Pulsatile tinnitus and imaging diagnosis. A case report

Abstract

Tinnitus is the perception of sound in one or both ears when no external noise exists to cause that perception. It can be otological, neurological, drug-related, traumatic, due to exposure to high decibel levels, or associated with a vascular abnormality-the latter usually causing pulsatile tinnitus. We present the diagnostic image of a patient with pulsatile tinnitus with terminal plate dehiscence of the jugular bulb and review the diagnostic workup. Jugular bulb dehiscence is a venous variant that consists of an upper and lateral extension of the jugular bulb into the middle ear through a dehiscent sigmoid plate. It is the most common vascular anatomical variant of the petrous portion of the temporal bone. Imaging studies are essential for establishing a diagnosis and defining possible anatomical variants.

Keywords: Computed tomography; Diagnostic imaging; Jugular bulb; Magnetic resonance; Tinnitus.

Fig. 1

Coronal view of both middle ears by computed tomography in a patient with pulsatile tinnitus in the left ear. The asymmetry of both jugular bulbs can be observed at the level of the jugular foramen, with dominance and elevation of the left jugular bulb. Note the sigmoid plate dehiscence on the left side (white arrowhead), which conditions discrete protrusion of the left jugular bulb into the middle ear.

Fig. 2

Contrast computed tomography of the left ear of the same patient, in axial (A), sagittal (B), and coronal (C) view by multiplanar reformatting, where sigmoid plate dehiscence is observed (white arrowhead).

Fig. 3

Reformatted images in axial (A), sagittal (B), and coronal (C) planes of a contrasted magnetic resonance with T1 + C SPGR technique in the venous phase of the left ear, where it is possible to observe elevation of the left jugular bulb and a discrete protrusion of the same towards the middle ear at the level of the hypotympanum (white arrowhead).