Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 14;83(3):248-253.
doi: 10.1055/s-0040-1722670. eCollection 2022 Jun.

Anatomical Variations of the Jugular Foramen Region in Patients with Pulsatile Tinnitus

Lifeng Li  1 , Bentao Yang  2 , Xiaobo Ma  1 , Pingdong Li  1 , Francis X Creighton  3 , Ricardo L Carrau  4 , Nyall R London Jr  3
Affiliations

Anatomical Variations of the Jugular Foramen Region in Patients with Pulsatile Tinnitus

Lifeng Li et al. J Neurol Surg B Skull Base. .

Abstract

Objective Structural anomalies of the jugular foramen (JF) and adjacent structures may contribute to development of pulsatile tinnitus (PT). The goal of this study was to assess anatomical variants in the ipsilateral JF region in patients with PT and to explore possible predisposing factors for PT. Methods One hundred ninety-five patients with PT who underwent CT angiography and venography of the temporal bone were retrospectively analyzed. Anatomic variants including dominance of the ipsilateral JF, bony deficiency of the sigmoid sinus and internal carotid artery canal, high riding or dehiscent jugular bulb, dehiscence of the superior semicircular canal, tumors in the JF region, or cerebellopontine angle were assessed. Results Of 195 patients with PT, the prevalence of a dominant JF on the ipsilateral side of patients with PT was 67.2%. Furthermore, the dominant JF demonstrated a significant correlation with the presence of ipsilateral PT ( p < 0.001). No anatomical variants were present in 22 patients (11.3%), whereas in patients with structural variants, bony deficiency of the sigmoid sinus was most common (65.6%), followed by high riding (54.9%) or dehiscent jugular bulb (14.4%). Dehiscent internal carotid artery canal (3.1%) and superior semicircular canal (4.1%) were occasionally identified, while arteriovenous fistula, arterial aneurysm and tumors arising from the JF region or cerebellopontine angle were rarely encountered. Conclusion Structural abnormalities of the JF and adjacent structures may predispose to the development of PT. Knowledge of these anatomical variants in the JF region may help establish a clinical strategy for addressing PT.

Keywords: dehiscent; jugular bulb; jugular foramen; pulsatile tinnitus; sigmoid sinus; structural anomaly.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest N.R.L. holds stock in Navigen Pharmaceuticals and was a consultant for Cooltech Inc. The other authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
( A ) Bony deficiency of the sigmoid sinus (green arrow), ( B ) high-riding jugular bulb (red arrow), and ( C, D ) dehiscent jugular bulb (blue arrows).
Fig. 2
Fig. 2
( A ) The bony deficiency of the internal carotid artery canal (red arrow) and ( B ) the bony deficiency of the superior semicircular canal (green arrow).
Fig. 3
Fig. 3
( A, B ) Patients with pulsatile tinnitus have tumors arising from the jugular foramen (green arrows), ( C ) patients with tumors arising from the internal acoustic meatus with extension into the cerebellopontine angle (blue arrow), and ( D ) aneurysm of the petrous internal carotid artery (red arrow).
See this image and copyright information in PMC

References

    1. Truesdale C M, El-Kashlan H K. Pulsatile tinnitus with imaging. JAMA Otolaryngol Head Neck Surg. 2018;144(05):451–452. - PubMed
    1. Hofmann E, Behr R, Neumann-Haefelin T, Schwager K. Pulsatile tinnitus: imaging and differential diagnosis. Dtsch Arztebl Int. 2013;110(26):451–458. - PMC - PubMed
    1. Wang A C, Nelson A N, Pino C, Svider P F, Hong R S, Chan E. Management of sigmoid sinus associated pulsatile tinnitus: a systematic review of the literature. Otol Neurotol. 2017;38(10):1390–1396. - PubMed
    1. Berguer R, Nowak P. Treatment of venous pulsatile tinnitus in younger women. Ann Vasc Surg. 2015;29(04):650–653. - PubMed
    1. Lyu A R, Park S J, Kim D, Lee H Y, Park Y H. Radiologic features of vascular pulsatile tinnitus - suggestion of optimal diagnostic image workup modalities. Acta Otolaryngol. 2018;138(02):128–134. - PubMed