A Case of Posterior Semicircular Canal Dehiscence Caused by High Jugular Bulb / 대한이비인후과학회지

Posterior semicircular canal dehiscence represents a third-window lesion manifesting as hearing loss with vestibular dysfunction. Computed tomography findings of a dehiscent posterior canal can be verified with increased vestibular evoked myogenic potential responses as in other third-window lesions. The jugular bulb is the bulbiform connection between the sigmoid sinus and the internal jugular vein at the skull base. High jugular bulb can erode into inner ear structures. According to the literature review, there has been no case report about posterior semicircular canal dehiscence caused by high jugular bulb in Asia. Therefore, the authors report a case with a review of literature.

A Case of Pulsatile Tinnitus from Dehiscent High Jugular Bulb Treated by Reconstruction of the Hypotympanum / 대한이비인후과학회지

Vascular tinnitus, a sort of pulsatile tinnitus, should be differentiated with other sensorineural tinnitus because it is possible to be cured by correction of underlying systemic disease or surgery. The dehiscent high jugular bulb, a common cause of venous pulsatile tinnitus, can be cured by reconstruction of hypotympanum. We present a case of pulsatile tinnitus with dehiscent high jugular bulb which has been treated by surgery. Preoperative microscopic finding showed dark bluish pulsating mass in posteroinferior portion of tympanic membrane. Temporal bone CT showed high jugular bulb with bone defect of hypotympanum. The hypotympanum was reconstructed and high jugular bulb lowered using the harvested bony fragment from mastoid cortical bone. The pulsatile tinnitus disappeared immediately after surgery.

A Case of High Jugular Bulb Associated with Conductive Hearing Loss / 대한이비인후과학회지

A high jugular bulb is often discovered as an incidental finding that is asymptomatic. The incidence of high jugular bulb protruding into the level of oval window is rare. Conductive hearing loss in association with this anomaly may occur, but has been reported infrequently in the literature. We report one case of high jugular bulb and the associated conductive hearing loss. Mechanisms to explain the conductive hearing loss include contact of the jugular bulb with tympanic membrane, interference with the ossicular chain, and obstruction of the round and oval window niche. The operative findings, radiographic and audiometric data that support these mechanisms of couductive hearing loss are presented.

The Clinical Usefulness of Translabyrinthine Approach for Removal of the Vestibular Schwannomas

OBJECTIVE: To determine the feasibility of translabyrinthine approach in the vestibular schwannoma patients, the authors reviewed eighteen consecutive cases, focusing at their functional outcome and operative complications. MATERIALS AND METHOD: To evaluate the functional outcome, we reviewed preoperative radiological findings such as size of tumors and location of jugular bulb as well as the preoperative neurological status including audiometric analysis and cranial nerve function in 18 patients, diagnosed as vestibular schwannoma. Also the surgical outcome was evaluated according to the functional preservation of facial nerve and incidence of the surgical complication as well as the extent of surgical resection. RESULTS: The age of patients ranged from 21 to 62 years, with a mean of 50 years. Of 18 patients operated in our center by the translabyrinthine approach, wide exposure with total removal of the mass was possible in 16 cases (88.8%). The facial nerve was anatomically preserved in 88.8%. At six-month follow-up, facial nerve function was good(Grade I-II) in 15 patients(83%) and acceptable(I-IV) in all patients. Although the jugular bulb was highly placed is five patients, gross total resection was possible without facial nerve injury in all patients by the translabyrinthine approach. One patient experienced CSF leakage after surgery, but there was no patient with disabling deficit. CONCLUSION: Use of the translabyrinthine approach for removal of vestibular schwannomas resulted in good anatomical and functional preservation of the facial nerve, with minimal incidence of morbidity and no mortality. In cases of high jugular bulb impacted into mastoid bone, total removal was possible by displacing the jugular bulb with Surgicel cellulose and placement of bone wax.

Otolaryngologic Analysis of High Jugular Bulb Using Temporal Bone Computed Tomography / 대한이비인후과학회지

BACKGROUND: If the level of dome of jugular bulb is superior to the round window niche or inferior annulus of the tympanic membrane, it is called a high jugular bulb. OBJECTIVES: Laterally directed high fossae can result in case histories of bleeding from a dehiscent jugular bulb damaged at myringotomy and hearing loss caused by protrusion of a huge bulb into the middle ear space, this effects the function of the ossicles or the round window. Medially situated high fossae may affect the inner ear. MATERIALS AND METHODS: The authors analysed incidence of high jugular bulb and its relation to the diseases using CT scan films of 352 patients who visited Soonchunhyang University Hospital with chronic otitis media, cholesteatoma, Bell's palsy, vestibular neuronitis or Meniere's disease. RESULTS: The following results were obtained: 1) High jugular bulb was seen in 84 cases(23.9%) out of total 352 cases. 2) Of 247 cases of otitis media, 56 cases(22.7%) had high jugular bulbs. 3) Nine cases(23.0%) of high jugular bulb were found in 39 cases with cholesteatoma. 4) Six cases(24.0%) out of 25 cases with vestibular neuronitis were found to have high jugular bulbs. 5) In the cases with Meniere's disease, the highest incidence of high jugular bulb(8 cases out of 19 cases) was noted. CONCLUSION: This result may suggest that high jugular bulb is significantly related to Meniere's disease.