Clinical presentation and imaging findings in patients with pulsatile tinnitus and sigmoid sinus diverticulum/dehiscence

Otol Neurotol. 2014 Jan;35(1):16-21. doi: 10.1097/MAO.0b013e31829ab6d7.


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.

Study design: Retrospective CT study and chart review.

Setting: Tertiary-care, academic center.

Patients: 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.

Intervention(s): All patients underwent a temporal bone CT for evaluation of PT. Clinical information was gathered using electronic medical records.

Main outcome measure(s): 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.

Conclusion: 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.

MeSH terms

  • Adult
  • Aged
  • Brain Diseases / complications
  • Brain Diseases / diagnostic imaging*
  • Cranial Sinuses / abnormalities*
  • Cranial Sinuses / diagnostic imaging
  • Diverticulum / complications
  • Diverticulum / diagnostic imaging*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Radiography
  • Retrospective Studies
  • Tinnitus / diagnosis*
  • Tinnitus / diagnostic imaging
  • Tinnitus / etiology