Related Experiment Video
Updated: May 8, 2026

Surgical Treatment of an Endolymphatic Sac Tumor
Published on: May 26, 2023
Clinical presentation and imaging findings in patients with pulsatile tinnitus and sigmoid sinus
Ameet K Grewal1, Han Y Kim, Richard H Comstock
1*Department of Otolaryngology, Georgetown University Hospital; †Department of Radiology, Howard University Hospital; and ‡Department of Radiology, Georgetown University Hospital, Washington, District of Columbia, U.S.A.
Objective:
Sigmoid sinus diverticulum/dehiscence (SSDD) is an increasingly recognized venous cause for pulsatile tinnitus (PT). SSDD is amenable to surgical/endovascular intervention. We aim to understand the clinical and imaging features of patients with PT due to SSDD.
Study Design:
Retrospective CT study and chart review.
Setting:
Tertiary-care, academic center.
Patients:
Cohort 1: 200 consecutive unique temporal bone CT were blindly reviewed for anatomic findings associated with PT. Cohort 2: 61 patients with PT were evaluated for otologic manifestations.
Intervention(S):
All patients underwent a temporal bone CT for evaluation of PT. Clinical information was gathered using electronic medical records.
Main Outcome Measure(S):
Otologic symptoms and physical findings (including body mass index (BMI), mastoid/neck bruits) were analyzed. Temporal bone CT scans were evaluated for the presence of SSDD and other possible causes of PT.
Results:
Cohort 1: 35 cases of SSDD were identified (18%); 10 (29%) true diverticula; and 25 (71%) dehiscence. Sixty-six percent were right sided. Twelve patients had PT (34%). Patients with SSDD are more likely to have PT (p = 0.003). A significant association between right SSDD and PT was found (p = 0.001). Cohort 2: 15 out of 61 patients had PT and CT-confirmed SSDD. All were female subjects; average age was 45 years (26-73 yr). Radiologic evaluation revealed 10 SSDD cases on the right (66.7%), 2 on the left (13.3%%), and 3 bilateral (20%). Sensorineural hearing loss was seen in 8 (53%), aural fullness in 12 (80%). Average BMI was 32.2 (21.0-59.82), and 4 (26%) had audible mastoid bruits.
Conclusion:
SSDD may be the most common identifiable cause for PT from venous origin and is potentially treatable. Temporal bone CT scans should be included in a complete evaluation of PT.
Related Concept Videos
Diverticular Disease of the Colon
Mitral Stenosis II: Clinical features and Diagnostic Tests
Aortic Regurgitation II: Clinical Features and Diagnostic Tests
Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
Aneurysm II: Clinical Manifestations and Diagnostic Studies
Cardiovascular System Abnormal Findings II: Auscultation
Abnormal Heart Sounds
Gallops:
