Jugular bulb dehiscence

Dehiscent jugular bulbs are present when the sigmoid plate between a high riding jugular bulb and the middle ear is absent, allowing the wall of the jugular bulb to bulge into the middle ear cavity.

Epidemiology

The estimated incidence is ~5% (range 3.5-7%) of the symptomatic population (e.g. those with tinnitus) .

Clinical presentation

It is one of the causes of pulsatile tinnitus and is a common cause of a retrotympanic vascular mass.

Patients can present with conductive hearing loss. This may occur when the jugular bulb contacts the tympanic membrane, interferes with the ossicular chain, or obstructs the round window .

Radiographic features

• given the often turbulent flow within the jugular bulb, the signal on MRI can be confusing
• the presence of the sigmoid plate can only be ascertained on CT

Differential diagnosis

• high riding jugular bulb: intact sigmoid plate
• glomus jugulare / tympanicojugulare paragangliomas: adjacent destructive bone changes

Practical points

Clearly, if it is mistaken for a middle ear tumor and biopsied, then the consequences can be disastrous (as is biopsying an aberrant internal carotid artery).

Siehe auch:

• Cavum tympani
• Bulbus-venae-jugularis-Hochstand
• aberrante Arteria carotis interna
• sigmoid plate
• pulssynchrones Ohrgeräusch
• jugular diverticulum
• jugular schwannoma
• jugular foramen meningioma
• Protrusion des Bulbus jugularis in das Tympanon

und weiter:

• jugular foramen
• Glomus jugulare Tumor
• retrotympanic vascular masses
• Bulbus superior venae jugularis internae