (PT) associated with vascular wall anomalies. Data Sources We searched PubMed, Embase, and the Cochrane Database. The period covered was from 1962 to 2018. Review Methods We included studies in all languages that reported resurfacing outcomes for patients with PT and radiographic evidence or direct visualization of sigmoid sinus wall anomaly, jugular bulb wall anomaly, or dehiscent or aberrant internal carotid artery. Results Of 954 citations retrieved in database searches and 5 citations retrieved from reference lists, 20 studies with a total of 141 resurfacing cases involving 138 patients were included. Resurfacing outcomes for arterial sources of PT showed 3 of 5 cases (60%) with complete resolution and 2 (40%) with partial resolution. Jugular bulb sources of PT showed 11 of 14 cases (79%) with complete resolution and 1 (7%) with partial resolution. Sigmoid sinus sources of PT showed 91 of 121 cases (75%) with complete resolution and 12 (10%) with partial resolution. Symptoms occurred more in females and on the right side. Most cases (94%) used hard-density materials for resurfacing. Material density did not appear to be associated with resurfacing outcomes. Use of autologous materials was associated with improved outcomes for arterial sources resurfacing. Major complications involving sigmoid sinus thrombosis or compression were reported in 4% of cases without long-term morbidity or mortality. Conclusions Resurfacing surgery is likely effective and well tolerated for select patients with PT associated with various vascular wall anomalies.

Longitudinal analysis of surgical outcome in subjects with pulsatile tinnitus originating from the sigmoid sinus

“…Moreover, it is relatively easy to handle in a limited surgical field. Fueled by a correlation between material density and resurfacing outcome 20 , the firm and secure characters of bone cement may contribute to long-term PT improvement, as evidenced in this study. Nonetheless, several studies suggest that maintaining the normal diameter of the SS during surgery is imperative 25,27 .…”

“…Possible mechanisms of PT development in patients with SS-Div/SS-Deh. Although the exact mechanism of PT development in patients with SS-Div/SS-Deh remains unclear, hemodynamic changes in the SS have continuously been implicated 19,20 . In line with the current case series, PT originating from morphologically abnormal SS on the right side is common, since the right venous system generally develops as dominant 21 .…”

“…In the current study, the presence of TSS was confirmed in 4 out of 15 patients, which is comparable to that in previous literature. Based on this evidence, mechanical perturbations of flow proximal to the transverse sinus are presumed to be a causal mechanism underlying PT generation 13,20 . Subsequently, hemodynamic change-induced turbulent flow may elicit the disruption of local laminar flow and continuous outward pressure, leading to focal dehiscence over the SS bony wall (SS-Deh).…”

“…Based on the underlying mechanism of PT perception in SS-Div/SS-Deh, transmastoid SS resurfacing/ reshaping aims to treat PT by restoring laminar flow, reconstructing a sound-proof barrier, and disconnecting the sound transmission route from the SS to the middle ear. In a recent systematic review, a promising outcome of transmastoid SS resurfacing has been reported in patients with SS-Div/SS-Deh, with complete or partial improvement noted in approximately 85% of cases 20 . However, its long-term efficacy remains unclear due to a paucity of long-term follow-up studies.…”

Multidisciplinary Tinnitus Research: Challenges and Future Directions From the Perspective of Early Stage Researchers

“…Subjective tinnitus refers to a phantom perception, whereas objective tinnitus refers to perceived sounds generated from an acoustic source located within the body. Pathologies causing objective tinnitus are rather heterogeneous and research to understand and treat this form of tinnitus is ongoing (Liu et al, 2019;Choi et al, 2020). It is, however, far less common than subjective tinnitus and its underlying mechanisms are usually clearer (Tunkel et al, 2014).…”