12例颈静脉源性耳鸣诊治分析  

Diagnosis and management of pulsatile tinnitus of venous origin

作　　者：张毅博[1] 王武庆[1] 戴春富[1] 陈良[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻咽喉科,上海200032

出　　处：《临床耳鼻咽喉头颈外科杂志》2010年第6期267-269,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨颈静脉源性耳鸣的诊断及治疗。方法:回顾性分析12例诊断为颈静脉源性耳鸣患者的临床表现、诊断依据及治疗方案,对接受颈内静脉结扎术后患者的近期和远期临床效果进行评价,并对相关文献作一综述。结果:术后1周内,7例诉耳鸣明显减轻或消失,5例无明显改善。远期随访到5例近期明显减轻的患者,其中3例耳鸣无改善,2例耳鸣明显减轻(2/7);远期随访到2例近期耳鸣无明显改善者,其中1例耳鸣无改善,另1例加重,发展为啸鸣音。远期随访时间为术后1～5年。随访到的7例均无明显并发症。结论:颈静脉源性脉动性耳鸣为一排除性诊断,并无金标准,单纯依据脉动性耳鸣病史,按压颈内静脉耳鸣明显减轻或消失,以及耳部CT和颅脑MRI排除相关占位性病变并不足以诊断,联合CT动脉及静脉检查有助于排除硬脑膜动静脉瘘、乙状窦憩室等病变。通过颈内静脉结扎术治疗颈静脉源性耳鸣仍存争议。Objective：To discuss the diagnosis and management of pulsatile tinnitus of venous origin.Method：A retrospective study was conducted on 12 patients who were diagnosed with pulsatile tinnitus of venous origin and treated with ligation of internal jugular veins.We reevaluated the evidences of identifying pulsatile tinnitus of venous origin and reviewed the short-term and long-term postoperative effects and complications.We also reviewed associated articles in this report.Result：Seven patients got relief of tinnitus in less than one week after the surgery,while the other 5 patients had no relief.Seven patients were inquired in this study and the other five lost to follow-up.According to the long review （from one to five years postoperatively）,two patients who acquired immediate effect got relief of tinnitus,four including complained of no relief and the seventh aggravated into roaring.Three patients who got no immediate relief got no improvement at all.No one in our review complained of any complications.Conclusion：It＇s assumed that a history of pulsatile tinnitus,alleviation of tinnitus when pressing jugular veins,tinnitus changing with head position or posture and no occupying lesion in temporal CT scan or cranial MRI are inadequate in diagnosing pulsatile tinnitus of venous origin.Vascular imaging is also necessary to exclude other pathological changes like dura arteriovenous fistula,sigmoid diverticulum and so on.CT arteriography and venography are recommended preferentially.Ligation of internal jugular veins is controversial in patients who have no absence of transverse and sigmoid sinus and identified as pulsatile tinnitus of venous origin.

关 键 词：耳鸣 脉动性 颈内静脉结扎术 静脉造影 

分 类 号：R764[医药卫生—耳鼻咽喉科]