1. Jugular bulb abnormalities
DR NGUYEN HUU BAO

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

3. Anatomy

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

5.  internal acoustic canal (IAC)

6. 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

7. ENDOSCOPY

9. Ct scan

11. MRI

12. Dehiscence of the jugular bulb
=> SURGERY

13. Dehiscence of the jugular bulb
sigmoid plate
is absent

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

15. Differential
diagnosis

16. 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

17. Dehiscence of the jugular bulb=> SURGERY

18. 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

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

20. High jugular bulb

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

22. Jugular bulb
diverticulum

23. Jugular bulb diverticulum

24. 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

25. 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.

26. 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