Computed tomography (CT) of the temporal bone showed evidence of a high jugular bulb abutting the TM and the ossicular chain, with a dehiscent middle ear floor (figure, C).
Surgical treatment of the high jugular bulb in patients with Meniere's disease and pulsatile tinnitus.
These evaluated vascular anomalies and variants were diagnosed on the following previously described criteria [Figure 1]: (1) High jugular bulb, the jugular bulb extended above the inferior border of the round window; [sup] (2) dehiscent jugular bulb or dehiscent sigmoid plate, the incomplete thin bone around the jugular bulb or the sigmoid sinus; [sup], (3) jugular bulb diverticulum, prominent protrusion or an irregular out-pouching of jugular bulb that was clearly distinguished from a smooth ellipsoidal form; [sup] (4) sigmoid sinus diverticulum, a diverticulum entered into the mastoid bone; [sup] (5) lateral sinus stenosis, the L/S ratio (L = the largest area of the vein; S = the smallest area of the vein) was >4.
In contrast to the anomalies described previously, [sup],, such as a venous sinus stenosis and a high jugular bulb, a dehiscent sigmoid plate was the most frequent anomaly on the symptomatic side in the current study, diagnosed in 86.
3) However, it is rare to find a high jugular bulb with a diverticulum as was seen in our case.
Unilateral conductive hearing loss secondary to a high jugular bulb in a pediatric patient.
CT had demonstrated a high jugular bulb and laterally placed and enlarged sigmoid sinuses.
In our opinion, there were two possible causes of her pulsatile tinnitus: atherosclerotic carotid artery disease (ACAD) or the high jugular bulb.
High-resolution computed tomography (CT) revealed a dehiscent high jugular bulb
attached to the tympanic membrane in the right ear (figure 2).
In fact, in an article on the surgical lowering of the high jugular bulb
in the treatment of 13 patients with Meniere's disease and pulsatile tinnitus, Couloigner et al postulated that the symptoms in these patients were caused by compression of venous drainage of the endolymphatic duct and/or sac by the high jugular bulb
The differential diagnosis includes a glomus tumor, middle ear effusion, high jugular bulb
, and cholesterol granuloma.
A high jugular bulb
might be accompanied by pulsatile tinnitus or by a vascular retrotympanic mass on otoscopic examination.