Sigmoid sinus diverticulum: a new surgical approach to the correction of pulsatile tinnitus

Abstract

Objective: Tinnitus represents a bothersome symptom not infrequently encountered in an otology practice. Tinnitus can be the harbinger of identifiable middle or inner ear abnormality; but more frequently, tinnitus stands alone as a subjective symptom with no easy treatment. When a patient complains of tinnitus that is pulsatile in nature, a thorough workup is indicated to rule out vascular abnormality. We report of a new diagnostic finding and method of surgical correction for select patients with pulsatile tinnitus.

Study design: Retrospective case series.

Setting: Tertiary care, academic referral center.

Patients: Among patients seen for complaints of unilateral or bilateral pulsatile tinnitus, five were identified with diverticula of the sigmoid sinus. All patients had normal in-office otoscopic, tympanometric, and audiometric evaluations. Patients with paragangliomas or benign intracranial hypertension were excluded. Auscultation of the pinna or mastoid revealed an audible bruit in most patients. All patients underwent computed tomographic angiography of the temporal bone. In all cases, this finding was on the side coincident with the tinnitus.

Intervention: Three of five patients underwent transmastoid reconstruction of the sigmoid sinus.

Main outcome measure: Patients were evaluated clinically for presence or absence of pulsatile tinnitus after reconstructive surgery.

Results: All patients electing surgical reconstruction had immediate and lasting resolution of the tinnitus.

Conclusion: Surgical reconstruction can provide lasting symptom relief for patients with pulsatile tinnitus and computed tomographic evidence of a sigmoid sinus diverticulum.