Balloon occlusion testing for non-sinus-stenosis venous pulsatile tinnitus: A technical case series

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Otolaryngology

Background:

• Pulsatile tinnitus (PT) affects approximately 10% of the population and can be debilitating.
• Venous etiologies are increasingly recognized as a cause of PT.
• Identifying the specific symptomatic vessel among multiple venous anomalies is diagnostically challenging.

Purpose of the Study:

• To evaluate the utility of venous balloon occlusion testing (vBOT) in identifying symptomatic vessels in cases of non-sinus stenosis venous PT.
• To assess the effectiveness of vBOT in guiding targeted endovascular interventions for PT.

Main Methods:

• A case series utilizing venous balloon occlusion testing (vBOT) for real-time diagnosis in patients with non-sinus stenosis venous PT.
• vBOT involved fluoroscopic guidance and a transform balloon to occlude venous anomalies, with immediate symptom assessment.
• Successful identification of culprit vessels guided subsequent endovascular coil embolization.

Main Results:

• Four cases involving high-riding jugular bulbs, jugular bulb diverticula, and enlarged emissary veins were reported.
• vBOT successfully identified the symptomatic vessels in all reported cases.
• Endovascular coil embolization guided by vBOT resulted in significant symptom resolution for all patients.

Conclusions:

• vBOT is a valuable tool for accurately identifying symptomatic vessels in non-sinus stenosis venous PT.
• This method enables precise, targeted endovascular interventions, improving patient outcomes.
• Consideration of vBOT's limitations, such as potential false negatives, is important for comprehensive patient management.