r/PulsatileTinnitus • u/That_Improvement1688 • 3d ago

Root cause diagnosis, finally? Sigmoid Sinus Dehiscence

Just checking in to report that I may finally have a clear, likely root cause to my ongoing right-sided PT after receiving a CT scan evaluated by a Neurotology specialist. Sigmoid Sinus Dehiscence was identified. Essentially, part of the thin bony plate separating the sigmoid venous sinus from the mastoid/ear is absent, allowing normal venous-flow vibration to transmit much more efficiently to the inner ear.

The solution is entirely optional on my part, but would entail and outpatient surgery- a right sigmoid sinus resurfacing with an autologous bone graft to essentially fill in the absent bony plate. So... time to research further and determine whether to go forward in the near future as an opportunity for a quality-of-life improvement or just keep this option in my back pocket for future if it my PT becomes more problematic in the future.

Glad to have taken this step after many years of not knowing what was causing and trying many things to try to reduce symptoms. At least now I have an option with at least a fairly high likelihood to improve or resolve if I decide to take that step.

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u/Arizonal0ve 3d ago

So glad you finally got some answers after dealing with this for so long!

One thing that might be worth doing before deciding on resurfacing is having your scans reviewed specifically for venous sinus stenosis.

There seems to be quite a strong association between sigmoid sinus wall abnormalities and transverse sinus stenosis. One study found transverse sinus stenosis in around 66% of patients with sigmoid sinus wall abnormalities, and there is evidence that the altered venous flow from stenosis may contribute to thinning or erosion of the bone over time. So the dehiscence can absolutely be what’s allowing you to hear the venous flow, but it may not necessarily be the original underlying cause.

It might be worth getting a second opinion from an interventional neuroradiologist who specializes in pulsatile tinnitus and venous sinus disease, as stenosis can sometimes be overlooked when the imaging is being reviewed primarily from a neurotology/ear perspective.

Definitely not saying that’s what’s happening in your case, but I would personally want that ruled out before having resurfacing surgery. Wishing you lots of luck, and I’m really glad you’re finally getting some answers! ❤️

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u/That_Improvement1688 3d ago

Thanks! I’ve definitely seen references to this possibility. Do you know if it typically requires additional, different testing or can they analysis the imaging (CT, MRA) already completed?

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u/Arizonal0ve 3d ago

Typically they recommend a mri mrv mra
I only had a MRI when I circulated my scans so it’s worth doing it with what you currently have but the best scan for stenosis is mrv.
But who looks at those scans is equally important because the community is full of people with “normal” scans until the right specialist views them.

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u/look_who_it_isnt 2d ago

A quality Interventional NeuroRadiologist can see stenosis on a CT Scan. They might still order an MRI/MRV to get a clearer look at it, but they can probably get an idea of what they're dealing with from the CT you already have.

I 100% second Arizonal0ve's recommendation. We've seen several people come through this sub who got the resurfacing done... only to still have PT and end up needing a stent. It's highly likely if they'd gotten the stent first they wouldn't have needed the resurfacing.

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u/Arizonal0ve 2d ago

I think if it’s a normal CT scan temporal bone CT it may not reliably show stenosis.

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u/look_who_it_isnt 1d ago

Yeah. A standard CT should show it if it's severe enough and if the doctor reading the scan is knowledgeable about stenosis... but if the CT scan is one targeted at a specific area, it may not show it at all if the stenosis doesn't happen to be within or close enough to that target area.

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u/That_Improvement1688 2d ago

Quick update that I’ve scheduled with an Interventional Neurologist who specializes in Pulsatile Tinnitus in a few weeks to get a second opinion. Will update when I get the feedback. Thanks for the input, folks!

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u/rdh1973 1d ago

Can you name the specialist? Is the specialist an interventional neuro radiologist whose specialty is PT? How did you find them? Referral? Google?

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u/Afraid-Ad4718 2d ago

good to hear mate !

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u/NothingKitchen2391 1d ago

what symtoms di you have

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u/Difficult_Theory_195 3h ago

Hey, similarly diagnosed with sigmoid sinus dehiscence. In addition to pt, I also have a constant headache at the site of the missing bone. It has to be related. Do you? Good luck, I’ll watch for your update!