Surgical Outcomes of Sigmoid Sinus Resurfacing for Pulsatile Tinnitus: The Predictive Value of the Water Occlusion Test and Imaging Studies
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Objectives. Sigmoid sinus resurfacing (SS-R) is one of the most effective surgical treatments for patients with pulsatile tin-nitus (PT) originating from anatomical variants of the vascular walls in the temporal bone. This study aimed to pro-vide updated information on the clinical outcomes of SS-R and evaluate the efficacy of the water occlusion test(WOT) as an additional diagnostic modality. Methods. We retrospectively reviewed medical records including tinnitus questionnaires, temporal bone computed tomog-raphy (TBCT) scans, audiologic tests, and preoperative WOT results from patients who underwent SS-R. Results. In total, 26 patients were included in the study. The mean age was 44 years, and the mean symptom duration was3 months. Fourteen patients (53.8%) were completely cured, seven (26.9%) significantly improved, and five (19.2%)remained stable. The mean visual analog scale loudness score decreased from 5.26 to 1.34 (P <0.001) and the meanTinnitus Handicap Inventory score also improved from 50.23 to 5.5 (P <0.001) after SS-R surgery. In 10 patients withdiscrepancies between the preoperative TBCT and intraoperative findings, WOT showed a significant additive effectin predicting surgical outcomes. No patients experienced severe intraoperative or postoperative complications duringthe entire follow-up period. Conclusion. SS-R provides significant symptom improvement in patients with sigmoid sinus dehiscence who had a positiveWOT without other sigmoid sinus variants. A combined diagnostic approach with TBCT, WOT, and intraoperativefindings is crucial for achieving better surgical outcomes in patients with PT caused by sigmoid sinus variants.
Abstract
Objectives. Sigmoid sinus resurfacing (SS-R) is one of the most effective surgical treatments for patients with pulsatile tin-nitus (PT) originating from anatomical variants of the vascular walls in the temporal bone. This study aimed to pro-vide updated information on the clinical outcomes of SS-R and evaluate the efficacy of the water occlusion test(WOT) as an additional diagnostic modality. Methods. We retrospectively reviewed medical records including tinnitus questionnaires, temporal bone computed tomog-raphy (TBCT) scans, audiologic tests, and preoperative WOT results from patients who underwent SS-R. Results. In total, 26 patients were included in the study. The mean age was 44 years, and the mean symptom duration was3 months. Fourteen patients (53.8%) were completely cured, seven (26.9%) significantly improved, and five (19.2%)remained stable. The mean visual analog scale loudness score decreased from 5.26 to 1.34 (P <0.001) and the meanTinnitus Handicap Inventory score also improved from 50.23 to 5.5 (P <0.001) after SS-R surgery. In 10 patients withdiscrepancies between the preoperative TBCT and intraoperative findings, WOT showed a significant additive effectin predicting surgical outcomes. No patients experienced severe intraoperative or postoperative complications duringthe entire follow-up period. Conclusion. SS-R provides significant symptom improvement in patients with sigmoid sinus dehiscence who had a positiveWOT without other sigmoid sinus variants. A combined diagnostic approach with TBCT, WOT, and intraoperativefindings is crucial for achieving better surgical outcomes in patients with PT caused by sigmoid sinus variants.
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