This month’s Ed’s choice is an interesting systematic review into the management of pulsatile tinnitus. There are impressive results from resurfacing of symptomatic anatomical abnormalities of the temporal bone and I suspect that referrals for further imaging and otology clinic waiting lists will increase as a result. Another otology review worth your attention is the prospective RCT looking at the benefit of steroids in acute vestibular neuronitis. Lastly, there is a great review of a rhinology paper measuring the absorption of cocaine following the instillation of Moffat’s solution for sinus surgery. The review details the serum peaks and decay of cocaine and its metabolites following surgery. Many thanks to our team of reviewers for keeping us up to date.
Charles Giddings FRCS(ORL-HNS), FRACS Consultant ENT, head and neck surgeon, Monash Health, Melbourne, Australia.
This systematic review aimed to review the literature on outcomes following temporal bone-resurfacing techniques for pulsatile tinnitus (PT) associated with vascular wall anomalies. PRISMA guidelines were followed. Target population were patients with PT associated with vascular wall anomalies (dehiscence or diverticulum) or aberrancy of major vasculature in temporal bone (sigmoid sinus, jugular bulb or internal carotid artery). Interventions included resurfacing and reconstruction procedures, and other methods of reducing sound transmission from vessel to cochlea. Outcomes of interest included reduction of PT and complications. Out of 959 papers, 20 studies (141 cases involving 138 patients) were included. Of these patients, 66% were right sided and 85% female, with an age range of eight to 86 years. Overall results suggest that resurfacing surgery is likely effective with a low complication rate. Out of 141 cases, 106 (75%) had complete resolution, 15 (11%) had partial resolution, 19 (13%) no resolution, and one (1%) had worsened PT. Results were also stratified according to vascular source of PT and material used. Outcomes for arterial sources showed three of five (90%) had complete resolution, and two (40%) with partial resolutions. The three with complete resolution had resurfacing with autologous material while the other two were with artificial material suggesting higher efficacy with autologous material. Stratifying by material type did not show any association with improved outcome among cases of jugular bulb or sigmoid sinus wall anomalies. Stratifying by material density did not show an association with better outcomes among all three types of vascular sources. Complications arose in 23 of 95 cases. Four were considered major in the form of sigmoid sinus compression or thrombosis. There were no reports of long-term morbidity or mortality.