Transtemporal Venous Decompression for Pulsatile Tinnitus

Objective: This study aims to evaluate the clinical characteristics and present surgical outcomes of transtemporal venous decompression technique in the treatment of pulsatile tinnitus.

Study Design: Prospective cohort study.

Setting: Tertiary private neurotologic skull base clinic.

Patients: The primary author, between March 2012 and February 2013, evaluated 55 patients with the complaint of pulsatile tinnitus. Total 7 out of the 55 patients were diagnosed with severe, unrelenting idiopathic pulsatile tinnitus, and were placed into the study.

Intervention: These seven patients had temporal bone computed tomography, magnetic resonance imaging, arteriogram, videonystagmography, electrocochleography, and lumbar puncture based on the symptoms. All seven patients underwent transtemporal venous decompression surgery.

Main Outcome Measure: Resolution of pulsatile tinnitus was determined as the primary outcome measure.

Results: Six out of seven patients had complete resolution of their pulsatile tinnitus immediately after surgery and at 3- to 6-year follow-up. One patient developed intracranial hypertension after 3 months requiring ventriculoperitonial shunt, which resolved pulsatile tinnitus as well. No complications occurred.

Conclusion: A significant subset of the pulsatile tinnitus patient population has known reversible causes. The more common include conductive hearing loss, superior canal dehiscence, benign intracranial hypertension, jugulo-sigmoid venous anomalies and stapedial myoclonus, etc. There exists a subset of patients that have idiopathic pulsatile tinnitus. Transtemporal venous decompression is a surgical technique that can be employed to give patients with idiopathic pulsatile tinnitus long-term relief.

IRB Number: CR-10–059.