Hypotympanic Sound Baffle for Amelioration of Pulsatile Tinnitus due to Carotid and Jugular Bulb Dehiscence

Objective: To share our experience with treating pulsatile tinnitus by insulating a dehiscent carotid artery with a hypotympanic sound baffle, and compare outcomes with a similar resurfacing approach for jugular bulb wall anomalies. Study Design: Retrospective case series. Setting: Tertiary academic medical center. Patients: Adult patients with troublesome pulsatile tinnitus with radiologic evidence of carotid artery dehiscence or jugular bulb wall anomaly within the temporal bone. Intervention: Hypotympanic exposure of vessel followed by resurfacing using hydroxyapatite cement (carotid dehiscence) or autologous tissue (jugular bulb wall anomalies). Main Outcomes Measures: Alleviation or reduction of pulsatile tinnitus. Results: Two patients presented with unilateral, debilitating pulsatile tinnitus and history and imaging consistent with carotid dehiscence and underwent hypotympanic resurfacing with hydroxyapatite cement. Both had considerable initial improvement of tinnitus, and 40% resolution of tinnitus with improved quality of life at an average follow-up of 13.5 months. Two patients with jugular bulb dehiscence/diverticulum treated by resurfacing had complete elimination of symptoms at an average follow up of 17.3 months. There were no major adverse outcomes (permanent hearing loss, vascular injury, or intracranial hypertension). Conclusion: Creation of a hypotympanic sound baffle offers promise as a means of reducing pulsatile tinnitus emanating from a dehiscent carotid artery transmitted to the tympanum, with substantial improvement in reported functional ability. Treatment of venous etiologies of pulsatile tinnitus with similar techniques demonstrates higher success rates, which may be attributable to incomplete resurfacing of carotid artery dehiscence along its extent towards the petrous apex due to safety concerns.