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tinnitus is prevalent in Paget’s disease (61%) but
PT is also recognized.
30
On CT the appearance
may mimic a severe case of pericochlear and
fenestral otospongiosis but the bony changes
usually extend beyond the otic capsule
(
Fig. 12
).
Venous tinnitus
Venous tinnitus may be due to IIH or venous
anomalies and variations.
Idiopathic intracranial hypertension
Idiopathic intracranial hypertension (IIH) is a disease
of undefined pathophysiology associated with PT,
although it more commonly presents with headache,
Figure 13
A middle-aged woman was referred with an
asymmetric hearing loss, balance disturbance, head-
ache, and right-sided PT. Volume-rendered image from
a CT venogram study demonstrates bilateral severe ste-
noses of the transverse sinuses (arrowheads), typical of
that seen in idiopathic intracranial hypertension.
Figure 14
A 36-year-old woman with PT developed
raised intracranial pressure for which she was treated
by serial lumbar punctures and diuretics. CT showed
a low-density mass in the right jugular foramen (which
enhanced peripherally and extended subcranially on
MRI studies). This was felt to represent a vagal schwan-
noma resulting in venous outflow obstruction and sec-
ondary intracranial hypertension.
Figure 15
(a) Contrast-enhanced CT study in a patient
with venous tinnitus, shows dominant right-sided venous
drainage, a laterally deviated right sigmoid sinus, with
small sigmoid and jugular diverticulae, and a dehiscent
jugular bulb (confirmed on bone windows). (b) A 12-
year-old child presented with right-sided hearing loss
and PT. A ‘‘blue drum’’ was explored and found to rep-
resent a middle ear filled by his only jugular bulb. Fron-
tal maximum intensity projection of an MRV study
demonstrates markedly right-sided dominant venous
drainage with a high-riding jugular bulb.
G. Madani, S.E.J. Connor
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