非外傷性浅側頭動脈内頸静脈瘻が原因と考えられた他覚的耳鳴の1例 Objective pulsatile tinnitus caused by nontraumatic superficial temporal artery : internal jugular vein fistula
Objective pulsatile tinnitus (PT) is caused by various diseases, including glomus tumors, atherosclerotic carotid artery disease, and arteriovenous shunts. Of these above mentioned diseases, both aquired arteriovenous fistulas (AVF) and aneurysms of the superficial temporal artery (STA) have generally occurred after trauma. To the best of our knowledge, only two cases with nontraumatic AVF of the STA have been described<BR>A 70-year-old woman presented with PT of the left ear without a past history of head trauma. The continuous PT was synchronous with her heartbeat. The vascular bruit at the left preauricular region was audible with otoscope and stethoscope.<BR>A palpable thrill at the same region disappeared by compressing the proximal STA. Ultrasound, CT, MRI and selective angiography were performed and a fistula from aneurysm of the STA through the unknown vein into the internal jugular was demonstrated. The patient underwent surgery to remove the lesion. The thrill pulsated deep behind the parotid gland was disappeared, when temporary clips was placed on the external carotid artery. So the external carotid artery was ligated, and there has been no sign of recurrence 11 months after the surgery.<BR>The patients with a complaint of PT are not so common, but life-threatening diseases could be present. And the treatment for PT could be possible in some cases. Therefore, it is important to make a correct diagnosis in these patients by meticulous history taking as well as physical examinations. Examinations by otoscope and stethoscope are essential in all patients. Furthermore, ultrasound and selective angiography were helpful for diagnosis in the present case.
- Otology Japan
Otology Japan 17(5), 681-685, 2007-12-25
THE JAPAN OTOLOGICAL SOCIETY