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Radiographic Sigmoid Sinus Wall Abnormalities and Pulsatile Tinnitus: A Case-Control Study.

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Sigmoid sinus wall abnormalities (SSWAs) are more common in patients with pulsatile tinnitus (PT). In about 65% of cases, SSWAs likely contribute to PT, but other factors may be involved.

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Area of Science:

  • Otorhinolaryngology
  • Radiology
  • Neurosurgery

Background:

  • Pulsatile tinnitus (PT) can significantly impact quality of life.
  • Sigmoid sinus wall abnormalities (SSWAs) are increasingly recognized as a potential cause of PT.
  • Understanding the association between SSWAs and PT is crucial for effective management.

Purpose of the Study:

  • To compare the incidence of SSWAs and other radiographic abnormalities in patients with PT versus a control group.
  • To investigate the correlation between SSWAs and the laterality of PT.

Main Methods:

  • A retrospective case-control study was conducted at a tertiary referral center.
  • High-resolution computed tomography (HRCT) imaging of adults with PT (n=141) was compared to controls (n=149, 298 ears).
  • Demographics and other radiographic findings were analyzed as secondary outcomes.

Main Results:

  • Patients with PT showed a significantly higher incidence of SSWAs (34% vs. 9%, p < 0.001) and superior canal dehiscence (23% vs. 12%, p = 0.017) compared to controls.
  • A weak correlation was found between ipsilateral PT and SSWA (r = 0.354, p < 0.001).
  • In patients with both PT and SSWA, the SSWA correlated with PT laterality in 65% of cases, partially correlated in 25%, and did not correlate in 10%.

Conclusions:

  • SSWAs are a likely contributing factor in approximately 65% of PT cases.
  • In a third of patients with PT and SSWA, the association is not solely causative.
  • Surgeons should consider potential treatment failures due to comorbid conditions when counseling patients with PT and SSWA.