title: Clinical presentation and imaging findings in patients with pulsatile tinnitus and sigmoid sinus diverticulum/dehiscence.
abstract: OBJECTIVE
  Sigmoid sinus diverticulum/dehiscence (SSDD) is an increasingly recognized venous cause for pulsatile tinnitus (PT). SSDD is amenable to surgical/endovascular intervention. We aim to understand the clinical and imaging features of patients with PT due to SSDD.
  
  
  METHODS
  Retrospective CT study and chart review.
  
  
  METHODS
  Tertiary-care, academic center.
  
  
  METHODS
  Cohort 1: 200 consecutive unique temporal bone CT were blindly reviewed for anatomic findings associated with PT. Cohort 2: 61 patients with PT were evaluated for otologic manifestations.
  
  
  METHODS
  All patients underwent a temporal bone CT for evaluation of PT. Clinical information was gathered using electronic medical records.
  
  
  METHODS
  Otologic symptoms and physical findings (including body mass index (BMI), mastoid/neck bruits) were analyzed. Temporal bone CT scans were evaluated for the presence of SSDD and other possible causes of PT.
  
  
  RESULTS
  Cohort 1: 35 cases of SSDD were identified (18%); 10 (29%) true diverticula; and 25 (71%) dehiscence. Sixty-six percent were right sided. Twelve patients had PT (34%). Patients with SSDD are more likely to have PT (p = 0.003). A significant association between right SSDD and PT was found (p = 0.001). Cohort 2: 15 out of 61 patients had PT and CT-confirmed SSDD. All were female subjects; average age was 45 years (26-73 yr). Radiologic evaluation revealed 10 SSDD cases on the right (66.7%), 2 on the left (13.3%%), and 3 bilateral (20%). Sensorineural hearing loss was seen in 8 (53%), aural fullness in 12 (80%). Average BMI was 32.2 (21.0-59.82), and 4 (26%) had audible mastoid bruits.
  
  
  CONCLUSIONS
  SSDD may be the most common identifiable cause for PT from venous origin and is potentially treatable. Temporal bone CT scans should be included in a complete evaluation of PT.
authors.affiliation: *Department of Otolaryngology, Georgetown University Hospital; †Department of Radiology, Howard University Hospital; and ‡Department of Radiology, Georgetown University Hospital, Washington, District of Columbia, U.S.A.
authors.forename: Ameet K
authors.initials: AK
authors.lastname: Grewal
authors.forename: Han Y
authors.initials: HY
authors.lastname: Kim
authors.forename: Richard H
authors.initials: RH
authors.lastname: Comstock
authors.forename: Frank
authors.initials: F
authors.lastname: Berkowitz
authors.forename: Hung Jeffrey
authors.initials: HJ
authors.lastname: Kim
authors.forename: Ann K
authors.initials: AK
authors.lastname: Jay
mesh_terms: D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D003392:Cranial Sinuses / Q000002:abnormalities* / Q000000981:diagnostic imaging; D004240:Diverticulum / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D014012:Tinnitus / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology