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Niger J Clin Pract. 2019 Oct;22(10):1430-1434. doi: 10.4103/njcp.njcp_128_19.

Is there any association between jugular venous reflux and nonpulsatile subjective tinnitus? A preliminary study of four-dimensional magnetic resonance angiography.

Author information

1
Department of Medical Imaging, Vocational School of Health Sciences, Acibadem University, Istanbul, Turkey.
2
Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
3
Department of Emergency Medicine, School of Medicine, Acibadem University, Istanbul, Turkey.
4
Department of Biostatistics and Medical Informatics, School of Medicine, Halic University, Istanbul, Turkey.
5
Department of Otorhinolaryngology, Acibadem Taksim Hospital, Istanbul, Turkey.
6
Department of Radiology, Istanbul GATA Sultan Abdulhamid Han Hospital, Istanbul, Turkey.
7
Private Practice Clinician, Istanbul, Turkey.
8
Department of Radiology, School of Medicine, Trakya University, Edirne, Turkey.

Abstract

Objective:

To demonstrate whether there is an association between jugular venous reflux and nonpulsatile subjective tinnitus (NST) using real-time four-dimensional magnetic resonance imaging (MRI) angiography.

Materials and Methods:

Patients with unilateral NST who underwent contrast-enhanced MRI with a special protocol were included in the study. Thick slab dynamic maximum intensity projection images were obtained including interleaved stochastic trajectories (TWIST)-MRI examination. All patients were requested to perform Valsalva maneuver during the sequence. Jugular venous reflux grading was performed as follows: absence of reflux or if reflux does not reach the base of the skull: grade 0; if reflux reaches the jugular bulb, but no intracranial contrast is observed: grade 1; and if reflux extends into the intracranial cortical veins and/or the cavernous sinus above the jugular bulb: Grade 2.

Results:

A total number of 30 patients, 23 male and 7 female, were included in the study. Jugular venous reflux was not identified (Grade 0) in 20 patients. Grade 1 reflux was determined in 7 cases and Grade 2 reflux was observed in 3 cases. Notably, only patients with Grade 2 reflux described worsening of their tinnitus symptoms during the examination and their daily activities as well.

Conclusions:

NST might also be associated with hemodynamic problems of the venous system and the MRI protocol starting with TWIST accompanied with Valsalva maneuver is not well-known, yet seems to be a feasible and beneficial method to detect potential jugular venous reflux in NST patients.

KEYWORDS:

Four-dimensional magnetic resonance-angiography; TWIST; Valsalva maneuver; magnetic resonance imaging; tinnitus; venous reflux

PMID:
31607735
DOI:
10.4103/njcp.njcp_128_19

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