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Otolaryngology–Head and Neck Surgery 160(5)

Table 3. Resurfacing Outcomes for Pulsatile Tinnitus Associated with Arterial Aberrancy or Dehiscence by Material Used. a Cases with Resolution, b n (%)

Table 5. Resurfacing Outcomes for Pulsatile Tinnitus Associated with Sigmoid Sinus Wall Anomalies by Material Used. a

Cases with Resolution, n (%)

Material

Complete

Partial

Total

Material

Complete Partial

None Worse Total

Source

Source

Autologous

3 (100)

0

3 2 5 4 1 5

Autologous 48 (69)

9 (13) 12 (17)

1 (1)

70

Artificial

0

2 (100)

Artificial

3 (100)

0

0

0 0

3

Total

3 (60)

2 (40)

Both Total

40 (83) 91 (75)

3 (6)

5 (10)

48

Density Hard

12 (10) 17 (14)

1 (1)

121

2 (50)

2 (50)

Density Hard

Soft

1 (100)

0

87 (74)

12 (10) 17 (15)

1 (1)

117

Total

3 (60)

2 (40)

Soft

4 (100)

0

0

0

4

Total

91 (75)

12 (10) 17 (14)

1 (1)

121

a Does not include 1 case report from Song et al 29 of manually displacing aberrant ICA away from tympanic membrane without resurfacing with solid material. Only the 2 ICA resurfacing cases were drawn from Vaisbuch et al. 8 b Cases with no resolution, n = 0.

a Only sigmoid sinus–resurfacing cases were included from Vaisbuch et al 8 and Yeo et al. 7

Outcomes for the 14 resurfacing cases included 11 (79%) with complete resolution, 1 (7%) with partial resolution, and 2 (14%) with no resolution. Stratifying by material source did not show an association between material source and resurfacing outcome ( P = .47). Stratifying by material den sity did not show an association between material density and resurfacing outcome ( P = .59; Table 4 ). Sigmoid Sinus Wall Anomalies Thirteen included studies reported a total of 121 resurfacing cases to treat PT associated with SSWA. Nine studies reported on sigmoid sinus diverticulum, 4,5,7,8,26,27,32-34 and 7 reported on sigmoid sinus dehiscence. 4,8,24-26,28,30 Transmastoid resurfacing approaches were used in all cases ( Figure 3 ). Outcomes for the 121 resurfacing cases included 91 (75%) with complete resolution, 12 (10%) with partial resolu tion, 17 (14%) with no resolution, and 1 (1%) with worsened PT. Stratifying by material source did not show an associa tion between material source and resurfacing outcome ( P = .58). Stratifying by material density did not show an associa tion between material density and resurfacing outcome ( P = .71; Table 5 ). Because most sigmoid sinus resurfacing cases used hard materials (117 of 121 cases), we also stratified out comes of cases with hard materials by source (ie, artificial vs autologous) and found no significant difference ( P = .10). Complications Complications, aside from persistent or worsened PT, were noted in 7 of the 20 included studies and affected at least 23 out of 95 resurfacing cases ( Table 6 ). For resurfacing cases in the Eisenman et al study, 4 data on complications were obtained from an earlier related study by Raghavan et al. 36 Interestingly, larger case reports were more likely to report complications: all 7 included studies that described 4 resurfacing cases reported complications, whereas all 13 included studies that described \ 4 cases reported no complications.

Table 4. Resurfacing Outcomes for Pulsatile Tinnitus Associated with Jugular Bulb Wall Anomalies by Material Used. a

Cases with Resolution, n (%)

Material

Complete

Partial

None

Total

Source

Autologous

7 (70)

1 (10)

2 (20)

10

Artificial

4 (100)

0

0

4

Total

11 (79)

1 (7)

2 (14)

14

Density Hard

8 (73)

1 (9)

2 (18)

11

Soft

3 (100)

0

0

3

Total

11 (79)

1 (7)

2 (14)

14

a Only the jugular bulb–resurfacing cases were used from Vaisbuch et al 8 and Yeo et al. 7

(40%) with partial resolution. Stratifying by material source showed a statistically significant association between mate rial source (autologous vs artificial) and resurfacing out come ( P = .03), with greater tinnitus improvement associated with use of autologous materials. Stratifying by material density did not show a significant association between material density and resurfacing outcome ( P = .36; Table 3 ). Jugular Bulb Wall Anomalies Five included studies reported a total of 14 resurfacing cases to treat PT associated with jugular bulb wall anomaly (dehiscence or diverticulum). These 5 studies included 3 reporting dehiscent high jugular bulb, 6,14,31 2 reporting jugu lar bulb diverticulum, 7,8 and 1 reporting jugular bulb dehis cence without associated high-riding jugular bulb. 8 Hypotympanic resurfacing approaches were used ( Figure 2 ), except in 1 study that used a transmastoid approach to obliterate and resurface jugular bulb diverticulum. 7