FLEX January 2024

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Otolaryngology–Head and Neck Surgery 160(5)

Figure 1. Pulsatile tinnitus can arise from turbulent flow in the sigmoid sinus (A, lateral view; B, axial view), jugular bulb (C), or internal carotid artery (D). Dehiscence enhances transmission of sounds to the round window. Black double arrows indicate tympanic membrane vibration.

electrocoagulation. 4,9,14 Resurfacing has been theorized to reduce PT by restoring laminar flow and to create a ‘‘sound baffle’’ to reduce transmission of turbulent flow sounds from the dehiscent vessel to the middle ear via the mastoid air cell system ( Figures 1 - 3 ). Recent resurfacing techniques 5,15 have demonstrated promise in alleviating PT associated with 3 groups of vascu lar wall anomalies: sigmoid sinus wall anomalies (SSWAs), including sigmoid sinus dehiscence and sigmoid sinus diver ticulum 4 ; jugular bulb wall anomalies, including jugular bulb dehiscence and diverticulum 6,7 ; and ICA dehiscence 9 and aberrancy. 10 The reported successes of applying similar resurfacing techniques to treat all 3 vascular causes of PT is remarkable given the potentially different mechanisms by which each vascular wall anomaly may cause PT. PT associated with vascular wall anomaly is a relatively rare condition, with prevalence likely \ 0.5%. 1-3,16,17 Evidence for resurfacing treatment is therefore mostly described in single-institution retrospective case series. Therefore, a systematic review approach is particularly apropos for assessing resurfacing outcomes based on litera ture data.

Given the emergence of ICA and jugular bulb wall anomalies as indications for PT resurfacing surgery in addi tion to SSWA, an increase in non-English case reports on resurfacing cases performed globally, and a lack of standar dized treatment for vascular PT, we sought to conduct a sys tematic review of the worldwide literature on resurfacing outcomes for PT associated with vascular wall anomaly or aberrancy. Three groups of vascular etiologies were consid ered: the sigmoid sinus, jugular bulb, and ICA. Methods This study was carried out following the PRISMA guide lines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). 18 Our target population was patients with PT associated with wall anomalies (dehiscence or diverticulum) or aberrancy of major vasculature in the tem poral bone, including the sigmoid sinus, jugular bulb, and ICA. Interventions of interest included resurfacing and reconstruction procedures, as well as other methods of reducing sound transmission from vessel to cochlea, includ ing physical separation of aberrant vessels near or in contact