title: A clinical and histopathologic study of jugular bulb abnormalities.
abstract: OBJECTIVE
  To further define the spectrum of clinical presentation and explore the histologic sequelae of jugular bulb abnormalities (JBAs).
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Thirty patients with radiologic evidence of inner ear dehiscence by JBA.
  
  
  METHODS
  Thirty patients with radiologic inner ear dehiscence by JBA and 1579 temporal bone specimens were evaluated for consequences from JBA.
  
  
  RESULTS
  We found that JBA-associated inner ear dehiscence could be identified on computed tomography of the temporal bone but not on magnetic resonance imaging scan. Jugular bulb abnormalities eroded the vestibular aqueduct most often (in 25 patients), followed by the facial nerve (5 patients) and the posterior semicircular canal (4 patients). Half of the patients (15) were asymptomatic. Results from vestibular evoked myogenic potential (VEMP) tests were positive in 8 of 12 patients with inner ear dehiscence. Histologically, only 2 of 41 temporal bones with dehiscence of the vestibular aqueduct demonstrated endolymphatic hydrops.
  
  
  CONCLUSIONS
  Jugular bulb abnormalities can erode into the vestibular aqueduct, facial nerve, and the posterior semicircular canal. While symptoms may include pulsatile tinnitus, vertigo, or conductive hearing loss, in contrast to earlier reports, half of the patients were asymptomatic. Dehiscence of vestibular aqueduct rarely leads to clinical or histologic hydrops. The VEMP testing was useful in confirming the presence of inner ear dehiscence due to JBAs. Because the natural history of JBAs is unknown, these patients should be followed closely to evaluate for progression of the JBA or development of symptoms.
authors.affiliation: Department of Otolaryngology, New York University School of Medicine, New York, 10016, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Friedmann
authors.forename: Jan
authors.initials: J
authors.lastname: Eubig
authors.forename: Leon S
authors.initials: LS
authors.lastname: Winata
authors.forename: Bidyut K
authors.initials: BK
authors.lastname: Pramanik
authors.forename: Saumil N
authors.initials: SN
authors.lastname: Merchant
authors.forename: Anil K
authors.initials: AK
authors.lastname: Lalwani
mesh_terms: D016009:Chi-Square Distribution; D007758:Ear, Inner / Q000000981:diagnostic imaging / Q000473:pathology*; D018159:Endolymphatic Hydrops / Q000000981:diagnostic imaging / Q000473:pathology; D005154:Facial Nerve / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012665:Semicircular Canals / Q000000981:diagnostic imaging / Q000473:pathology; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014723:Vestibular Aqueduct / Q000000981:diagnostic imaging / Q000473:pathology; D058585:Vestibular Evoked Myogenic Potentials