Study Type
Study Type
Study Objective(Purpose of Study)
Study Objective(Purpose of Study)
Study Results
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Study Quality
1. National Institutes of Health. National Institute on Deafness and Other Communication Disorders (NIDCD). Quick Statistics. Available at: Review/Other-Dx N/A To present statics regarding deafness and other communication disorders. No results stated in abstract. 4
2. Fife TD. Neuro-otology of Systemic Disease. In: Lewis SL, ed. Neurological Disorders due to Systemic Disease. 1st ed. Oxford, UK: Wiley-Blackwell Health Sciences; 2013:145-154. Review/Other-Dx Book chapter. N/A N/A 4
3. Tunkel DE, Bauer CA, Sun GH, et al. Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg. 2014;151(2 Suppl):S1-S40. Review/Other-Dx N/A To provide evidence-based recommendations for clinicians managing patients with tinnitus. No results stated in abstract. 4
4. American College of Radiology. ACR Appropriateness Criteria®: Hearing Loss and/or Vertigo. Available at: Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for Hearing Loss and/or Vertigo. No abstract available. 4
5. American College of Radiology. ACR Appropriateness Criteria®: Head Trauma. Available at: Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. No abstract available. 4
6. American College of Radiology. ACR Appropriateness Criteria®: Cerebrovascular Disease. Available at: Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. N/A 4
7. Sonmez G, Basekim CC, Ozturk E, Gungor A, Kizilkaya E. Imaging of pulsatile tinnitus: a review of 74 patients. Clin Imaging. 2007;31(2):102-108. Review/Other-Dx 74 patients To assess the effectiveness of imaging modalities in detecting the underlying pathologies in patients with pulsatile tinnitus. The underlying pathology of tinnitus was detected in 50 patients (67.6%), and 24 patients were normal with radiologic studies. The most common cause was high jugular bulbus (21%) followed by atherosclerosis, dehiscent jugular bulbus, aneurysm of internal carotid artery, dural arteriovenous fistula, aberrant internal carotid artery, jugular diverticulum, and glomus tumor. 4
8. Alaani A, Chavda SV, Irving RM. The crucial role of imaging in determining the approach to glomus tympanicum tumours. Eur Arch Otorhinolaryngol. 2009;266(6):827-831. Review/Other-Dx 9 patients To present our management approach for tinnitus based on a series of nine cases. No results stated in abstract. 4
9. Bierry G, Riehm S, Marcellin L, Stierle JL, Veillon F. Middle ear adenomatous tumor: a not so rare glomus tympanicum-mimicking lesion. J Neuroradiol. 37(2):116-21, 2010 May. Review/Other-Dx N/A To present several radiologic and clinical findings that will help the radiologist to discriminate MEAT from GT. MEAT and GT appeared as tissular lesion with significant enhancement on CT and MR. A vascular blush was present on angiography in all cases of GT and absent from all cases of MEAT. A close relationship between the tumor and the Jacobson's nerve or its branches was identified in all cases of GT. Pulsatile tinnitus was present in all patients with GT and absent in all patients with MEAT. 4
10. Sismanis A. Pulsatile tinnitus. Otolaryngol Clin North Am. 2003;36(2):389-402, viii. Review/Other-Dx N/A To describe the different classifications of tinnitus and the approaches used to diagnose them. No results stated in abstract. 4
11. Zhao P, Wang Z, Xian J, Yan F, Liu Z. Persistent petrosquamosal sinus in adults: qualitative imaging evaluation on high-resolution CT venography. Acta Radiol. 2014;55(2):225-230. Observational-Dx 532 patients To analyze the characteristics of PSS on high-resolution CT venography (HRCTV) in order to improve imaging diagnostic accuracy as well as to assist clinical management. The average diameter of the PSS was 1.4 mm. Twenty-nine TBs (74%) had PSS origin from the dorsolateral surface of the transverse sinus before its junction with the superior petrosal sinus (Position A); three TBs (8%) had PSS origin from the ventroinferior surface of the transverse sinus after or before the junction (Position B or C); seven TBs (18%) had PSS without definite origin (Position D). Eighteen TBs (46%) had PSS course in a lateral bony canal/groove (lateral canal type); 15 TBs (38%) had PSS course in petrosquamosal fissure (PSF) (PSF type); six TBs (15%) had PSS course in both (lateral canal/PSF type). For other imaging findings, a branch entering the cranial part of PSS was identified in 10 TBs (26%); a vascular mass was formed in five TBs (13%); focal defect of bony wall was observed in seven TBs (18%). A postglenoid foramen (PGF) was detected in 25 TBs (64%). 3
12. Narvid J, Do HM, Blevins NH, Fischbein NJ. CT angiography as a screening tool for dural arteriovenous fistula in patients with pulsatile tinnitus: feasibility and test characteristics. AJNR Am J Neuroradiol. 2011;32(3):446-453. Observational-Dx 7 patients To determine the sensitivity and specificity of CTA compared with cerebral angiography for DAVF in patients presenting with PT. The presence of arterial feeders showed good test characteristics for screening, with a sensitivity of 86% (95% CI, 42-99) and a specificity of 100% (95% CI, 52-100). A shaggy sinus or tentorium was highly specific: sensitivity of 42% (95% CI, 11-79) and specificity of 100% (95% CI, 56-100). The presence of transcalvarial venous channels demonstrated a poor sensitivity of 29% (95% CI, 5-70) but a high specificity 86% (95% CI, 42-99). CT attenuation of the jugular veins showed statistically significant asymmetry in the DAVF group versus the control group (P < .05). 2
13. Spittau B, Millan DS, El-Sherifi S, et al. Dural arteriovenous fistulas of the hypoglossal canal: systematic review on imaging anatomy, clinical findings, and endovascular management. J Neurosurg. 2015;122(4):883-903. Review/Other-Tx 120 cases To describe clinical and imaging findings of HCDAVF, as well as treatment strategies and subsequent outcomes, based on a systematic literature review supplemented by the authors' own cases (120 cases total). Three major types of venous drainage are associated with distinct clinical patterns: Type 1, with anterograde drainage (62.5%), mostly presents with pulsatile tinnitus; Type 2, with retrograde drainage to the cavernous sinus and/or orbital veins (23.3%), is associated with ocular symptoms and may mimic cavernous sinus DAVF; and Type 3, with cortical and/or perimedullary drainage (14.2%), presents with either hemorrhage or cervical myelopathy. For Types 1 and 2 HCDAVF, transvenous embolization demonstrates high safety and efficacy (2.9% morbidity, 92.7% total occlusion). 4
14. Grewal AK, Kim HY, Comstock RH 3rd, Berkowitz F, Kim HJ, Jay AK. Clinical presentation and imaging findings in patients with pulsatile tinnitus and sigmoid sinus diverticulum/dehiscence. Otol Neurotol. 35(1):16-21, 2014 Jan. Review/Other-Dx 261 patients To understand the clinical and imaging features of patients with PT due to SSDD. Cohort 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. 4
15. Harvey RS, Hertzano R, Kelman SE, Eisenman DJ. Pulse-synchronous tinnitus and sigmoid sinus wall anomalies: descriptive epidemiology and the idiopathic intracranial hypertension patient population. Otol Neurotol. 2014;35(1):7-15. Review/Other-Dx 13 patients To describe the clinical features of a population of patients with sinus wall anomalies (SWA) and pulse-synchronous tinnitus (PST). hirteen patients presented with sigmoid sinus diverticulum (39.4%) and 20 (60.6%) with sinus wall dehiscence. Thirty ears were successfully treated with surgery (responders), and 3 were not (nonresponders). Responders' mean age was 38 years, with 26 female patients (92.9%) and 2 male (7.1%). BMI of responders compared with nonresponders did not differ significantly (35.5 versus 33.4 kg/m2, p = 0.08). BMI of responders was elevated compared with an asymptomatic control group (35.5 versus 27.4 kg/m2, p < 0.0001). BMI of responders did not differ significantly compared with a cohort of patients with spontaneous CSF otorrhea and temporal bone encephaloceles (35.5 versus 40.7 kg/m2, p = 0.17). 4
16. Schoeff S, Nicholas B, Mukherjee S, Kesser BW. Imaging prevalence of sigmoid sinus dehiscence among patients with and without pulsatile tinnitus. Otolaryngol Head Neck Surg. 150(5):841-6, 2014 May. Review/Other-Dx 194 patients To define the radiographic prevalence of sigmoid sinus diverticulum or dehiscence (SSDD) in patients with and without pulsatile tinnitus (PT). Within the PT group, SSDD was identified in 24% of ears (9/37) and 23% of patients (7/30); all SSDD patients were female (P = .024). Patients with SSDD were significantly younger (P = .037). SSDD more frequently caused objective tinnitus (P = .016). There was no difference in average BMI between those with and those without SSDD. In the non-PT group, SSDD was identified in 2 (both female) of 164 patients (1.2%; 0.6% of ears). The difference in SSDD prevalence between groups was significant (P < .0001). 4
17. Ellenstein A, Yusuf N, Hallett M. Middle ear myoclonus: two informative cases and a systematic discussion of myogenic tinnitus. Tremor Other Hyperkinet Mov (N Y). 2013;3. Review/Other-Dx N/A To systematically evaluate the different mechanisms and movement disorder phenomena that could lead to a diagnosis of middle ear myoclonus (MEM). From a functional neuroanatomic perspective, we explain how tensor tympani MEM is best explained as a form of peritubal myogenic tinnitus, similar to the related disorder of essential palatal tremor. From a pathogenic perspective, we discuss how MEM symptomatology may reflect different mechanical and neurologic processes. We emphasize the diagnostic imperative to recognize when myogenic tinnitus is consistent with a psychogenic origin. 4
18. Fox GN, Baer MT. Palatal myoclonus and tinnitus in children. West J Med. 1991;154(1):98-102. Review/Other-Dx 1 patient To review palatal myoclonus and tinnitus in children. No results stated in abstract. 4
19. Park SN, Bae SC, Lee GH, et al. Clinical characteristics and therapeutic response of objective tinnitus due to middle ear myoclonus: a large case series. Laryngoscope. 2013;123(10):2516-2520. Observational-Tx 58 patients To evaluate the clinical characteristics and therapeutic response of tinnitus due to middle ear myoclonus (MEM) and to suggest appropriate diagnostic methods. Patients had a mean age of 29.8 years (range, 6-70 years), 20.7% (n = 12) were <10 years old, 39.7% (n = 23) were <20 years old, 74.1% (n = 43) were <40 years old, and 5.2% (n = 3) were >/=60 years old. Remembered stressful events or noise exposure were associated with the onset of MEM in 51.8% (n = 30) and 27.6% (n = 16) of patients, respectively. The most frequent nature of the tinnitus was a crackling sound. MEM associated with forceful eyelid closure was observed in 15% of patients. Impedance audiogram and otoendoscopic examinations of the tympanic membrane were helpful tools for diagnosing MEM. With medical therapy, more than 75% of patients exhibited complete or partial remission of their tinnitus. Patients with intractable MEM who underwent sectioning of the middle ear tendons had very good outcomes. 2
20. Sinclair CF, Gurey LE, Blitzer A. Palatal myoclonus: algorithm for management with botulinum toxin based on clinical disease characteristics. Laryngoscope. 2014;124(5):1164-1169. Observational-Dx 15 patients To review the clinical characteristics and management of patients with palatal myoclonus and devise an algorithm for treatment with botulinum toxin based on presenting symptoms, clinical examination findings, and involved muscle groups. Patients were more commonly female (60.0% vs. 40.0%) with average age at onset of 35.6 years. In 40.0% of patients, the myoclonus began after a viral upper respiratory tract infection. Two-thirds of patients had been previously treated unsuccessfully with oral medications. Predominant presenting symptoms included clicking tinnitus (46.7%), nonaudible awareness of palatal movements +/- rhinolalia (20.0%), or both (33.3%). Clinical examination revealed co-incident involvement of pharyngeal musculature in 53.3%. Palatal site for initial botulinum toxin injection depended on the predominant presenting symptom: for tinnitus, 2.5 U were injected transorally into the tensor veli palatini muscle at the level of the pterygoid hamulus/lateral soft palate; for palatal movements, the injection was placed medially on either side of the uvula. Dose and location of subsequent injections were tailored depending on response to the toxin and location of subsequent observed maximal muscular contractions. 4
21. Remley KB, Coit WE, Harnsberger HR, Smoker WR, Jacobs JM, McIff EB. Pulsatile tinnitus and the vascular tympanic membrane: CT, MR, and angiographic findings. Radiology. 1990;174(2):383-389. Review/Other-Dx 107 patients To identify the frequency and types of lesions, to construct an imaging algorithm utilizing basic historical and physical examination information, and to define the role of MR imaging in the diagnostic evaluation. Of the 100 patients with pulsatile tinnitus, 25 had objective tinnitus. A vascular tympanic membrane was present in 37 cases (35%). Normal vascular variants were present in 23 patients (21%). Twenty-seven patients (25%) had acquired vascular lesions. Temporal bone tumors were found in 33 patients (31%). No abnormality was identified in 21 cases (20%). 4
22. Willinsky RA. Tinnitus: imaging algorithms. Can Assoc Radiol J. 1992;43(2):93-99. Review/Other-Dx N/A To review imaging algorithms based on symptoms and signs. For patients with nonpulsatile tinnitus and a normal drum, magnetic resonance imaging is preferred if a retrocochlear lesion is suspected, whereas high-resolution computed tomography (HRCT) is recommended if a cochlear abnormality is likely. If a chronic inflammation in the middle ear is suspected, HRCT is the study of choice to differentiate cholesteatoma from chronic otitis media. If the bruit is objective and the tympanic membrane normal, selective cerebral angiography should be the initial investigation, because most such patients have an acquired vascular abnormality, usually a dural arteriovenous fistula. If there is pulsatile tinnitus and a retrotympanic mass, HRCT should be the first examination because this technique allows differentiation of a vascular variation, such as an aberrant carotid artery or jugular dehiscence, from a paraganglioma. 4
23. Hillman TA, Kertesz TR, Hadley K, Shelton C. Reversible peripheral vestibulopathy: the treatment of superior canal dehiscence. Otolaryngol Head Neck Surg. 2006;134(3):431-436. Observational-Tx 30 patients To review cases of SCD found at our institution and report their presentation, workup, and response to therapy. Thirty patients were identified with SCD. Patients presented with chronic disequilibrium (63%), Tullio's phenomenon (41%), pressure evoked vertigo (44%), hearing loss (30%), and pulsatile tinnitus (7%). ENG performed early in our series revealed abnormal nystagmus with sound presentation, Valsalva, or tympanogram; however, history and CT examination alone was used to identify this condition in most of our patients. Twenty-seven of the 30 patients had some symptoms related to SCD; the other 3 were found to have incidental SCD on CT examination. Of these patients, 14 had severe enough symptoms to warrant operative intervention. All, but one had resolution of their symptoms after completion of intervention. 3
24. Ceylan N, Bayraktaroglu S, Alper H, et al. CT imaging of superior semicircular canal dehiscence: added value of reformatted images. Acta Otolaryngol. 2010;130(9):996-1001. Review/Other-Dx 93 patients To investigate prevalence of SSCD, its length and its correlation with symptoms in patients who had previously undergone temporal bone CT examination that was reported normal and to demonstrate the importance of reformatted images in the diagnosis of SSCD. Ninety-three patients were included in the study. Nineteen patients with semicircular canal dehiscence were detected. The mean age of the study group was 45 years. Radiologic evidence of SSCD occurred in 23 of 186 temporal bones with a radiologic prevalence of 12%. The most common symptoms in dehiscent patients were vertigo, hearing loss and tinnitus. Defect lengths varied between 1 mm and 6.5 mm. 4
25. Cho IK, Jung JY, Yoo DS, Suh MW. 3-Dimensional reconstruction of the venous system in patients suffering from pulsatile tinnitus. Acta Otolaryngol. 2012;132(3):285-289. Observational-Dx 11 patients and 12 normal control ears To compare, through 3D-reformatted images of the intracranial venous system, the volume, cross-sectional area, and caliber changes in patients with PT and normal controls. The L/S ratio was significantly increased in the PT group (5.01), compared with the control group (3.42). When the threshold value of the L/S ratio was assessed by the ROC method, 4.75 seemed to be the significant dissecting point. The sensitivity of this method was 0.64 and the specificity was 0.83. 3
26. Liu Z, Chen C, Wang Z, et al. Sigmoid sinus diverticulum and pulsatile tinnitus: analysis of CT scans from 15 cases. Acta Radiol. 54(7):812-6, 2013 Sep. Observational-Dx 15 patients To examine the computed tomography (CT) characteristics of sigmoid sinus diverticulum accompanied with PT. Sigmoid sinus diverticulum was located on the same side of PT in 15 patients. Diverticula originated at the superior curve of the sigmoid sinus in 11 patients and the descending segment of the sigmoid sinus in four patients. Sigmoid sinus diverticula focally eroded into the adjacent mastoid air cells in 12 patients and mastoid cortex in three patients. Among eight patients with unilateral dominant brain venous systems, the diverticula were seen on the dominant side in seven patients and non-dominant side in one patient. In contrast, the other seven patients showed co-dominant brain venous systems, with three presenting diverticula on the right side and four on the left. More notably, dehiscent sigmoid plate on the PT side was demonstrated in all patients. In addition, temporal bone hyper-pneumatization was found in nine patients, good and moderate pneumatization in three patients, respectively. 4
27. Mattox DE, Hudgins P. Algorithm for evaluation of pulsatile tinnitus. Acta Otolaryngol. 2008;128(4):427-431. Review/Other-Dx 54 patients To evaluate the incidence of identifiable anomalies in patients with pulsatile tinnitus. Fifty-four patients were seen between January 2002 and June 2007 with the chief complaint of constant pulsatile tinnitus, excluding those with chemodectomas. On the basis of physical examination and imaging, 14 were considered arterial, 23 venous, and 15 were indeterminate in origin. Among patients with venous tinnitus, sigmoid sinus diverticulum was the most common finding. Among patients with arterial tinnitus, carotid atherosclerotic disease was the most common. One patient had erosion of the cochlea by the carotid artery. Non-vascular entities identified include superior semicircular canal dehiscence and benign intracranial hypertension. 4
28. Krishnan A, Mattox DE, Fountain AJ, Hudgins PA. CT arteriography and venography in pulsatile tinnitus: preliminary results. AJNR Am J Neuroradiol. 2006;27(8):1635-1638. Observational-Dx 16 patients To evaluate the utility of CTA/V in the imaging work-up of PT. Seven of the 16 patients had lesions on CTA/V that could account for their PT. Examples of pathologic conditions in the series included a significantly dominant venous system, a venous diverticulum with stricture, and a transverse sinus stenosis. 4
29. Pelkonen O, Tikkakoski T, Luotonen J, Sotaniemi K. Pulsatile tinnitus as a symptom of cervicocephalic arterial dissection. J Laryngol Otol. 2004;118(3):193-198. Review/Other-Dx 136 consecutive patients To investigate pulsatile tinnitus as a presenting symptom in cervicocephalic arterial dissection (CCAD). Of the 136 consecutive patients with confirmed CCAD, 16 presented with pulsatile tinnitus. On admission 10 patients presented with subjective tinnitus and five with objective tinnitus, tinnitus being the only presenting symptom in one case. In one further case with bilateral ICA dissection (ICAD) subjective tinnitus appeared three months after the initial symptoms of arterial dissection, despite a contralateral cervical bruit being evident on admission. Thirteen patients presented with headache or neck pain. Ischaemic symptoms were detected in six and Horner's syndrome in four patients. Vertigo and dysgeusia were reported in two patients each. Arterial dissection involved unilateral ICA in 11, bilateral ICA in two, unilateral vertebral artery (VA) in two and bilateral ICA and bilateral VA in one patient. In angiography the most common finding was irregular stenosis, and the majority of these abnormalities normalized during follow-up. To avoid delay in diagnosis a high index of suspicion and early angiography (digital subtraction or magnetic resonance angiography) are warranted. 4
30. von Babo M, De Marchis GM, Sarikaya H, et al. Differences and similarities between spontaneous dissections of the internal carotid artery and the vertebral artery. Stroke. 2013;44(6):1537-1542. Observational-Dx 970 patients To compare potential risk factors, clinical symptoms, diagnostic delay, and 3-month outcome between spontaneous internal carotid artery dissection (sICAD) and spontaneous vertebral artery dissection (sVAD). Patients with sICAD were older (46.3 +/- 9.6 versus 42.0 +/- 10.2 years; P<0.001), more often men (62.7% versus 53.0%; P=0.004), and presented more frequently with tinnitus (10.9% versus 3.4%; P<0.001) and more severe ischemic strokes (median National Institutes of Health Stroke Scale, 10 +/- 7.1 versus 5 +/- 5.9; P<0.001). Patients with sVAD had more often bilateral dissections (15.2% versus 7.6%; P<0.001) and were more often smokers (36.0% versus 28.7%; P=0.007). Thunderclap headache (9.2% versus 3.6%; P=0.001) and neck pain were more common (65.8% versus 33.5%; P<0.001) in sVAD. Subarachnoid hemorrhage (6.0% versus 0.6%; P<0.001) and ischemic stroke (69.5% versus 52.2%; P<0.001) were more frequent in sVAD. After multivariate analysis, sex difference lost its significance (P=0.21), and all other variables remained significant. Time to diagnosis was similar in sICAD and sVAD and improved between 2001 and 2012 compared with the previous 10-year period (8.0 +/- 10.5 days versus 10.7 +/- 13.2 days; P=0.004). In sVAD, favorable outcome 3 months after ischemic stroke (modified Rankin Scale, 0-2: 88.8% versus 58.4%; P<0.001), recurrent transient ischemic attack (4.8% versus 1.1%; P=0.001), and recurrent ischemic stroke (2.8% versus 0.7%; P=0.02) within 3 months were more frequent. 3
31. Deuschl C, Goricke S, Gramsch C, et al. Value of DSA in the diagnostic workup of pulsatile tinnitus. PLoS One. 2015;10(2):e0117814. Observational-Dx 54 patients To evaluate the diagnostic impact of DSA in the diagnostic workup of patients with PT in comparison to MRI alone. 37 of the 54 patients revealed a pathology explaining PT on MRI, which was detected by the readers in 100% and proofed by means of DSA. 24 dAVF, four paraganglioma, two AVM and seven more pathologies were described. All patients without pathology on MRI did also not show any pathology in DSA. 3
32. Noguchi K, Melhem ER, Kanazawa T, Kubo M, Kuwayama N, Seto H. Intracranial dural arteriovenous fistulas: evaluation with combined 3D time-of-flight MR angiography and MR digital subtraction angiography. AJR Am J Roentgenol. 2004;182(1):183-190. Observational-Dx 17 MR angiograms in 15 patients and 35 MR angiograms in 35 controls To compare the diagnostic utility of 3D time-of-flight (TOF) MR angiography and MR digital subtraction angiography in patients with angiographically proven moderate- to high-flow intracranial dural arteriovenous fistula. In patients with dural arteriovenous fistula, source images of 3D TOF MR angiography showed two abnormal findings: multiple high-intensity curvilinear or nodular structures adjacent to the sinus wall and high-intensity areas in the venous sinus. Findings of multiple high-intensity structures adjacent to the sinus wall were observed in all cases of dural arteriovenous fistula. Findings of high-intensity areas in the venous sinus were observed in 13 of 17 cases of dural arteriovenous fistula. Findings of multiple high-intensity structures adjacent to the sinus wall were not observed in any control subjects. Findings of high-intensity areas within the venous sinus were observed in five of 35 control subjects. Findings of MR digital subtraction angiography showed early filling of the venous sinus, suggestive of dural arteriovenous fistula, in 13 of 15 patients with dural arteriovenous fistula. Sensitivity and specificity of multiple high-intensity structures adjacent to the sinus wall, high-intensity areas in the venous sinus, and early filling of the venous sinus were 100% and 100%, 76% and 86%, and 87% and 100%, respectively. Although 3D TOF MR angiography failed to show the findings of retrograde cortical venous drainage and venous sinus occlusion, MR digital subtraction angiography clearly showed both findings in all five subjects. 2
33. Guevara N, Deveze A, Buza V, Laffont B, Magnan J. Microvascular decompression of cochlear nerve for tinnitus incapacity: pre-surgical data, surgical analyses and long-term follow-up of 15 patients. Eur Arch Otorhinolaryngol. 2008;265(4):397-401. Review/Other-Dx 15 patients To select a homogeneous group of patients suffering from incapacitating tinnitus who underwent endoscopy-assisted microvascular decompression through a retrosigmoid keyhole approach. During the surgery, a vascular compression was found on every patient. In a long-term follow-up, 53.3% (8 cases) of our tinnitus cases improved and 20% (3 cases) of them were completely cured. The ABR returned to normal in all patients who had good clinical results (diminished or disappeared tinnitus). When a vertebral artery loop (5 cases) was concerned we obtained 80% of good clinical results. No one showed amelioration or sudden aggravation of their hearing. Three cases required surgical correction of cerebrospinal fluid leak and one case developed spontaneously regressive swallowing problems. Such microvascular decompression surgery of the cochlear nerve appears to be successful in treating incapaciting tinnitus in particular when a vertebral artery loop is observed. Therefore, in such a case, one might recommend neurovascular decompression surgery, keeping in mind that the complications of this surgery should be minimized by a careful closure of the retrosigmoid approach. In order to ensure a better selection of patient more accurate cochlear nerve monitoring and functional MRI should be a promising assessment. 4
34. Nowe V, De Ridder D, Van de Heyning PH, et al. Does the location of a vascular loop in the cerebellopontine angle explain pulsatile and non-pulsatile tinnitus? Eur Radiol. 2004;14(12):2282-2289. Observational-Dx 47 patients To investigate patients with unexplained pulsatile and non-pulsatile tinnitus by means of MR imaging of the cerebellopontine angle (CPA) and to correlate the clinical subtype of tinnitus with the location of a blood vessel (in the internal auditory canal or at the cisternal part of the VIIIth cranial nerve). High-resolution T2-weighted CISS images of the CPA demonstrate a significantly higher number of vascular loops in the internal auditory canal in patients with pulsatile tinnitus. Virtual endoscopy of the CPA provides a non-invasive view of the anatomical relationships between nerves and blood vessels and can be of use to demonstrate vascular contacts with the cisternal part of the VIIIth cranial nerve in patients with non-pulsatile tinnitus. Our findings indicate that in some patients with non-pulsatile tinnitus, the location of the blood vessel impinging on the cisternal segment of the VIIIth cranial nerve can be correlated with the clinical subtype of tinnitus (high pitch and low pitch). Furthermore, we found a correlation between the clinical presentation of tinnitus (high pitch and low pitch) and the perceptive hearing loss in patients with non-pulsatile tinnitus. 3
35. Chadha NK, Weiner GM. Vascular loops causing otological symptoms: a systematic review and meta-analysis. Clin Otolaryngol. 2008;33(1):5-11. Meta-analysis 5 studies To determine evidence for a relationship between vascular loops in contact with the vestibulocochlear nerve (CN VIII) and otological symptoms. Five case-control studies included. A statistically significant association was demonstrated for the prevalence of vascular loops in contact with CN VIII, with unilateral sensorineural hearing loss: pooled odds ratio (OR) 2.0 [95% confidence interval (CI): 1.5-2.6]. No association was demonstrated for non-pulsatile tinnitus. A highly significant association with vascular loops was shown in subjects having pulsatile tinnitus, with pooled OR: 78.8 (95% CI: 10.9-821.8). M
36. Yeh SJ, Tsai LK, Jeng JS. Clinical and carotid ultrasonographic features of intracranial dural arteriovenous fistulas in patients with and without Pulsatile Tinnitus. J Neuroimaging. 2010;20(4):354-358. Observational-Dx 67 patients To characterize the clinical and ultrasonographic features of DAVF in patients with pulsatile tinnitus. Pulsatile tinnitus was highly associated with the location and feeding arteries of DAVF (P < .001). The sensitivity of resistive index (RI; Norm, >.72) and end diastolic velocity (EDV; Norm, <21 cm/sec) of external carotid artery (ECA) in CDS study for diagnosing DAVF in patients with pulsatile tinnitus was 95% and 92%, respectively. Changes of RI and EDV of ECA also correlated with the changes of tinnitus status. 3
37. Gimsing S. Vestibular schwannoma: when to look for it? J Laryngol Otol. 2010;124(3):258-264. Observational-Dx 199 vestibular schwannoma patients and 225 non-tumour patients To compare audiometric parameters in patients with vestibular schwannoma and in those with asymmetric hearing loss from other causes; and to assess proposed screening criteria by comparing published protocols. Vestibular schwannoma and non-tumour patients with little or no hearing loss in the unaffected ear were inseparable; however, vestibular schwannoma patients with hearing loss in the unaffected ear had greater audiometric asymmetry, compared with non-tumour patients with the same pattern of hearing loss. The sensitivity of screening protocols varied from 73 to 100 per cent; parallelism was observed between sensitivity and screening rate. 3
38. Jiang ZY, Kutz JW, Jr., Roland PS, Isaacson B. Intracochlear schwannomas confined to the otic capsule. Otol Neurotol. 2011;32(7):1175-1179. Review/Other-Dx 10 cases To determine the natural history and management for patients with intracochlear schwannomas. Hearing loss was present in all 10 patients at their initial presentation. Tinnitus was present in 50% of patients, and vertigo was present in 30% of patients. No patient presented with aural fullness or facial weakness. The pattern of hearing loss seemed to correlate with the location of the lesion within the cochlea. Of the 9 patients that had follow-up MRIs, 3 patients showed tumor growth. Two of the 10 patients underwent surgical excision for intractable vertigo that resulted in resolution of symptoms 4
39. Springborg JB, Poulsgaard L, Thomsen J. Nonvestibular schwannoma tumors in the cerebellopontine angle: a structured approach and management guidelines. Skull Base. 2008;18(4):217-227. Review/Other-Dx N/A To provide a structured approach to the diagnosis of nonvestibular schwannoma cerebellopontine angle (CPA) lesions and also management guidelines. No results listed in abstract. 4
40. van de Langenberg R, de Bondt BJ, Nelemans PJ, Dohmen AJ, Baumert BG, Stokroos RJ. Predictors of volumetric growth and auditory deterioration in vestibular schwannomas followed in a wait and scan policy. Otol Neurotol. 2011;32(2):338-344. Observational-Dx 63 patients To identify factors predicting growth and audiologic deterioration during follow-up (FU) in a wait and scan (W&S) policy of vestibular schwannomas (VSs) using a novel volumetric measuring tool. Labyrinthine hypointensity on T2-weighted magnetic resonance images and complaints of hearing loss at presentation are predictive of a faster deterioration of hearing (p < 0.05). Growth during the first FU year predicts further growth. Vestibular schwannoma volume does not correlate with audiologic deterioration significantly. 4
41. Chole RA, Parker WS. Tinnitus and vertigo in patients with temporomandibular disorder. Arch Otolaryngol Head Neck Surg. 1992;118(8):817-821. Review/Other-Dx 1032 patients To observe tinnitus and vertigo in patients with temporomandibular disorder No results listed in abstract. 4
42. Lee CF, Lin MC, Lin HT, Lin CL, Wang TC, Kao CH. Increased risk of tinnitus in patients with temporomandibular disorder: a retrospective population-based cohort study. Eur Arch Otorhinolaryngol. 2016;273(1):203-208. Review/Other-Dx 37,925 patients To determine whether there is an increased risk of tinnitus in patients with temporomandibular joint (TMJ). A higher proportion of TMJ disorder patients suffered from hearing loss (5.30 vs. 2.11 %), and degenerative and vascular ear disorders (0.20 vs. 0.08 %) compared with the control patients. The crude hazard ratio (HR) of tinnitus in the TMJ disorder cohort was 2.73-fold higher than that in the control patients, with an adjusted HR of 2.62 (95 % CI = 2.29-3.00). The comorbidity-specific TMJ disorder cohort to the control patients' adjusted HR of tinnitus was higher for patients without comorbidity (adjusted HR = 2.75, 95 % CI = 2.39-3.17). We also observed a 3.22-fold significantly higher relative risk of developing tinnitus within the 3-year follow-up period (95 % CI = 2.67-3.89). 4
43. Park RJ, Moon JD. Prevalence and risk factors of tinnitus: the Korean National Health and Nutrition Examination Survey 2010-2011, a cross-sectional study. Clin Otolaryngol. 2014;39(2):89-94. Review/Other-Dx 10,061 individuals To examine the association between tinnitus and several potential risk factors in Korean population. Of the 10,061 participants ranging from 20 to 97 years old, the overall prevalence of any tinnitus was 21.4% and annoying tinnitus was 7.3%. In a multivariable logistic regression model, the following factors were associated with having tinnitus: occupational noise exposure [any tinnitus, odd ratio (OR) = 1.34; annoying tinnitus, OR = 1.47], non-occupational noise exposure (any tinnitus, OR = 1.48; annoying tinnitus, OR = 2.02), hearing impairment (any tinnitus, OR = 2.27; annoying tinnitus, OR = 3.61), chronic otitis media (any tinnitus, OR = 1.53; annoying tinnitus, OR = 1.36), chronic rhinosinusitis (any tinnitus, OR = 1.38; annoying tinnitus, OR = 1.38), temporomandibular disorder (any tinnitus, OR = 1.69; annoying tinnitus, OR = 1.90), depression (any tinnitus, OR = 1.44; annoying tinnitus, OR = 1.70), and higher stress level (any tinnitus, OR = 1.28; annoying tinnitus, OR = 1.76). 4
44. Vernon J, Griest S, Press L. Attributes of tinnitus that may predict temporomandibular joint dysfunction. Cranio. 1992;10(4):282-287; discussion 287-288. Review/Other-Dx 1002 patients To describe attributes of tinnitus that may predict temporomendibular joint dysfunction. No results listed in abstract. 4
45. Pyykko I, Zou J, Poe D, Nakashima T, Naganawa S. Magnetic resonance imaging of the inner ear in Meniere's disease. Otolaryngol Clin North Am. 2010;43(5):1059-1080. Review/Other-Dx N/A A critical review of the recent advancements in the inner ear MRI technology, contrast agent application and the correlated ototoxicity study, and the uptake dynamics of GdC in the inner ear. GdC causes inflammation of the mucosa of the middle ear, but there are no reports or evidence of toxicity-related changes in vivo either in animals or in humans. Intravenously administered GdC reached the guinea pig cochlea about 10 minutes after administration and loaded the scala tympani and scala vestibuli with the peak at 60 minutes. However, the perilymphatic loading peak was 80 to 100 minutes in mice after intravenous administration of GdC. In healthy animals the scala media did not load GdC. In mice in which GdC was administered topically onto the round window, loading of the cochlea peaked at 4 hours, at which time it reached the apex. The initial portions of the organ to be filled were the basal turn of the cochlea and vestibule. In animal models with endolymphatic hydrops (EH), bulging of the Reissner's membrane was observed as deficit of GdC in the scala vestibuli. Histologically the degree of bulging correlated with the MR images. In animals with immune reaction-induced EH, MRI showed that EH could be limited to restricted regions of the inner ear, and in the same inner ear both EH and leakage of GdC into the scala media were visualized. More than 100 inner ear MRI scans have been performed to date in humans. Loading of GdC followed the pattern seen in animals, but the time frame was different. In intravenous delivery of double-dose GdC, the inner ear compartments were visualized after 4 hours. The uptake pattern of GdC in the perilymph of humans between 2 hours and 7 hours after local delivery needs to be clarified. In almost all patients with probable or suspected Meniere's disease, EH was verified. Specific algorithms with a 12-pole coil using fluid attenuation inversion recovery sequences are recommended for initial imaging in humans. 4
46. Wu Q, Dai C, Zhao M, Sha Y. The correlation between symptoms of definite Meniere&#39;s disease and endolymphatic hydrops visualized by magnetic resonance imaging. Laryngoscope. 126(4):974-9, 2016 Apr. Observational-Dx 54 patients To investigate the correlation between a battery of diagnostic symptoms of definite Meniere's disease (MD) and the degree of endolymphatic hydrops (EH) in the inner ear. Various degrees of EH were observed in the vestibule and/or each turn of the cochlea in the affected ears of all patients. The duration of MD disease and low-tone and middle-tone hearing thresholds were proportional to the extent of EH in the vestibule and cochlear. However, no significant correlation was demonstrated between EH and other aspects of symptoms such as high-tone hearing loss, tinnitus, and aural fullness. Of all subjects, 16.7% exhibited bilateral EH on MRI exam who were diagnosed with unilateral MD based on diagnostic criteria. 3
47. Han L, Zhaohui L, Fei Y, et al. Disrupted neural activity in unilateral vascular pulsatile tinnitus patients in the early stage of disease: evidence from resting-state fMRI. Prog Neuropsychopharmacol Biol Psychiatry. 2015;59:91-99. Observational-Dx 34 patients and 34 controls To investigate changes in spontaneous brain activity among patients with unilateral pulsatile tinnitus in the early stage of disease (less than forty-eight months) and determine the relationship of these changes with clinical data. Compared with normal controls, the patients with PT had significantly increased ReHo and ALFF in the posterior cingulate cortex, right inferior parietal lobule (IPL) and right cerebellum posterior lobe. The PT group showed increased ReHo in the posterior cingulate cortex (PCC), precuneus, right IPL, right superior frontal gyrus, some occipital areas and part of the right cerebellum posterior lobe. For ALFF, the increased clusters were in the PCC and precuneus and in some areas of the cerebellum posterior lobe, bilateral IPL and inferior frontal gyrus (IFG). Increased PT duration was correlated with increased ALFF in the bilateral inferior frontal gyrus (IFG) and precuneus. An increased THI score was correlated with ReHo and ALFF values in the precuneus. 3
48. Zobay O, Palmer AR, Hall DA, Sereda M, Adjamian P. Source space estimation of oscillatory power and brain connectivity in tinnitus. PLoS One. 2015;10(3):e0120123. Observational-Dx 28 patients and 19 controls To compare resting-state oscillatory activity of tinnitus participants and normal-hearing controls to examine effects on spectral power as well as functional and effective connectivity. We find increased functional connectivity within the auditory cortices in the alpha band. A significant increase is also found for the effective connectivity from a global brain network to the auditory cortices in the alpha and beta bands. 3
49. Chen YC, Xia W, Feng Y, et al. Altered interhemispheric functional coordination in chronic tinnitus patients. Biomed Res Int. 2015;2015:345647. Review/Other-Dx 28 patients and 30 controls To investigate interhemispheric functional coordination in tinnitus patients and to study the relationships between altered interhemispheric functional connectivity and other tinnitus characteristics Compared to the controls, tinnitus patients showed significantly increased VMHC in the middle temporal gyrus, middle frontal gyrus, and superior occipital gyrus. In tinnitus patients, a positive correlation was found between tinnitus duration and VMHC of the uncus. Moreover, correlations between VMHC changes and tinnitus distress were observed in the transverse temporal gyrus, superior temporal pole, precentral gyrus, and calcarine cortex. 4
50. Chen YC, Zhang J, Li XW, et al. Altered intra- and interregional synchronization in resting-state cerebral networks associated with chronic tinnitus. Neural Plast. 2015;2015:475382. Observational-Dx 29 patients and 30 controls To compare the resting-state functional magnetic resonance imaging (fMRI) patterns of tinnitus patients and healthy controls and identify aberrant neural networks involved in chronic tinnitus, Relative to healthy controls, tinnitus patients had significant greater ReHo values in several brain regions including the bilateral anterior insula (AI), left inferior frontal gyrus, and right supramarginal gyrus. Furthermore, the left AI showed enhanced functional connectivity with the left middle frontal gyrus (MFG), while the right AI had enhanced functional connectivity with the right MFG; these measures were positively correlated with Tinnitus Handicap Questionnaires (r = 0.459, P = 0.012 and r = 0.479, P = 0.009, resp.). 3
51. de Aguiar PH, Zicarelli CA, Isolan G, et al. Brainstem cavernomas: a surgical challenge. Einstein (Sao Paulo). 2012;10(1):67-73. Review/Other-Tx 13 patients To present the authors’ experience in brainstem cavernomas surgery, and compare it with literature data. The mean age was 42.4 years (ranging from 19 to 70). No predominant gender: male-to-female ratio, 6:7. Pontine cases were more frequent. Magnetic resonance imaging was used as the imaging method to diagnose cavernomas in all cases. The mean follow-up was 71.3 months (range of 1 to 138 months). Clinical presentation was a single cranial nerve deficit, VIII paresis, tinnitus and hearing loss (69.2%). All 13 patients underwent resection of the symptomatic brainstem cavernoma. Complete removal was accomplished in 11 patients. Morbidity and mortality were 15.3 and 7.6%, respectively. 4
52. Saito N, Watanabe M, Liao J, et al. Clinical and radiologic findings of inner ear involvement in sickle cell disease. AJNR Am J Neuroradiol. 2011;32(11):2160-2164. Review/Other-Dx 89 patients To examine the prevalence of inner ear involvement and to assess the relationship between clinical and imaging findings in patients with SCD. Among 89 patients with SCD identified (41 males, 48 females), 17 patients (14 males, 3 females; 10-48 years old) underwent imaging evaluation for inner ear complaints, including SNHL, dizziness, vertigo, and tinnitus. LH was identified in 3 patients (3 males) and LO was identified in another 3 patients (2 males, 1 female). All patients with LH had sickle-hemoglobin C disease, whereas those with LO consisted of 2 patients homozygous for HbS (2) and 1 with HbS/beta-thalassemia. Patients with LH presented with vestibular symptoms (2 vertigo, 1 dizziness), whereas patients with LO presented with SNHL. LH was seen in the basal turn of cochlea and vestibule, whereas LO involved the lateral semicircular canal. 4
53. Shulman A, Goldstein B, Strashun AM. Central nervous system neurodegeneration and tinnitus: a clinical experience. Part I: Diagnosis. Int Tinnitus J. 2007;13(2):118-131. Review/Other-Dx 96 patients A retrospective review and analysis of consecutive tinnitus patients. Of these 96 patients, 54 had SIT of the predominantly central type and of these, 18 (ages 39-75 years) were recommended for nuclear medicine imaging (single-photon emission computed tomography [SPECT] and fluorodeoxyglucose-positron emission tomography/computed tomography [FDG-PET/CT]). Patient selection for nuclear medicine imaging fulfilled the criteria of a medical-audiological ND tinnitus profile: completion of a patient protocol that diagnosed a predominantly central-type, severe, disabling, subjective, idiopathic tinnitus lasting in excess of 1 year, and failure of existing modalities of treatment attempting tinnitus relief. In 16 of the 18 patients, objective evidence of ND was reported in multiple neural substrates of brain obtained with SPECT or FDG-PET/CT of brain. Classification of CNS ND and tinnitus differentiated between (1) ND of nonspecific or unknown etiology; (2) ND manifested by perfusion asymmetries in brain associated with ischemia (n = 11/18); and (3) neurodegenerative CNS disease consistent with nuclear medicine criteria for senile dementia of the Alzheimer's type (n = 5/18). The diagnosis has been associated with cerebrovascular disease (n = 16/18). The identification of neurodegenerative CNS disease in a selected cohort of patients with subjective idiopathic tinnitus as a soft sign of such CNS disease has implications for diagnosis and treatment. 4
54. Arai M, Takada T, Nozue M. Orthostatic tinnitus: an otological presentation of spontaneous intracranial hypotension. Auris Nasus Larynx. 2003;30(1):85-87. Observational-Dx 1 patient To report a case of spontaneous intracranial hypotension with orthostatic tinnitus. Cranial MRI with gadolinium infusion showed diffuse enhancement of the dura mater. Radionuclide cisternography demonstrated CSF leaks at the upper and lower thoracic levels. Epidural blood patches at these leak sites alleviated the orthostatic headache, however, orthostatic tinnitus and muffled hearing persisted. Initial audiometry was unremarkable; repeat audiometry performed 6 weeks later demonstrated low-frequency hearing loss in the right ear. Continuous epidural saline infusion for 3 consecutive days was performed; auditory symptoms disappeared 4 weeks thereafter. 4
55. Ferrante E, Savino A, Sances G, Nappi G. Spontaneous intracranial hypotension syndrome: report of twelve cases. Headache. 2004;44(6):615-622. Review/Other-Dx 12 patients To investigate clinical, MRI, and radioisotope findings and therapeutic outcome of the syndrome of spontaneous intracranial hypotension (SIH). Eleven patients presented orthostatic headache, one patient had continuous nonpostural headache. Additional clinical symptoms included nausea, vomiting, tinnitus, diplopia, and back pain. All the patients had low CSF opening pressure, seven had increased CSF albumin, and four had pleocytosis. Brain MRI showed diffuse pachymeningeal gadolinium enhancement. Other features included subdural fluid collections (hematoma/hygroma) in four patients, downward displacement of the brain in four patients, and enlargement of the pituitary gland in one patient. Radioisotope cisternography results indicated, in two patients, a CSF leakage site in the cervico-thoracic region, and in one patient showed limited ascent of the tracer to the cerebral convexity and early appearance of radioisotope in the bladder. All the patients had complete resolution of headache with conservative treatment. 4
56. Isildak H, Albayram S. Spontaneous intracranial hypotension syndrome accompanied by bilateral hearing loss and venous engorgement in the internal acoustic canal and positional change of audiography. J Craniofac Surg. 2010;21(1):165-167. Review/Other-Dx 1 patient To describe spontaneous intracranial hypotension (SIH) as a curable reason of hearing loss, tinnitus, and vertigo. Spontaneous intracranial hypotension, which may cause Meniere syndrome-like symptoms, is a curable reason of hearing loss, tinnitus, and vertigo. In addition, the fluctuation of the hearing loss with positional changes supports the use of positional audiometry when evaluating hearing loss-related SIH. Venous engorgement in the internal acoustic canal may be related to the symptoms. 4
57. Falcioni M, Taibah A, Rohit. Pulsatile tinnitus as a rare presenting symptom of residual cholesteatoma. J Laryngol Otol. 2004;118(2):165-166. Review/Other-Dx 1 patient To present a case of residual cholesteatoma with pulsatile tinnitus, nine years after the first surgery. No results stated in abstract. 4
58. Lao Z, Sha Y, Chen B, Dai CF, Huang WH, Cheng YS. Labyrinthine sequestrum: four case studies. Otolaryngol Head Neck Surg. 147(3):535-7, 2012 Sep. Review/Other-Tx 4 patients To present 4 case studies of patients with labyrinthine sequestrum. Imaging studies showed an osteolytic soft mass with calcified debris in the inner ear, and the bony labyrinth was eroded partly or completely by granulation mass, with loss of bony morphology. Further pathological examination was coincident with inflammatory granulation tissue with some calcification or osseous tissue. The disease process is attributed to chronic osteomyelitis due to the presence of osteonecrosis. Prompt CT and MRI examinations and optimal therapeutic management facilitate definitive diagnosis and protect against fatal complications. 4
59. Yamashita K, Yoshiura T, Hiwatashi A, et al. The radiological diagnosis of fenestral otosclerosis: the utility of histogram analysis using multidetector row CT. Eur Arch Otorhinolaryngol. 2014;271(12):3277-3282. Observational-Dx 38 patients and 30 controls To evaluate the utility of CT histogram analysis in diagnosing fenestral otosclerosis. The number of pixels below mean minus SD in the control (%Lowcont) and total subjects (%Lowtotal) were also compared. In addition, the area under the receiver operating characteristic curves (AUC) value for the discrimination between otosclerosis patients and normal controls was calculated. 51 temporal bones of 38 patients with otosclerosis and 30 temporal bones of 30 control subjects were included. The mean CT value was significantly lower in otosclerosis cases than in normal controls (p < 0.01). In addition, variance, entropy, %Lowcont and %Lowtotal were significantly higher in otosclerosis cases than in normal controls (p < 0.01, respectively). The AUC values for the mean CT value, %Lowcont and %Lowtotal were 0.751, 0.760 and 0.765, respectively. 3
60. Samii M, Nakamura M, Mirzai S, Vorkapic P, Cervio A. Cavernous angiomas within the internal auditory canal. J Neurosurg. 2006;105(4):581-587. Review/Other-Dx 7 patients To describe the symptomatology, radiological features, and surgical treatment of patients with cavernous angiomas within the internal auditory canal (IAC). Cavernous angiomas of the IAC are very uncommon lesions that can imitate the symptoms of VSs. Although it is the most sensitive study available, MR imaging does not show sufficiently specific findings to differentiate the two lesion types. Thus, the preoperative diagnosis must be based on patient symptoms plus the CT and MR imaging features. 4
61. Nowe V, Van de Heyning P, Parizel PM. MRI in patients with otovestibular complaints of unknown origin. B-ENT. 2007;3 Suppl 7:27-35. Observational-Dx 430 patients To investigate the role of MRI in patients with otovestibular and cranial nerve complaints of unknown aetiology. The detection rate for essential lesions was 4.9%. Two groups of retrocochlear lesions were frequently observed: central WMLs/atrophy and neurovascular conflict affecting a cranial nerve. 4
62. Kang HM, Kim MG, Hong SM, Lee HY, Kim TH, Yeo SG. Comparison of temporal bone fractures in children and adults. Acta Otolaryngol. 2013;133(5):469-474. Observational-Dx 32 children and 186 adults To investigate differences in temporal bone fractures in adults and children by examining the manifestations and clinical symptoms of temporal bone fractures in pediatric patients. Causes of fracture, gender distribution, manifestations of temporal bone fracture, and clinical symptoms were similar in adults and children (p > 0.05 each). Petrous fracture, ear fullness, dizziness, and tinnitus were significantly more frequent in adults than in children (p < 0.05 each). 4
63. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: Review/Other-Dx N/A Guidance document on exposure of patients to ionizing radiation. No results stated in abstract. 4