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Selective embolization of the mastoid emissary vein for pulsatile tinnitus treatment: when is it indicated?
  1. Michael Eliezer1,
  2. Rafael Kiyuze Freitas2,
  3. Matteo Fantoni1,
  4. Alexis Guedon1,
  5. Emmanuel Houdart1
  1. 1 Neuroradiology Unit, Lariboisière University Hospital, Paris, France
  2. 2 Division of Interventional Neuroradiology, Department of Radiology, Hematology, and Oncology, Medical School of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
  1. Correspondence to Dr Michael Eliezer, Neuroradiology Unit, Lariboisière University Hospital, Paris 75010, France; mcheliezer{at}


Background Venous pulsatile tinnitus (PT) can be caused by the perception of blood flow through the mastoid emissary vein (MEV). However, the causal relationship of this anomaly has not been established as selective occlusion of this vein has never been performed. The aim of this study was to report on a small series of patients suspected of having PT caused by an MEV, who underwent MEV embolization as treatment for PT, and to identify the correct indications for this procedure.

Methods This was a single center retrospective study (CNIL 2215065) including six patients with isolated disabling PT treated by embolization of the MEV, recruited between December 2017 and August 2019. Patient charts were systematically reviewed. All patients underwent non-contrast temporal bone CT and MRI.

Results Mean age of the patients (five women, one male) was 56.3 years (range 40–71 years). Two patients presented with venous PT and four had neutral PT. The MEV was in direct contact with the mastoid air cells on temporal bone CT in all patients. Based on clinical examination, two patients presented with venous PT while four patients had neutral PT. In all cases of venous PT, selective embolization of the MEV caused the tinnitus to disappear, suggesting technical success. In contrast, embolization of the MEV had no effect in patients with neutral PT.

Conclusions We demonstrated that MEV could be a source of venous PT. Embolization of the MEV was effective only in cases of clinical venous PT.

  • temporal bone
  • CT
  • angiography

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  • Contributors ME performed the data collection, analyzed the data, and drafted the paper. RKF wrote the statistical analysis plan, analyzed the data, and drafted the paper. MF monitored the date collection. AG designed the data collection tools. EH designed the data collection tools and monitored the data collection.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was obtained (CNIL 2215065).

  • Provenance and peer review Not commissioned; externally peer reviewed.