A 66-year-old woman presented with right-sided hearing loss, insidious in onset. Otoscopic examination showed pulsation of the tympanic membrane in a seated position (Video 1) which diminished on lying down. A CT venogram of the auditory canal showed a dehiscent right jugular bulb along the hypotympanic surface (Figures 1 and 2). A dehiscent jugular bulb develops because of the absence of sigmoid plate separating the bulb from the middle ear. It appears as blue mass behind the tympanic membrane which may distend with Valsalva or internal jugular vein compression. Affected individuals, while often asymptomatic, can experience conductive/sensorineural hearing loss, tinnitus, or vestibular dysfunction.1 The patient is followed with imaging periodically for disease progression. Over 10 years, her hearing has been stable. Neurologists should be familiar with the otoscopic appearance of auditory canal dehiscence as tinnitus, and vestibular dysfunction is a common presentation. Treatment involves reassurance and follow-up with serial imaging. Surgical or endovascular intervention is reserved for intolerable symptoms.2
Video 1
Otoscopic examination of the auditory canal showing a pulsatile tympanic membrane.Download Supplementary Video 1 via http://dx.doi.org/10.1212/012469_Video_1
Study Funding
The authors report no targeted funding.
Disclosure
W.T. Siddiqui reports no disclosures relevant to the manuscript. M. Byrne reports no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Appendix Authors
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Teaching slides links.lww.com/WNL/B464
- © 2021 American Academy of Neurology
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
