Hydroxyapatite cement resurfacing the dehiscent jugular bulb: Novel treatment for pulsatile tinnitus.

OBJECTIVES/HYPOTHESIS: The objectives were to discuss the presentation and symptomatology of patients with jugular bulb abnormalities, summarize the literature describing jugular bulb abnormalities, compare methods of treating symptomatic dehiscent jugular bulb, describe a novel surgical technique and pitfalls to repair dehiscent bulbs with hydroxyapatite cement, and present a case series to demonstrate outcomes with this technique STUDY DESIGN: Case series presentation, PubMed literature review, and description of operative technique.

METHODS: A series of patients presenting with pulsatile tinnitus due to dehiscent jugular bulbs who underwent operative repair with hydroxyapatite cement resurfacing is described. Literature review was conducted via a PubMed database search. Abstracts and references were reviewed to identify relevant sources. Surgical technique of repair and outcomes are reported.

RESULTS: Three patients who presented with unilateral, bothersome, pulsatile tinnitus with history and imaging consistent with a diagnosis of high riding, dehiscent jugular bulbs underwent jugular bulb resurfacing with hydroxyapatite cement. Two patients associated the onset of their symptoms with trauma. All patients reported complete resolution of their tinnitus at an average follow-up of 15 months. No hearing, vestibular, or intracranial complications were encountered.

CONCLUSIONS: Compressive, obliterative, and endovascular interventions have been attempted to treat pulsatile tinnitus due to high-riding dehiscent jugular bulbs. Reconstruction of the middle ear floor with autologous tissue grafts has also been described. These techniques have been associated with variable results and with the risk of increased intracranial pressure. Hydroxyapatite cement resurfacing may be considered as an alternative for the treatment of this pathology.

LEVEL OF EVIDENCE: 4. Laryngoscope, 128:1186-1190, 2018.