Sigmoid sinus diverticulum: a new surgical approach to the correction of pulsatile tinnitus.
Otto KJ, Hudgins PA, Abdelkafy W, Mattox DE
Department of Otolaryngology, Emory University School of Medicine, Atlanta,
Georgia 30322, USA.
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
All patients had normal in-office otoscopic, tympanometric, and
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 messure: 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.
Otol Neurotol. 2007 Jan;28(1):48-53.