Low-Frequency Air–Bone Gap and Pulsatile Tinnitus Due to a Dural Arteriovenous Fistula: Considerations upon Possible Pathomechanisms and Literature Review

IF 2.1 Q1 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY Audiology Research Pub Date : 2023-11-01 DOI:10.3390/audiolres13060073
Andrea Tozzi, Andrea Castellucci, Giuseppe Ferrulli, Salvatore Martellucci, Pasquale Malara, Cristina Brandolini, Enrico Armato, Angelo Ghidini
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Abstract

Low-frequency air–bone gap (ABG) associated with pulsatile tinnitus (PT) and normal impedance audiometry represents a common finding in patients with third window syndromes. Other inner disorders, including Meniere’s disease (MD), perilymphatic fistula and intralabyrinthine schwannoma, might sometimes result in a similar scenario. On the other hand, PT is frequently associated with dural arteriovenous fistula (DAVF), while conductive hearing loss (CHL) is extremely rare in this clinical setting. A 47-year-old patient was referred to our center with progressive left-sided PT alongside ipsilateral fullness and hearing loss. She also experienced headache and dizziness. Otoscopy and video-oculographic examination were unremarkable. Conversely, a detailed instrumental audio-vestibular assessment revealed low-frequency CHL with normal impedance audiometry, slight left-sided caloric weakness, slightly impaired vestibular-evoked myogenic potentials on the left and normal results on the video-head impulse test, consistent with an MD-like instrumental profile. Gadolinium-enhanced brain MRI revealed an early enhancement of the left transverse sinus, consistent with a left DAVF between the left occipital artery and the transverse sinus, which was then confirmed by angiography. A trans-arterial embolization with Onyx glue was performed, resulting in a complete recession of the symptoms. Post-operatively, the low-frequency ABG disappeared, supporting the possible role of venous intracranial hypertension and abnormal pressure of inner ear fluids in the onset of symptoms and offering new insights into the pathomechanism of inner ear CHL.
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硬脑膜动静脉瘘引起的低频气骨间隙和搏动性耳鸣:对可能的病理机制的考虑和文献综述
低频气骨间隙(ABG)与搏动性耳鸣(PT)和正常阻抗听力学相关,是第三窗综合征患者的常见发现。其他内部疾病,包括梅尼埃病(MD)、淋巴管周围瘘管和alabyrinthine内神经鞘瘤,有时也可能导致类似的情况。另一方面,PT常与硬脑膜动静脉瘘(DAVF)相关,而传导性听力损失(CHL)在临床上极为罕见。一名47岁的患者被转介到我们的中心,伴有进行性左侧PT伴同侧丰满和听力损失。她还感到头痛和头晕。耳镜及视像检查无明显差异。相反,详细的仪器听力-前庭评估显示低频CHL阻抗听力正常,左侧轻度热量无力,左侧前庭诱发的肌源性电位轻微受损,视频头脉冲测试结果正常,与md样仪器特征一致。钆增强脑MRI显示左横窦早期强化,符合左枕动脉和横窦之间的左DAVF,然后通过血管造影证实。经动脉栓塞用缟玛石胶进行,导致症状完全消退。术后低频ABG消失,支持静脉颅内高压和内耳液压异常可能在症状发生中的作用,为内耳CHL的病理机制提供了新的认识。
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来源期刊
Audiology Research
Audiology Research AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY-
CiteScore
2.30
自引率
23.50%
发文量
56
审稿时长
11 weeks
期刊介绍: The mission of Audiology Research is to publish contemporary, ethical, clinically relevant scientific researches related to the basic science and clinical aspects of the auditory and vestibular system and diseases of the ear that can be used by clinicians, scientists and specialists to improve understanding and treatment of patients with audiological and neurotological disorders.
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