Abstract
Objective To evaluate the clinical characteristics and present surgical outcomes of transtemporal
venous decompression technique in the treatment of pulsatile tinnitus (PT).
Study Design This is a prospective cohort study.
Setting This study was done at the tertiary private neurotologic skull base clinic.
Participants The primary author, between March 2012 and February 2013, evaluated 55 patients with
the complaint of PT. Seven out of the 55 patients were diagnosed with severe, unrelenting
idiopathic pulsatile tinnitus (IPT), and were placed into the study. These seven patients
had temporal bone computed tomography, magnetic resonance imaging, arteriogram, videonystagmography,
electrocochleography, and lumbar puncture based on the symptoms. All the seven patients
underwent transtemporal venous decompression surgery.
Main Outcome Measure Resolution of PT was determined as the primary outcome measure.
Results Six out of seven patients had complete resolution of their PT immediately after surgery
and at 3 to 4 years follow-up. One patient developed intracranial hypertension after
3 months requiring ventriculoperitoneal shunt, which resolved PT as well. No complications
occurred.
Conclusion A significant subset of the PT patient population has known reversible causes. The
more common includes conductive hearing loss, superior canal dehiscence, benign intracranial
hypertension, jugulosigmoid venous anomalies, stapedial myoclonus, etc. There exists
a subset of patients who have IPT. Transtemporal venous decompression is a surgical
technique that can be employed to give patients with IPT long-term relief.
Keywords
tinnitus - pulsatile tinnitus - sigmoid sinus - jugular bulb - intracranial - hypertension
- turbulent flow of blood - venous decompression
