An unknown type of tinnitus induced by valsalva: Practical diagnosis with 4D- MR-Angiography.

Post-processing software enjoys a wide sphere of use thanks to advances in technology, and the fact that central venous insufficiency may be associated with tinnitus has been revealed using MRI. Our aim in this study was to use a relatively easier and shorter MRI method (4D-MRAngiography) to reveal whether or not there is an association between tinnitus and jugular venous reflux by adding the valsalva maneuver to technique. Thirty patients with unilateral tinnitus and undergoing contrast enhanced MRI with a special protocol were included in the study. Thick slab dynamic maximum intensity' projection (MIP) images were obtained following short imaging with TWIST-MRA lasting a total of 90-110 sec. Reflux degree was graded (as grade 0, 1, 2) on MIP images obtained during valsalva maneuver. In all cases no dural arteriovenous fistula was defined. Jugular venous reflux was not identified (grade 0) in 20 cases. Grade 1 reflux was determined on the right in five of the remaining cases and on the left in two. Reflux past the base of the skull and reaching the cortical veins and cavernous sinuses was determined during TWIST-MRA in three cases exhibiting a significant increase in tinnitus severity with valsava in their clinical histories. This study reveals a relation between jugular venous reflux and tinnitus using an objective, non-operator dependent modality. In our opinion, determination of this etiology will have a positive impact on the entire diagnosis-treatment- follow-up algorithm in cases of refractory tinnitus resistant to other treatments and induced with valsava. [ABSTRACT FROM AUTHOR]