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Late at night I quietly rushed to the paper in front of the computer
Suddenly there was a sharp alarm
"Drops! -- "Ringing in my ears."
The sound flickered left and right, and from time to time
But it has been haunting all around
Repeated confirmation is not the appliance after the alarm
I felt like I was ringing in the ears
This uncomfortable feeling made me think of it suddenly
A case encountered last month...
For two years, the "bang bang" sound has never disappeared
One Wednesday clinic, a thin woman in her early thirties appeared in my clinic, her face seemingly revealing anxiety and sorrow.
She told me that she felt like I was getting a strange disease.
For two years, she had felt that her right ear could faintly hear the sound of "bang, bang, bang". The "bang bang" sound is not fast or slow, synchronized with his own heartbeat; neither light nor heavy, just enough to be heard, but not very clear.
In order to eliminate this "bang" sound, she has tried various methods, resting, giving injections, taking medicine, acupuncture, and listening to music. However, no matter how hard she tried, the "bang" sound stayed in her right ear and never disappeared.
But when she puts her hand on the right side of her neck and presses it gently, the "bang" sound will weaken or even disappear.
Through her description and preliminary otological examination, I roughly judged that the "bang" sound heard by this patient was not ordinary tinnitus, but a special symptom called "pulsatile tinnitus".
Medical examinations revealed the real culprit of "bang bang"
For tinnitus patients, we usually recommend an audiology test first. However, for patients with "pulsatile tinnitus", whose tinnitus rhythm is consistent with the rhythm of the heartbeat, its symptoms are most likely related to vascular lesions at the base of the skull, which is a kind of "vascular pulsatile tinnitus". Vascular pulsatile tinnitus is usually caused by vascular anatomical variations, malformations, or vascular-associated tumors, so imaging evaluation of the blood vessels at the base of the skull is essential. So, while arranging for her to have a hearing test, he also made an appointment for her to have a CT examination of her temporal bone.
Sure enough, a CT scan quickly revealed the problem: the bone plate on the surface of the patient's right sigmoid sinus was defective.
▲ Patient's temporal bone CT scan imaging. Upper left: transverse image of the temporal bone on the right side, see plate defect between the sigmoid sinus and the mastoid on the right side. Upper right: left image of the transverse segmentation of the temporal bone, see left sigmoid sinus and intermaspit bone plate completed. Bottom: bilateral image of the temporal bone coronation, showing multiple bone defects between the right sigmoid sinus and mastoids.
The "sigmoid sinus" is an important intracranial circuit, one on the left and one on the left, and the blood supplying the brain is mainly returned to the heart through the sigmoid sinus, while the "mastoid" is an important anatomical structure of the middle ear.
Normally, there is a thin layer of bone plate between the sigmoid sinus and the mastoid, but in this patient, this bone plate is unexpectedly defective. Since the mastoids themselves have a certain sound transmission function, the sound of blood flow in the sigmoid sinuses is likely to be transmitted to the inner ear through the mastoids, allowing the patient to hear a "bang" sound consistent with the rhythm of the heartbeat.
The bone plate is repaired, and the "bang bang" sound finally disappears
In response to this patient's situation, I suggested that she be hospitalized and surgically repair the bone plate of the sigmoid sinus surface defect, and the patient accepted my suggestion and expressed his willingness to try.
After admission, audiology and imaging examinations were improved, other skull base tumors and vascular malformations were ruled out, and a surgical plan was determined: through the post-ear incision into the mastoid process, repairing the defective bone plate.
During the operation, it was found that there were indeed multiple bone plates on the surface of the patient's sigmoid sinuses, ranging in size from 1*1mm to 4*6mm. In the end, we successfully repaired the defective bone plates using the patient's own bone meal and soft tissue, and the procedure went smoothly in only 1.5 hours.
On the second day after the operation, the patient felt that the "bang" sound in the right ear was significantly smaller than before the operation, and there were no serious surgical complications, and the patient was discharged from the hospital on the third day after the operation.
A month later, the patient came to my clinic again for a follow-up, and her overall mental state was much better, and people became cheerful. She excitedly said that she could hardly hear that kind of "bang bang bang" sound now! Audiology showed that the hearing in her right ear had not changed compared to before the operation.
This patient was lucky, with a smaller lesion and a relatively small surgical range. In some patients, the cause of pulsatile tinnitus is a tumor (e.g., jugular venous spheroidoma), and the scope of surgery is much larger. If the tumor unfortunately invades important structures such as nerves and blood vessels at the base of the skull, complications such as facial paralysis, hoarseness, dysphagia, and cerebrospinal fluid leakage may occur after surgery, requiring secondary surgical repair and long-term rehabilitation. In addition, patients need to have their MRI checked regularly to assess whether the tumor has recurred.
Precautions for the treatment of tinnitus
1. In most cases, tinnitus cannot find the exact cause, is not life-threatening, and does not require special treatment. Tinnitus patients should avoid fear, anxiety, do not "rush to the doctor", blindly believe in some folk remedies, earthwork and unscientific treatment methods.
2. In rare cases, tinnitus may be an early sign of some serious disease (e.g., tumor, vascular disease). Patients should therefore pay particular attention to whether tinnitus is unilateral or pulsatile. If such tinnitus occurs, you should go to a regular medical institution to check for related diseases.
3. Once it is found that there are tumors or vascular mutations, malformations, etc. in the skull or at the junction of the head and neck, the patient should go to the relevant department to assess the severity of the condition. Communicate fully with the doctor in charge to decide on the final treatment plan.
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Text 丨Jiang Hua, Liu Xiao
Typography 丨Donald Jenny
Audit 丨Yang Beibei Jiang Hua Liu Xiao
Responsible editor 丨 Tang Jianni Lu Qing