Management of venous pulsatile tinnitus with normal otoscopic findings

We conducted a retrospective study to analyze the therapeutic effects of ligation of the internal jugular vein in a series of adults with pulsatile tinnitus of venous origin. Our study group was made up of 12 patients-all women, aged 27 to 61 years (mean: 40 ± 6.1)-who had been diagnosed with venous pulsatile tinnitus and who were treated with jugular vein ligation. Follow-up had been conducted by telephone interviews for 1 to 6 years postoperatively to assess tinnitus status over the long term. Seven patients achieved complete relief of their tinnitus immediately after surgery, but 5 of them experienced a recurrence within 2 years. The remaining 5 patients received no relief from surgery, including 1 patient who actually experienced a worsening of her tinnitus to the point that it became an intolerable roar. We conclude that treatment of pulsatile tinnitus of venous origin by ligation of the internal jugular vein should be avoided because of poor outcomes and in view of the possibility of complications. In addition to our study findings, we discuss 2 of our cases in more detail.