A novel approach for surgical repair of dehiscent high jugular bulb.

INTRODUCTION The jugular bulb is found at the junction of the horizontal segment of the sigmoid sinus and the superior end of the internal jugular vein. A high jugular bulb (HJB) may extend into the middle ear cavity lateral to the cochlea. The superior threshold of HJB varies according to various authors. The limits include the inferior bony annulus, the lower border of the round window, and the upper limit of the basal turn of the cochlea. A dehiscent high jugular bulb (DHJB) occurs when a high jugular bulb lacks a bony covering within the middle ear. The incidence of HJB and DHJB has been reported as 3.5% to 22.6% and 0.5% to 1.7% percent, respectively. DHJB may initially manifest with profuse hemorrhage during myringotomy or middle ear surgery. When a DHJB impinges on tympanic structures, such as the tympanic membrane (TM), ossicles, or round window, patients may experience conductive hearing loss (CHL), aural fullness, or pulsatile tinnitus. Sensorineural hearing loss has also been described as a consequence of DHJB and is thought to occur from protrusion of the jugular bulb through the round window. In general, conservative management has been favored over surgical intervention. The pathophysiology of symptoms and operative complications of DHJB have been attributed to its close proximity with the TM. Where surgical intervention has been tried, the focus has been on control or manipulation of the jugular bulb. We describe a novel technique whereby symptoms were relieved through lateralization of the inferior TM without repositioning of the jugular bulb.