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Year : 2019  |  Volume : 22  |  Issue : 10  |  Page : 1430-1434

Is there any association between jugular venous reflux and nonpulsatile subjective tinnitus? A preliminary study of four-dimensional magnetic resonance angiography

1 Department of Medical Imaging, Vocational School of Health Sciences, Acibadem University, Istanbul, Turkey
2 Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
3 Department of Emergency Medicine, School of Medicine, Acibadem University, Istanbul, Turkey
4 Department of Biostatistics and Medical Informatics, School of Medicine, Halic University, Istanbul, Turkey
5 Department of Otorhinolaryngology, Acibadem Taksim Hospital, Istanbul, Turkey
6 Department of Radiology, Istanbul GATA Sultan Abdulhamid Han Hospital, Istanbul, Turkey
7 Private Practice Clinician, Istanbul, Turkey
8 Department of Radiology, School of Medicine, Trakya University, Edirne, Turkey

Correspondence Address:
Dr. D Temirbekov
Department of Otorhinolaryngology, Acibadem Taksim Hospital, Istanbul
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njcp.njcp_128_19

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Objective: To demonstrate whether there is an association between jugular venous reflux and nonpulsatile subjective tinnitus (NST) using real-time four-dimensional magnetic resonance imaging (MRI) angiography. Materials and Methods: Patients with unilateral NST who underwent contrast-enhanced MRI with a special protocol were included in the study. Thick slab dynamic maximum intensity projection images were obtained including interleaved stochastic trajectories (TWIST)-MRI examination. All patients were requested to perform Valsalva maneuver during the sequence. Jugular venous reflux grading was performed as follows: absence of reflux or if reflux does not reach the base of the skull: grade 0; if reflux reaches the jugular bulb, but no intracranial contrast is observed: grade 1; and if reflux extends into the intracranial cortical veins and/or the cavernous sinus above the jugular bulb: Grade 2. Results: A total number of 30 patients, 23 male and 7 female, were included in the study. Jugular venous reflux was not identified (Grade 0) in 20 patients. Grade 1 reflux was determined in 7 cases and Grade 2 reflux was observed in 3 cases. Notably, only patients with Grade 2 reflux described worsening of their tinnitus symptoms during the examination and their daily activities as well. Conclusions: NST might also be associated with hemodynamic problems of the venous system and the MRI protocol starting with TWIST accompanied with Valsalva maneuver is not well-known, yet seems to be a feasible and beneficial method to detect potential jugular venous reflux in NST patients.

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