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Vascular loops causing otological symptoms: a systematic review and meta-analysis
1Department of ENT, Royal Devon and Exeter Hospital, Exeter, Devon, UK. neil@chadhanet.com
Summary
Vascular loops near the vestibulocochlear nerve are linked to hearing loss and pulsatile tinnitus. These loops may cause pulsatile tinnitus, sometimes requiring surgery.
Area of Science:
- Neurology
- Otolaryngology
- Medical Imaging
Background:
- Vascular loops contacting the vestibulocochlear nerve (CN VIII) are common anatomical variations.
- Their association with specific otological symptoms requires further investigation.
Purpose of the Study:
- To systematically review and meta-analyze evidence linking vascular loops in contact with CN VIII to otological symptoms.
- To determine if vascular loops are associated with unilateral sensorineural hearing loss and pulsatile tinnitus.
Main Methods:
- Systematic review and meta-analysis of five observational case-control studies.
- Searched multiple databases (MEDLINE, EMBASE, CINAHL, Cochrane) without language restrictions.
- Compared prevalence of vascular loops in symptomatic versus asymptomatic ears and in symptomatic individuals versus controls.
Main Results:
- A statistically significant association was found between vascular loops contacting CN VIII and unilateral sensorineural hearing loss (OR 2.0, 95% CI: 1.5-2.6).
- No significant association was observed for non-pulsatile tinnitus.
- A highly significant association was found for pulsatile tinnitus (OR 78.8, 95% CI: 10.9-821.8).
Conclusions:
- Vascular loops contacting CN VIII are a normal variant but are more prevalent in ears with unilateral hearing loss.
- The strong association with pulsatile tinnitus suggests a potential causal relationship in some cases.
- Surgical intervention may be considered for pulsatile tinnitus attributed to vascular loops.
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