Tinnitus Can Be A Sign of Jugular Bulb Anomaly

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CT scan showing right dehiscent high riding jugular bulb with absence of the right sigmoid plate (arrow) in a patient who presented with tinnitus

A ringing sensation in the ear unveiled to be an anomaly

A 41-year-old female presented with complaints of a ringing sensation in the right ear for the past 2 years. The patient was admitted for further evaluation of tinnitus.

Doctors performed a temporal bone computed tomography scan, which revealed a right dehiscent high riding jugular bulb. The right sigmoid plate was absent.

A jugular bulb is the dilation of the bulbous part of the jugular vein. Normally, it is located on the hypotympanum floor, a bony sigmoid plate covers it.

Tinnitus and more in jugular bulb anomaly:

There can be anomalies of the jugular bulb, such as a high-riding jugular bulb, dehiscent jugular bulb, etc. Patients may present with complaints of tinnitus, conductive hearing loss, dizziness, and vertigo, but it can also be found in asymptomatic patients.

A dehiscent jugular bulb is a rare anatomical variation of the jugular vein with a superior-lateral extension of the jugular bulb into the middle-ear cavity. Dehiscence is the absence of the bony wall (sigmoid) between the jugular foramen and the middle ear cavity. It is one of the common causes of pulsatile tinnitus. On otoscopy, it appears as a bluish (red-purplish) pulsatile mass.

It is imperative to be aware of this anatomical variant, as it may lead to complications secondary to injury during middle ear surgery.

References:

Koo YH, Lee JY, Lee JD, Hong HS. Dehiscent high-riding jugular bulb presenting as conductive hearing loss: A case report. Medicine (Baltimore). 2018;97(26):e11067. doi:10.1097/MD.0000000000011067

Erdogan H, Arslan S, Arslan FZ, Durmaz MS, Cengiz A (2017) Dehiscent High Jugular Bulb. Clin Med Img Lib 3:065. doi.org/10.23937/2474-3682/1510065

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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