Surgical treatment of the high jugular bulb in patients with Meniere's disease and pulsatile tinnitus

The aim of this retrospective study was to evaluate the functional results of surgical lowering of the high jugular bulb in the treatment of patients with Meniere's disease and pulsatile tinnitus. Fifteen patients with disabl ing Meniere's disease associated with pulsatile tinnitus and a high and med ial jugular bulb were included in this study. As treatment a complete masto idectomy was performed, after which the jugular bulb was freed by an infral abyrinthine and subfacial approach. The bulb was then displaced downwards w ith surgical wax. Functional results of surgery were assessed by a question naire according to the 1995 guidelines of the United States American Academ y Committee on Hearing and Equilibrium, audiometric and vestibular tests, a nd by magnetic resonance and computed tomographic imaging with vascular seq uences. Surgical treatment was contraindicated in two cases: one had hypopl asia of the contralateral sigmoid sinus and the other a small petrous heman gioma located around the jugular bulb that was discovered peroperatively. A mong the 13 patients treated by definitive surgery, attacks of vertigo were reported as disabling in 12 cases preoperatively (92%) versus 1 (8%) after surgical treatment, No significant change in hearing was observed after su rgery. Tinnitus had been reported in all patients preoperatively and decrea sed in intensity in four (31%) and disappeared in three (23%) after surgery .