搏动性耳鸣的新病因：岩下窦与枕窦狭窄  

A New Cause of the Correlated Intractable Pulsatile Tinnitus: Inferior Petrosal Sinus Stenosis or Occipital Sinus Stenosis

作　　者：李宝民[1] 王君[1] 梁永平[1] 苏慧[1] 刘新峰[1] 杜志华[1] 曹向宇[1] 张荣举[1] 张雅静[1] LI Baomin;WANG Jun;LIANG Yongping;SU Hui;LIU Xinfeng;DU Zhihua;CAO Xiangyu;ZHANG Rongju;ZHANG Yajing(Department of Neurology in The 1st Medical Center,Chinese PLA General Hospital,Beijing,100853,China)

机构地区：[1]解放军总医院第一医学中心神经内科

出　　处：《中华耳科学杂志》2019年第5期681-685,共5页Chinese Journal of Otology

摘　　要：目的探讨耳鸣同侧的岩下窦和枕窦狭窄结构对静脉源性搏动性耳鸣的影响。方法在MRV提示有横窦和乙状窦发育不良和枕窦代偿性回流、岩下窦纤细和同侧较大的颈静脉球结构的同时,选择难以忍受的搏动性耳鸣并出现焦虑状态的7例患者;在全脑血管造影的引导下,经测试枕窦和岩下窦球囊闭塞试验阳性后,3例枕窦狭窄接受球囊扩张并支架成形;4例岩下窦狭窄或纤细者接受单纯球囊扩张处理。结果3例枕窦狭窄的耳鸣在支架成形术后即刻消失,随访3-8年无复发;2例岩下窦狭窄在球囊扩张后耳鸣完全消失、1例耳鸣降低50%,随访4-7月无复发或加重;1例治疗无效。结论枕窦和岩下窦狭窄或纤细并同侧颈静脉球扩大的结构可能是静脉源性搏动性耳鸣的重要成因;介入血管内球囊扩张或并支架成形是消除和缓解此类搏动性耳鸣的有益方式。Objective This article is to investigate the effects of ipsilateral inferior petrosal sinus or occipital sinus stenosis on the venous pulsatile tinnitus.Methods 7 cases with intolerable intractable pulsatile tinnitus originating from ipsilateral occipital sinus or inferior petrosal sinus stenosis underwent endovascular treatment.All of them were confirmed by Balloon Occlusion Test(BOT)under digital subtraction angiography(DSA).3 cases with occipital sinus stenosis underwent balloon dilatation and stent implantation;4 cases with inferior petrosal sinus stenosis or slender underwent balloon dilatation only.Results In occipital sinus stenosis group:Pulsatile tinnitus symptoms disappeared immediately after stenting in all the 3 cases.There was no recurrence of pulsatile tinnitus over a follow-up period of 3-8 years;In inferior petrosal sinus stenosis group:Pulsatile tinnitus symptoms disappeared immediately after balloon dilatation in 2 cases,1 case relieved about 50%.The treatment is ineffectual in 1 case.There was no recurrence or aggravation of pulsatile tinnitus over a follow-up period of 4-7 months.Conclusion Occipital sinus or inferior petrosal sinus stenosis with ipsilateral jugular bulb dilatation may be a important cause of venous pulsatile tinnitus.Balloon dilatation and/or stent implantation technique for treating this kind of pulsatile tinnitus is feasible and also have good operation safety.It can eliminate or relieve the patients’clinical symptom.

关 键 词：搏动性耳鸣 岩下窦 枕窦 狭窄 球囊 支架 

分 类 号：R764[医药卫生—耳鼻咽喉科]