Download Navigating the Inner Ear: A Pictorial Essay of Inner

Control Number: 1948
Abstract Number: EP-96
Tianbo Ren M.D.
Ajay Malhotra M.D.
Yale University School of Medicine
None of the authors have any conflicts of interest
 Aberrant jugular bulb is a common incidental finding
on temporal bone CT studies
 Cases of aberrant jugular bulb has been associated
with hearing loss, as well as vestibular canal
dehiscence
 We seek to evaluate whether there is also an
association with osseus adhesion between the
aberrant jugular bulb and the ossicles, and whether
this may contribute toward hearing loss
 Also known as “high riding jugular bulb”
 Occurs more often on right side
 Have been associated with:
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Hearing Loss
Vertigo
Tinnitus
Intra-op bleeding
High riding RIGHT
jugular bulb bulging into
the middle ear cavity
Upper margin of a
normal LEFT jugular bulb
 Vestibular aqueduct dehiscence (VAD) in the presence
of aberrant jugular bulb (AJB) have been seen in
patients suffering hearing loss
 Kupfer et. al. Otolaryngol Head Neck Surg, 2012
 VAD/AJB seen in 8.3% of patients with hearing loss
 VAD/AJB seen in 7.1% of patients without hearing loss
 Hourani et. al. J Comput Assist Tomogr, 2005
 11.5% of patients had both AJB and VAD
 47.8% of these patients had hearing loss
 However, neither study showed a significant
correlation between VAD/AJB and hearing loss
 In the presence of aberrant jugular bulb, osseus
adhesion has been observed between the high riding
jugular bulb and the ossicular chain
 Can such osseus adhesion within the middle ear cavity
be associated with hearing loss?
 Retrospective analysis on patients who underwent high
resolution head CT or temporal bone CT at Yale New Haven
Hospital, and whose reports mentioned the jugular bulb
 2 readers evaluated each case to determine whether there is
presence of vestibular aqueduct dehiscence and/or osseus
adhesion between the jugular bulb and the ossicles
 For those patients who exhibit osseus adhesion, their electronic
medical record charts were evaluated to determine if they suffer
from hearing loss
• Total starting patients: 70
• Total excluded patients: 17
•
•
14 subjects did not have aberrant jugular bulbs
3 subjects’ ossicles were eroded/not visualized
• Total number of subjects evaluated: 53
• Subject sex and age breakdown:
Age Group
Male
Female
0-15
8
4
16-30
3
5
31-45
5
7
46-60
4
10
>60
2
5
Total
22
31
 53 subjects all exhibit aberrant jugular bulb
 16/53 (30.2%) exhibited vestibular aqueduct
dehiscence
 3/53 (5.7%) exhibited osseus adhesion between the
jugular bulb and ossicles
 1 of the 3 patients with osseus adhesion has a history
of conductive hearing loss
Osseus Adhesion
Malleus
Aberrant jugular bulb
 3 out of 53 subjects evaluated in this study exhibited
concomitant aberrant jugular bulb and osseus adhesion
between the jugular bulb and ossicles, with 1 of the 3 subjects
affected by hearing loss.
 These findings suggest an additional possible mechanism for the
development of hearing loss in patients who have aberrant
jugular bulbs.
 Incidence of osseus adhesion (3/53) seem lower than that of
vestibular aqueduct dehiscence (16/53). As no large scale
studies have been performed to evaluate osseus adhesion,
further study using a larger sample size may prove beneficial.
•
Chennupati SK, Reddy NP, O’Reilly RC. High-riding jugular bulb presenting as conductive hearing loss. International Journal of
Pediatric Otorhinolaryngology Extra.6(4):235-237.
•
Friedmann DR, Le BT, Pramanik BK, Lalwani AK. Clinical spectrum of patients with erosion of the inner ear by jugular bulb
abnormalities. The Laryngoscope. 2010;120(2):365-372.
•
Hourani R, Carey J, Yousem DM. Dehiscence of the Jugular Bulb and Vestibular Aqueduct: Findings on 200 Consecutive
Temporal Bone Computed Tomography Scans. Journal of Computer Assisted Tomography. 2005;29(5):657-662.
•
Kupfer RA, Hoesli RC, Green GE, Thorne MC. The relationship between jugular bulb-vestibular aqueduct dehiscence and
hearing loss in pediatric patients. Otolaryngol Head Neck Surg 2012;146(3):473-477.
•
Saito T, K. L, H. S. High jugular bulb adhering to the eardrum. Annals of otology, rhinology & laryngology. 06 1999;108(6):620622.
•
Weiss RL, G. Z, E. G, H. P, J. SM. High jugular bulb and conductive hearing loss. The Laryngoscope. 03 1997;107(3):321-327.
Tianbo Ren M.D.

[email protected]

Yale University School of Medicine
333 Cedar Street (Room CB-30)
PO Box 208042
New Haven, CT 06520-8042