Jugular bulb abnormalities DR NGUYEN HUU BAO

jugular bulb ? A jugular bulb results from dilatation of the upper bulbous portion of the jugular vein.

Anatomy

Although their size, location, and configuration vary, most jugular bulbs lie below the hypotympanum.

 internal acoustic canal (IAC)

dehiscence of the jugular bulb Case report FEMALE , 28 YRS TINNITUS # 7 MONTHS NO COMPLAINT ABOUT HEARING LOSS OR VERTIGO No history of head trauma

ENDOSCOPY

Ct scan

MRI

Dehiscence of the jugular bulb => SURGERY

Dehiscence of the jugular bulb sigmoid plate is absent

Retrotympanic vascular mass The estimated incidence is ~5% (range 3.5-7%) of the symptomatic population (e.g. those with tinnitus). Retrotympanic vascular mass

Differential diagnosis

Clinical presentation Patients can present with conductive tinnitus, hearing loss, and vertigo Radiographic features the presence of the sigmoid plate can only be ascertained on CT Turbulent flow within the jugular bulb, the signal on MRI can be confusing

Dehiscence of the jugular bulb=> SURGERY

Review of jugular bulb adnormalities Jugular bulb abnormalities (JBA): 10% -15% of the population. Righ side > Left side High jugulara bulb Jugular bulb diverticulum Dehiscence of the jugular bulb

High jugular bulb Superior aspect of JB extends above floor of IAC with no middle ear connection 5-8% of temporal bone specimens

High jugular bulb

Jugular bulb diverticulum Jugular bulb diverticulum present in 35% of cases with high Jugular Bulb

Jugular bulb diverticulum

Jugular bulb diverticulum

JBA leads to inner-ear erosion in 1.5% to 2.8% of cases The erosions are related to HJB in almost all cases and are also associated with JBD in more than 50% of cases The range of symptomatic forms of JBA is unclear, but it could be involved in ~50% of cases when it is associated with inner-ear erosion

Symptoms include tinnitus and/or hearing loss, and/or vertigo. Intensity of symptoms is variable, but vertigo can be very disabling and may need surgical treatments, for example, jugular bulb lowering or posterior semicircular canal plugging.

Surgical techniques => reducing tinnitus, hearing loss, and vertigo, but require careful surgery to avoid damaging the jugular bulb wall, the inner ear, or the facial nerve Major complications have occurred, such as hearing loss or major bleeds. New treatment for vertigo caused by JBA using an endovascular technique. This technique allows complete removal of symptoms and no complications