Internal Jugular Vein Compression Collar for Symptomatic Relief of Venous Pulsatile Tinnitus

Objective: Evaluate efficacy of mild internal jugular (IJV) compression via an FDA approved compression collar for symptomatic treatment of venous pulsatile tinnitus.

Introduction: Venous pulsatile tinnitus (VPT) is an objective tinnitus caused by variations in the venous anatomy for which minimal therapeutic options exist. The pathognomonic sign of VPT is improvement of symptoms with compression of the ipsilateral IJV. The purpose of this pilot study is to evaluate the safety and efficacy of a venous compression collar in providing symptomatic relief for VPT.

Methods: This study is a prospective, open arm, single cohort trial that recruited 20 patients with venous pulsatile tinnitus. Inclusion criteria was adult patients with venous pulsatile tinnitus. Patients completed the Tinnitus Handicap Inventory (THI), were fitted with an FDA approved internal jugular vein compression collar, and then while wearing the collar rated their symptoms on a 10-point tinnitus intensity scale. Once weekly for four weeks, they answered a survey with the 10-point tinnitus intensity scale before and during collar use and reported any safety issues or adverse events. Lastly, they completed an exit interview in which they completed a final THI and commented on their experience. The primary outcome was symptomatic relief, with secondary outcomes of safety, effect of treatment setting, effect of time, and quality of life assessed via nonparametric hypothesis testing.

Results: Across 18 participants, 276 paired before/during collar use intensity scores were submitted. The median symptom intensity without the collar was 6 (IQR 4,7) while with the collar it was 3 (IQR 2,5), for a median symptomatic relief of 50%. The collar had a significant effect in reducing symptom intensity (p < 0.0001) and burden of illness via the THI (p < 0.0001). There was no effect of setting (clinical vs. home) or time on symptomatic relief with the collar. There were no serious adverse safety events reported, though many participants reported minor discomfort upon initial collar application.

Conclusions: Venous compression collars offer acute symptom relief for select patients with venous pulsatile tinnitus. Further research needs to be performed to understand the underlying pathology and effects of more prolonged wear.

Publikationsverlauf

Artikel online veröffentlicht:
05. Februar 2024