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Many people experience tinnitus--a type of ringing, swooshing, or other type of noise that seems to originate in the ear or head. In addition to a full ENT exam, other tests may be needed to look for any treatable causes of tinnitus. Tinnitus with an obvious cause, such as an object in the ear canal or a middle ear infection, can usually be treated easily.
Household products: Eliminate use of perfumes, antiseptics, cleaning chemicals, and suntan lotions. Prescription medications: Reduce or eliminate use of drugs that list tinnitus as a side effect or have a toxic effect on the ear. Over-the-counter drugs: Reduce or eliminate use of aspirin or aspirin-type products (Empirin, Ecotrin, Bufferin, ibuprofen, Anacin, Midol, Pepto Bismol, and Aleve) and some antihistamines. Anti-anxiety medications, anticonvulsants, and tricyclic antidepressants are groups of drugs used to treat various conditions including depression, anxiety, seizure, panic, pain, muscle spasms, dizziness, and tinnitus.
Medical intervention in the treatment of tinnitus has gone beyond the realm of traditional treatments.
There are 2 types of carotid carvenous fistula (CCF) with different causes, the pathologic lesion and treatment but the same clinical manifestations: CCF due to trauma and dural arteriovenous fistular (DAVF) in which there are small branches of carotid artery flowing directly into the carvenous sinus (CS). A 24-year-old man, had a cranial trauma 2 years ago (he has been operated for the mandibular bone fracture). Dural arteriovenous fistulas (DAVFs) of the cavernous sinus are abnormal communications between the dural branches of the internal, or external carotid arteries, or both, and the carvenous sinus. The venous route usually goes through the jugular vein from the femoral vein up to the pathologic shunts of the carvenous sinus.
The route via inferior petrosal sinus is the nearest approach and often used to go to carvenous sinus.
Dural arteriovenous fistulas exist, the ophthalmic veins will dilate and drainage blood through the facial vein then into the internal carotid vein.
Some angiography cases have been seen that the ophthalmic vein goes from the external carotid vein to the superficial temporal vein or others which can put microcatheter via this way.


We need an ophthalmic surgeons or a neuro surgeon to make a small incision on the superior interior corner of the eye directly exposed to ophthalmic vein to take embolic materials over. The advantage: glue is much cheaper than coil and embolized totally because glue is fluid and can fulfil the shunt.
The disadvantage: glue can cause occlusion of the cerebral venous sinus or go to pulmonary veins. What Is the Role of Ventriculostomy, Hemicraniectomy, and Local Thrombolysis in the Patient with Hemorrhagic Stroke?
Ophthalmic veins often drainage blood from the eyes into the carvenous sinus, when CCFs exist, the high pressure in the CS makes the flow in the CS back to the eye causing exophthalmos, dilating the vessels of cornea and sclera forming vascular rays. Angiography showed the right carotid carvenous fistula (A), the dilated ophthalmic vein drainages toward the facial vein (B). The embolization via the veinous way, the inferior petrosal sinus (not shown) was obstructed so the microcatheter had to navigate via the interior carotid vein – the facial vein into the ophthalmic vein – carvenous sinus. Exophthamos, conjunctival erythema (A), blood flows of the left anterior and middle cerebral arteries comes from anterior and posterior communicating arteries collaterally (B).
Big fistula, the prolonged disease prognosed the complicated lesion of the carotid artery-carvenous sinus, the balloon sized 9×11 mm was fully inflated (A) could not make the fistula occlusion. These cases belong to type A and those patients are treated by transvenous embolization with balloon or coils. We can go into the contralateral carvenous sinus and through the vessels conecting between two sinuses to the target carvenous sinus. The advantage of the direct approach is the shortest route to the carvenous sinus, no need to put the catheter via the femoral vein and few of interventional materials, therefore, the cost of the procedure is significantly decreased. On ultrasonography, we noted that the patient had dilatation of the right ophalmic vein, the doppler spectrum showed arterial waves. No entrance to embolize the fistula via the carotid artery because the DAVF contents too small feeding arteries. Additional, all blood in the left internal carotid artery flows into the carvenous sinus, not toward the brain (blood-steal phenomenon) (C).


After inflating 2 balloons to occlude the fistula, in angiogram, there was not any blood flowing into the carvenous sinus, the flow went toward the middle cerebral artery(B), however there was not any flow into the ophthalmic artery, so it is difficult to recover the eyesight of this patient. The advantage of this route is always available, few of anatomical variations; if there is a torn artery lesion as a complication (although very rare), then there is no cerebral haemorrhage.
However, this is the more agressived route, the patient has to undergo a surgery with endotracheal anesthesia. Patients often go to see ophthalmologist, but the examinations of eye often show normal results and there has no specific treatment.
Disadvantage, if there is a torn of IPS due to a complication (although very rare, in theory), it can cause cerebral haemorrhage. When it comes to disadvantage, that is a long route and difficult to put catheter due to venous valves, especially the sharp angle at the conection of the facial and ophthalmic veins. Microcatheter has to go from the facial vein (thick arrow and short thin arrow) through the corner to the ophthalmic vein (long thin arrow). There are 2 types of carotid carvenous fistula (CCF) with different causes, the pathologic lesion and treatment but the same clinical manifestations: CCF due to trauma and dural arterioveinous fistular (DAVF) in which there are small branches of carotid artery flowing directly into the carvenous sinus. They often have to take embolic materials into carvenous sinus to occlude the shunts because there is no access through arteries. In cases, there is no directed communication between the IPS and the CS, catheterization cannot be performed through IPS way. Some reported that few authors performed this way successfully with the number of patients who can be counted on the fingers! The superior ophthalmic vein inferior root (double arrows) is always available but cannot put the catheter in.
To diagnose this veinous variant base on angiography; in that, the IPS will appear at late phase, instead of the arterial phase like the CS.



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04.11.2013 admin



Comments to «Tinnitus due to sinus infection»

  1. baby_girl writes:
    That there are no sinister findings have.
  2. Nikotini writes:
    Your head, neck and torso respiratory infections.
  3. Devushka_Jagoza writes:
    Individuals the reduction in tinnitus continues and ALA is assistance for nerves.