Combined Arterial and Venous Phase Computed Tomographic Imaging of the Skull Base in Pulsatile Tinnitus. Issue 9 (9th October 2022)

• Record Type: Journal Article
• Authors: Formeister, Eric J.; Xiao, Grace; Clark, James; Carey, John P.; Hui, Ferdinand; Agrawal, Yuri; Sun, Daniel Q.
• Is Part Of: Otology & neurotology. Volume 43:Issue 9(2022)
• Page Start: 1049
• Page End: 1055
• Publication Date: 2022-10-09
• Subjects: Arteriography -- Pulsatile tinnitus -- Skull base radiology -- Venography -- Venous sinus stenosis; Otology -- Periodicals; Ear -- Diseases -- Periodicals; Skull base -- Surgery -- Periodicals; 617.8005
• DOI: 10.1097/MAO.0000000000003672
• Languages: English
• ISSNs: 1531-7129

Abstract

Abstract : Objective: To describe the demographic, clinical, and radiologic findings in a consecutive series of patients presenting with a chief complaint of pulsatile tinnitus (PT). Study Design: Retrospective review of 157 patients undergoing a combined arterial/venous phase computed tomographic (CT) imaging study. Setting: Tertiary referral center. Patients: Adult patients referred to neurotology faculty for evaluation of PT between 2016 and 2020. Interventions: Triple phase high-resolution arteriography/venography/temporal bone CT. Main Outcome Measures: Prevalence of osseous, venous, and/or arterial pathology, clinicodemographic characteristics. Results: One hundred fifty-seven adults (mean age, 52 years; 79.6% female) were evaluated. A history of migraine headaches was common (19.7%). The average body mass index was 30.0 (standard deviation, 6.8), and 17.2% of subjects had a diagnosis of obstructive sleep apnea. Idiopathic intracranial hypertension was diagnosed by elevated opening pressure on lumbar puncture in 13.4%. Comorbid depression and anxiety were common (25.5% and 26.1%, respectively). Overall, abnormalities were found in 79.0% of scans, with bilateral transverse sinus stenosis (TSS) seen in 38.9% and unilateral TSS found in 20.4%. Fifteen subjects (9.6%) had evidence of osseous etiologies, including superior canal dehiscence or thinning in 8.9% and sigmoid sinus dehiscence in one subject. There were 3 dural arteriovenous fistulae identified. Unilateral PT was ipsilateral to the side of TSS in 84.4% of subjects with unilateral TSS. Conclusion: In a large consecutive series of patients with PT referred for CT venography/arteriography, transverse sinus stenosis was the most common finding at 59%. Venous etiologies for PT should be suspected when patients are referred to neurotologists for evaluation.