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Author: admin, 15.08.2015
Dilated petrosquamosal sinus, mastoid emissary vein, and external jugular vein: A rare cause of pulsatile tinnitus, vertigo, and sensorineural hearing loss.
Around 10% of population in the USA has tinnitus and 60% of them have no diagnosis, despite extensive workup done for them. Anatomy of the mastoid emissary vein and venous system of the posterior neck region: Neurosurgical implications. The cranial venous system in man in reference to development, adult configuration, and relation to the arteries. Morphology of the temporal canal and postglenoid foramen with reference to the size of the jugular foramen in man and selected species of animals. It can be associated with conditions like drug, allergy, or systemic illness, while objective one can be heard by both patients, and examina, which most of the time is related to a vascular cause. It gets relieved occasionally after he play sports and take shower and then starts again after few hours.Vertiginous attacks for two years (lasting for 20-60 minutes), true vertigo, it was related to head movement when he turned his head to either sides, but more toward the right side, and associated with nausea, vomiting, sweating and imbalance, no change of tinnitus, no aural fullness or hearing loss during the attacks, no cardiac or neurological symptoms, no headache. Three attacks of vertigo during the first year and five attacks during the last year have been observed. The last one is the most severe one lasting for seven hours, which was two months ago and has been admitted in the hospital and was associated with hearing loss in the right ear.
Now, since the last vertiginous attack two months ago, no more attacks of vertigo have been observed, but still continues to have tinnitus and mild hearing loss, occasional imbalance mainly on the right side.
He avoids looking quickly to right or left, instead he moves the head slowly to each side because when he turns the head quickly, he experiences vertigo.
There are many causes for subjective tinnitus like labrynthitis, otits media, ototoxicity, and otosclerosis. In around 70% of the patients with this type of tinnitus, the diagnosis will be achieved by imaging studies and treatment plan can be started accordingly.


Sometimes, turbulents of blood flow can cause noise (tinnitus) which may be decreased by applying pressure to area of responsible vein.
Mastoid emissary vein connect suboccipital venous plexus to sigmoid sinus through mastoid foramen.
Then, continuation of temporal vein to external jugular vein which was also dilated in this patient with no abberant distal obstruction, the diameter of external jugular vein was 11.7 mm [Figure 4].
This explains the reason when applying pressure over the area of deep temporal vein or external jugular vein causes decrease in tinnitus pitch by 50% according to the patient and does not disappear completely due to the presence of mastoid emissary vein dilatation.
Petro-squamosalsinus was described before CT scan based on temporal bone disecssions, [4],[11] but now-a-days, CT scan give us an excellent tool to help in the diagnosis of vascular anomaly in temporal bone which is much easier and faster with detailed description of the structure. We can't explain the presence of vertigo in this patient although it was reported before, but tinnitus presentation is first time to be reported in association with petro-squamosalsinus. The combination of presence of petro-squamosalsinus, dilated mastoid vein, dilated external jugular vein, tinnitus, vertigo, and sensorineural hearing loss is first described in our patient which was not described before in the literature.In general, presence of any vascular anomaly in the temporal bone raise the hazard of surgical procedure in such patients as severe bleeding. Also, we asked him to avoid turning his head quickly to any side in order to minimize the attacks of vertigo. With the follow-up of every six months, the patient has informed us that he has been following our instructions well and that he is felling much better now with only one mild attack of vertigo over the last six months, and tinnitus is still there, but it is not annoying him anymore.
Patients with petro-squamosalsinus (PSS), dilated mastoid emissay vein, and external jugular vein may be presented with vertigo, tinnitus, and hearing loss.



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