Osseus Adhesion between High Riding Jugular Bulb and the Ossicles

Tianbo Ren M.D.Ajay Malhotra M.D.

Yale University School of Medicine

Control Number: 1948Abstract Number: EP-96

DisclosuresNone of the authors have any conflicts of interest

Purpose

Introduction Aberrant jugular bulb is a common incidental finding

on temporal bone CT studies Cases of aberrant jugular bulb has been associated

with hearing loss, as well as vestibular canal dehiscence

We seek to evaluate whether there is also an association with osseus adhesion between the aberrant jugular bulb and the ossicles, and whether this may contribute toward hearing loss

Aberrant Jugular Bulb Also known as “high riding jugular bulb” Occurs more often on right side Have been associated with:

Hearing Loss Vertigo Tinnitus Intra-op bleeding

High riding RIGHT jugular bulb bulging into the middle ear cavity

Upper margin of a normal LEFT jugular bulb

Vestibular Aqueduct Dehiscence Vestibular aqueduct dehiscence (VAD) in the presence

of aberrant jugular bulb (AJB) have been seen in patients suffering hearing loss

Kupfer et. al. Otolaryngol Head Neck Surg, 2012 VAD/AJB seen in 8.3% of patients with hearing loss VAD/AJB seen in 7.1% of patients without hearing loss

Hourani et. al. J Comput Assist Tomogr, 2005 11.5% of patients had both AJB and VAD 47.8% of these patients had hearing loss

However, neither study showed a significant correlation between VAD/AJB and hearing loss

Ossicle Adhesion

In the presence of aberrant jugular bulb, osseus adhesion has been observed between the high riding jugular bulb and the ossicular chain

Can such osseus adhesion within the middle ear cavity be associated with hearing loss?

Materials & Methods

Study Design Retrospective analysis on patients who underwent high

resolution head CT or temporal bone CT at Yale New Haven Hospital, and whose reports mentioned the jugular bulb

2 readers evaluated each case to determine whether there is presence of vestibular aqueduct dehiscence and/or osseus adhesion between the jugular bulb and the ossicles

For those patients who exhibit osseus adhesion, their electronic medical record charts were evaluated to determine if they suffer from hearing loss

Study Subjects• Total starting patients: 70• Total excluded patients: 17

• 14 subjects did not have aberrant jugular bulbs• 3 subjects’ ossicles were eroded/not visualized

• Total number of subjects evaluated: 53• Subject sex and age breakdown:

Age Group Male Female

0-15 8 4

16-30 3 5

31-45 5 7

46-60 4 10

>60 2 5

Total 22 31

Results

Results 53 subjects all exhibit aberrant jugular bulb

16/53 (30.2%) exhibited vestibular aqueduct dehiscence

3/53 (5.7%) exhibited osseus adhesion between the jugular bulb and ossicles

1 of the 3 patients with osseus adhesion has a history of conductive hearing loss

Example of Osseus Adhesion

Malleus

Aberrant jugular bulb

Osseus Adhesion

Conclusions

Discussion 3 out of 53 subjects evaluated in this study exhibited

concomitant aberrant jugular bulb and osseus adhesion between the jugular bulb and ossicles, with 1 of the 3 subjects affected by hearing loss.

These findings suggest an additional possible mechanism for the development of hearing loss in patients who have aberrant jugular bulbs.

Incidence of osseus adhesion (3/53) seem lower than that of vestibular aqueduct dehiscence (16/53). As no large scale studies have been performed to evaluate osseus adhesion, further study using a larger sample size may prove beneficial.

References• Chennupati SK, Reddy NP, O’Reilly RC. High-riding jugular bulb presenting as conductive hearing loss. International Journal of

Pediatric Otorhinolaryngology Extra.6(4):235-237.

• Friedmann DR, Le BT, Pramanik BK, Lalwani AK. Clinical spectrum of patients with erosion of the inner ear by jugular bulb abnormalities. The Laryngoscope. 2010;120(2):365-372.

• Hourani R, Carey J, Yousem DM. Dehiscence of the Jugular Bulb and Vestibular Aqueduct: Findings on 200 Consecutive Temporal Bone Computed Tomography Scans. Journal of Computer Assisted Tomography. 2005;29(5):657-662.

• Kupfer RA, Hoesli RC, Green GE, Thorne MC. The relationship between jugular bulb-vestibular aqueduct dehiscence and hearing loss in pediatric patients. Otolaryngol Head Neck Surg 2012;146(3):473-477.

• Saito T, K. L, H. S. High jugular bulb adhering to the eardrum. Annals of otology, rhinology & laryngology. 06 1999;108(6):620-622.

• Weiss RL, G. Z, E. G, H. P, J. SM. High jugular bulb and conductive hearing loss. The Laryngoscope. 03 1997;107(3):321-327.

Contact Information

Tianbo Ren M.D.

tianbo.ren@yale.edu

Yale University School of Medicine333 Cedar Street (Room CB-30)PO Box 208042New Haven, CT 06520-8042