Surgical Outcomes of Sigmoid Sinus Resurfacing for Pulsatile Tinnitus: The Predictive Value of the Water Occlusion Test and Imaging Studies

Abstract

Objectives: Sigmoid sinus resurfacing (SS-R) is one of the most effective surgical treatments for patients with pulsatile tinnitus (PT) originating from anatomical variants of the vascular walls in the temporal bone. This study aimed to provide updated information on the clinical outcomes of SS-R and evaluate the efficacy of the water occlusion test (WOT) as an additional diagnostic modality.

Methods: We retrospectively reviewed medical records including tinnitus questionnaires, temporal bone computed tomography (TBCT) scans, audiologic tests, and preoperative WOT.

Results: from patients who underwent SS-R.

Results: In total, 26 patients were included in the study. The mean age was 44 years, and the mean symptom duration was 3 months. Fourteen patients (53.8%) were completely cured, seven (26.9%) significantly improved, and five (19.2%) remained stable. The mean visual analog scale loudness score decreased from 5.26 to 1.34 (P<0.001) and the mean Tinnitus Handicap Inventory score also improved from 50.23 to 5.5 (P<0.001) after SS-R surgery. In 10 patients with discrepancies between the preoperative TBCT and intraoperative findings, WOT showed a significant additive effect in predicting surgical outcomes. No patients experienced severe intraoperative or postoperative complications during the entire follow-up period.

Conclusion: SS-R provides significant symptom improvement in patients with sigmoid sinus dehiscence who had a positive WOT without other sigmoid sinus variants. A combined diagnostic approach with TBCT, WOT, and intraoperative findings is crucial for achieving better surgical outcomes in patients with PT caused by sigmoid sinus variants.

Keywords: Pulsatile Tinnitus; Surgery; Vascular Origin Tinnitus.

Fig. 1.

Multiple surgical methods for the treatment of pulsatile tinnitus. (A) Sigmoid sinus resurfacing surgery (SS-R) with autologous bone plate and bone cement for the treatment of sigmoid sinus dehiscence. (B) Obliteration with an inferiorly based periosteal flap for the treatment of sigmoid sinus diverticulum. (C) Ligation of the vein for the treatment of a prominent mastoid emissary vein.

Fig. 2.

Representative axial temporal bone computed tomography images of the right temporal bone showing various causes of pulsatile tinnitus. (A) Sigmoid sinus dehiscence (SS-Deh; arrow). (B) Sigmoid sinus diverticulum (SS-Div; arrows). (C) Prominent mastoid emissary vein (PMEV; arrow).

Fig. 3.

Surgical outcomes. (A) Preoperative and postoperative improvements in visual analog scale (VAS) scores. (B) Preoperative and postoperative changes in VAS loudness scores. (C) Preoperative and postoperative improvements in Tinnitus Handicap Inventory (THI) scores. (D) Preoperative and postoperative changes in THI scores. Values are presented as mean±standard deviation.

Fig. 4.

(A) Preoperative and (B) postoperative pure tone audiograms of a patient managed with sigmoid sinus resurfacing and high-jugular bulb resurfacing who showed newly developed conductive hearing loss as a complication of surgery.