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01.12.2014

Pulsatile tinnitus fluid in ear, fatigue dizziness nausea headache weakness - Test Out

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Inner ear disorders that increase hearing sensitivity (such as SCD) can cause pulsatile tinnitus. There are some very large blood vessels -- the carotid artery and the jugular vein -- that are very close to the inner ear (see diagram above). This is a congenital anomaly in which the internal carotid can present as a middle ear mass.
Arteriovenous fistulae cause loud noises, synchronous with the pulse, that can often be heard by others with a stethescope, or sometimes by simply putting one's ear next to the person's head. Benign tumors of glomus bodies can occur within the middle ear or at other sites: the temporal bone and neck, or within the jugular vein (the large vein in the upper neck which drains the head toward the heart). A CT demonstrates whether the bone in the lower portion of the middle ear connects to the jugular bulb.
Once the ear surgeon has determined the classification of glomus tumor, a careful evaluation of the x-ray results must be made in order to make certain there are no tumors associated with other blood vessels.
Many glomus tympanicum tumors can now be approached through the ear canal by elevating the eardrum and then destroying the tumor completely with an Argon or CO2 laser versus more radical surgeries performed in the past. Relatively large tumors of the middle ear can be approached by using the Argon or CO2 laser without opening the ear from behind. When a glomus tumor extends into the mastoid, it becomes necessary to make an incision behind the ear and open the mastoid bone.
If the glomus tumor continues to expand, it may invade the brain through the bone separating the middle ear and mastoid. Results of removal of glomus tumors of the middle ear and mastoid are extremely good in most cases, less so when the tumor has invaded the inner ear, facial nerve or brain. On our team, the ear surgeon performs the initial portions of the surgery isolating the facial nerve within the mastoid. DISCLAIMER: The Ear Surgery Information Center offers and maintains this web site to provide information of a general nature about the conditions requiring the services of an ear surgeon.


All other information contained within this web site is © 2015 Ear Surgery Information Center. Most patients with glomus tumors of the middle ear can hear a pulsing sound in the ear on the side which has the tumor. As the glomus tumor of the middle ear expands, it can grow into the mastoid itself or through the wall that divides the middle ear from the mastoid and deeply infiltrate the bone. However, in small glomus tumors of the middle ear, hearing can be quite normal and there may be no symptoms at all. It is necessary to differentiate between a glomus tumor limited to the middle ear, and a glomus tumor arising from the jugular vein. If the glomus tumor appears to be filling the lower half of the middle ear, it can be either a glomus tumor of the middle ear (limited to the middle ear), or a glomus jugulare which has eroded the bony covering of the jugular vein as it comes in touch with the lower portion of the middle ear space.
If there is a distinct bony covering of the jugular bulb and separation of the tumor from the carotid artery, the ear surgeon can inform the patient that the surgery will be limited primarily to the middle ear and not involve the blood vessels of the neck.
This is the exception in glomus tumors which arise from the middle ear and mastoid, but the usual situation in glomus jugular tumors.
The ear surgeon, the head and neck surgeon, and a neuroradiologist are all needed to remove glomus jugulare tumors. This portion of the procedure is extremely delicate and requires the close cooperation of the head and neck surgeon, ear surgeon and, in some cases, vascular and neurosurgeons. Monfared obtains a lumbar puncture or spinal tap in most patients with venous phase pulsatile tinnitus unless the diagnosis is made through an ophthalmologic examination or other causes are identified. Accordingly, other possibilities for vascular tinnitus include dehiscence (missing bone) of the jugular bulb -- an area in the skull which contains the jugular vein, and an aberrantly located carotid artery. It enters the skull through it's own foramen, courses through the medial part of the middle ear, and then rejoins the petrous ICA (Branstetter and Weissman, 2006).
Most glomus tumors are readily noted by a primary care physician’s routine examination of the ear.


The tumor itself is often identified on routine exam as being a red spot behind the eardrum.
If, however, there is erosion of the floor of the middle ear and jugular blub, CT scaning will provide the information. However, the larger, so-called glomus jugulare tumors, arising from the jugular vein, may be extremely vascular and are situated deep in the bone of the ear and neck. An enlarged jugular bulb on the involved side is common in persons with venous type pulsatile tinnitus. These baro receptors sense and help to regulate the oxygen pressure in the middle ear and mastoid. The size and extent of the glomus tumor of the middle ear can be well assessed by microscopic examination. In these cases, the canal wall separating the middle ear from the mastoid is generally removed when deeply invaded by tumor. The head and neck surgeon, ear surgeon and neurosurgeon, if necessary, perform a combined procedure which isolates the blood vessels in the neck. The eardrum may pulsate, if the glomus tumor is touching the under surface of the intact eardrum. Thus, the removal of the tumor from the middle ear, mastoid and neck can now be done in a single unit. In most cases, it is necessary to tie off or pack the jugular vein in the neck and the mastoid portion of the ear to prevent excessive bleeding at tumor removal.



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