• Ameet K Grewal, Han Y Kim, Richard H Comstock, Frank Berkowitz, Hung Jeffrey Kim, and Ann K Jay.
• *Department of Otolaryngology, Georgetown University Hospital; †Department of Radiology, Howard University Hospital; and ‡Department of Radiology, Georgetown University Hospital, Washington, District of Columbia, U.S.A.
• Otol. Neurotol. 2014 Jan 1;35(1):16-21.

ObjectiveSigmoid sinus diverticulum/dehiscence (SSDD) is an increasingly recognized venous cause for pulsatile tinnitus (PT). SSDD is amenable to surgical/endovascular intervention. We aim to understand the clinical and imaging features of patients with PT due to SSDD.Study DesignRetrospective CT study and chart review.SettingTertiary-care, academic center.PatientsCohort 1: 200 consecutive unique temporal bone CT were blindly reviewed for anatomic findings associated with PT. Cohort 2: 61 patients with PT were evaluated for otologic manifestations.Intervention(S)All patients underwent a temporal bone CT for evaluation of PT. Clinical information was gathered using electronic medical records.Main Outcome Measure(S)Otologic symptoms and physical findings (including body mass index (BMI), mastoid/neck bruits) were analyzed. Temporal bone CT scans were evaluated for the presence of SSDD and other possible causes of PT.ResultsCohort 1: 35 cases of SSDD were identified (18%); 10 (29%) true diverticula; and 25 (71%) dehiscence. Sixty-six percent were right sided. Twelve patients had PT (34%). Patients with SSDD are more likely to have PT (p = 0.003). A significant association between right SSDD and PT was found (p = 0.001). Cohort 2: 15 out of 61 patients had PT and CT-confirmed SSDD. All were female subjects; average age was 45 years (26-73 yr). Radiologic evaluation revealed 10 SSDD cases on the right (66.7%), 2 on the left (13.3%%), and 3 bilateral (20%). Sensorineural hearing loss was seen in 8 (53%), aural fullness in 12 (80%). Average BMI was 32.2 (21.0-59.82), and 4 (26%) had audible mastoid bruits.ConclusionSSDD may be the most common identifiable cause for PT from venous origin and is potentially treatable. Temporal bone CT scans should be included in a complete evaluation of PT.

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