Clinical spectrum of patients with erosion of the inner ear by jugular bulb abnormalities

Laryngoscope. 2010 Feb;120(2):365-72. doi: 10.1002/lary.20699.


Objectives/hypothesis: Anatomic variants of the jugular bulb (JB) are common; however, abnormalities such as large high riding JB and JB diverticulum (JBD) are uncommon. Rarely, the abnormal JB may erode into the inner ear. The goal of our study is to report a large series of patients with symptomatic JB erosion into the inner ear.

Study design: Retrospective review in an academic medical center.

Methods: Eleven patients with JB abnormality eroding into the inner ear were identified on computed tomography (CT) scan of the temporal bone.

Results: Age at presentation was from 5 years to 82 years with six males and five females. The large JB or JBD eroded into the vestibular aqueduct (n = 9) or the posterior semicircular canal (n = 4). The official radiology report usually identified the JB abnormality; however, erosion into these structures by the JB was not mentioned in all but one case. All patients were symptomatic with five having conductive hearing loss (CHL) and three complaining of pulsatile tinnitus. Those with pulsatile tinnitus and four of five with CHL had erosion into the vestibular aqueduct. Vestibular evoked myogenic potential (VEMP) findings in three of six patients were consistent with dehiscence of the inner ear.

Conclusions: High riding large JB or JBD can erode into the inner ear and may be associated with CHL and/or pulsatile tinnitus. CT scan is diagnostic and should be examined specifically for these lesions. As patients with pulsatile tinnitus may initially undergo a magnetic resonance imaging scan, identification of JB abnormality should prompt CT scan or VEMP testing to evaluate for inner ear erosion.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Diverticulum / complications
  • Diverticulum / diagnostic imaging
  • Evoked Potentials, Motor
  • Female
  • Hearing Loss, Conductive / etiology
  • Humans
  • Jugular Veins / abnormalities*
  • Jugular Veins / diagnostic imaging
  • Male
  • Middle Aged
  • Reflex, Acoustic
  • Semicircular Canals / diagnostic imaging
  • Semicircular Canals / pathology*
  • Tinnitus / etiology
  • Tomography, X-Ray Computed
  • Vascular Diseases / complications
  • Vascular Diseases / diagnostic imaging
  • Vestibular Aqueduct / diagnostic imaging
  • Vestibular Aqueduct / pathology*
  • Vestibular Function Tests
  • Young Adult