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Published on: October 16, 2012
Patterns of audiometric threshold shifts from pulsatile tinnitus due to sigmoid sinus wall anomalies
Kavita Bhatnagar1, Angela T Lataille1, David J Eisenman1
1Department of Otorhinolaryngology-Head & Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Purpose:
To determine the severity and nature of audiometric threshold shifts for patients with pulsatile tinnitus (PT) due to sigmoid sinus wall anomalies (SSWA).
Materials And Methods:
38 patients with SSWAs and available pre-operative audiograms were examined. Low- and high-frequency pure tone averages (LF-PTA, HF-PTA) were calculated. Audiometric data were compared between affected and unaffected ears, with the interaural difference (affected-unaffected PTA) representing the change in hearing due to PT. Additionally, post-operative change was examined in 14 patients with available data.
Results:
The average pre-operative air conduction (AC) LF-PTA was 17.04 dB on the affected side and 11.38 dB on the unaffected side (p < 0.001). The mean AC HF-PTA was significantly higher on the affected side as well (16.45 dB vs. 14.08 dB, p = 0.008). All shifts were sensorineural, with no significant air-bone gaps, and most subjects still had low-frequency thresholds in the normal range. Though the post-op change was not significant due to attrition, 5/14 patients (35.7%) had complete resolution of their pre-op interaural difference. A similar number developed a HF-PTA post-op threshold elevation in the surgical ear.
Conclusions:
PT due to SSWAs causes a mean 6 dB low-frequency bone-conduction threshold elevation, and smaller high-frequency threshold shifts, due to masking. Patients with larger threshold shifts should have other potential causes of hearing loss explored.
Level Of Evidence:
Level IV.
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