Pulse-Synchronous Tinnitus and Sigmoid Sinus Wall Anomalies

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.