FLEX January 2024

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Liu et al

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Figure 2. Hypotympanic resurfacing. (A) Green highlights area to be drilled for jugular bulb and carotid artery resurfacing. (B) Elevating external ear canal tympanomeatal anterior flap based on the malleus. (C) Carefully drilling the inferior external canal wall to expose the hypotympanum and the dehiscent jugular bulb or jugulocarotid area.

Figure 3. Transmastoid resurfacing. (A) Dehiscent bony canal aids transmission of pulsatile sounds from turbulent blood flow in venous sig moid sinus to middle ear, increasing patient’s perception of pulsatile tinnitus. (B) Resurfacing the dehiscence restores the bony ‘‘sound baffle’’ to reduce sound transmission and awareness of pulsatile tinnitus.

with the tympanic membrane. The outcomes of interest were reduction of PT and complications after surgery. Relevant studies were identified by searching PubMed, Embase, and the Cochrane Database, as well as scanning reference lists of articles. The following search terms were used: (‘‘pulsatile tinnitus’’ OR ‘‘objective tinnitus’’) AND (sigmoid * OR jugular * OR carotid * ). The date of the last search was May 16, 2018. We also evaluated related review articles to identify studies that were missed by searching PubMed, Embase, and the Cochrane Database. We assessed articles available only in print by obtaining hard copy scans via Stanford Lane Medical Library’s interlibrary loan and document delivery service. Inclusion Criteria and Study Selection Published studies were considered eligible for inclusion if they reported patients with a primary complaint of PT, preoperative imaging evidence or direct intraoperative

observation of associated vascular aberrancy or wall anom aly (sigmoid sinus dehiscence/diverticulum, jugular bulb dehiscence/diverticulum, ICA dehiscence/aberrancy, other aberrant arterial vasculature near cochlea), and postopera tive outcomes after resurfacing or reconstruction surgery. We included studies that performed resurfacing of sigmoid sinus and jugular bulb wall anomalies in combination with extravascular reduction of the diverticulum by packing and/ or electrocoagulation. Some studies reported other, related procedures that reduced sound transmission by increasing separation between the blood vessel and hearing structures—for example, by physically displacing an aber rant ICA in contact with the tympanic membrane or creating a recess to further displace an aberrant ICA from the tympa nic membrane. We included these studies because these pro cedures also used a sound baffle to reduce transmission of turbulent noises in vessels to hearing structures. We excluded studies involving vascular loop compression