Pulse-Synchronous Tinnitus and Sigmoid Sinus Wall Anomalies

Descriptive Epidemiology and the Idiopathic Intracranial Hypertension Patient Population

Abstract

Objective 

Describe the clinical features of a population of patients with sinus wall anomalies (SWA) and pulse-synchronous tinnitus (PST).

Study Design 

Retrospective review.

Setting 

Tertiary referral center.

Patients 

Patients with PST and SWA undergoing surgical management between 2007 and 2012.

Intervention 

Transmastoid sinus wall reconstruction.

Main Outcome Measure 

Age, sex, BMI, and postoperative course. Two-tailed t tests (p ≤ 0.05) compared BMI and age of the study group with negative and positive controls.

Results 

Thirteen patients presented with sigmoid sinus diverticulum (39.4%) and 20 (60.6%) with sinus wall dehiscence. Thirty ears were successfully treated with surgery (responders), and 3 were not (nonresponders). Responders’ mean age was 38 years, with 26 female patients (92.9%) and 2 male (7.1%). BMI of responders compared with nonresponders did not differ significantly (35.5 versus 33.4 kg/m², p = 0.08). BMI of responders was elevated compared with an asymptomatic control group (35.5 versus 27.4 kg/m², p < 0.0001). BMI of responders did not differ significantly compared with a cohort of patients with spontaneous CSF otorrhea and temporal bone encephaloceles (35.5 versus 40.7 kg/m², p = 0.17).

Conclusion 

The patients in this study had elevated BMI and were more likely to be female. This patient population strongly resembles that of patients with IIH, suggesting the possibility that SWA may be a cause of PST in some patients with IIH. Illustrative cases supporting this hypothesis are presented.