Complications from Jugular Bulb Diverticulum Stenting and Coiling

I’ve had pulsatile tinnitus for several years (right-sided). I underwent a stenting procedure in October 2023 for my Venous Sinus Stenosis. This did not cure my pulsatile tinnitus, but I did not have complications. My interventional neuroradiologist found a jugular bulb diverticulum and another enlargement near the jugular bulb. I was stented and had two coils placed in this on May 1st.

I went home on May 2nd. I was fine, although my ICU stay was miserable, and I ended up having a very bad panic attack. I had a sore throat, which I expected due to the breathing tube. However, on May 3rd, I woke up having difficulty swallowing and speaking—my voice sounded slurred. I thought it was odd but again attributed it to the breathing tube. However, by May 6th, it had not improved; I had been choking on even soft foods, still had slurred speech, and was even getting water up my nose when I drank. I contacted my surgeon and was told to go to the ER.

At the ER, they were very alarmed after hearing about my surgery and symptoms. They were concerned I’d either had a stroke, nerve damage, or a brain bleed/hematoma. I had a neuro exam and a CT angiogram of my head and neck. Everything was normal, but after the ER doctor discussed things with my surgeon, they decided I needed to be transferred back to the hospital where my surgeon works via ambulance and be admitted overnight for observation and further testing. When I heard this, I had another very bad panic attack. My ICU stay was so unpleasant, and I did not want to stay overnight in the hospital again. Even after being given anti-anxiety meds/sedatives, I was still inconsolable and refused to go to the hospital, ultimately checking myself out of the ER against medical advice. Not very smart, of course, but I have had severe anxiety my whole life, and it is always very overpowering.

The following day, I called my surgeon, and he prescribed me a round of steroids. This helped my symptoms a tiny bit, but not enough; I was still choking on food, and my voice was no longer slurred but was instead very hoarse and weak. So, he prescribed me another round (12 days of steroids total). This brought more improvement, and my voice became stronger, and I was able to eat more than just soft food. But as the month went on, I was still having symptoms and still getting water up my nose. Sometimes the water would fully drip out of my nostrils.

I was referred to a laryngologist and had that appointment three days ago. I had a long scope with a camera threaded up my nose and down into my throat, where I was instructed to make various sounds and say various sentences while holding a microphone to my throat. This way, they were able to visualize my voice box and palate. My doctor reviewed the video recorded with the scope and had me watch it with her (gross). She paused the video and explained what she saw. Ultimately, I was diagnosed with four issues. I have mild paresis in part of the palate of my mouth, preventing it from making a full seal, which allows water to go up my nose. Additionally, my right vocal cord is almost fully paralyzed.

Unfortunately, she believes this is a complication from my surgery. There are nerves that control speech and swallowing near the jugular. I have also had right-sided shoulder weakness and difficulty raising that arm, which she said is related to another nerve near the jugular. She said it’s possible it is still inflammation from the surgery that is compressing these nerves. I have a few options moving forward: I can wait until my two-month follow-up with her to reassess for any improvements, or I can do speech and physical therapy, as well as get filler in my palate and have my right vocal cord “nudged.” I’m opting to wait for now to see if it is just inflammation and if my symptoms continue to improve. I’m also waiting for my surgeon to discuss things with the specialist and reach out to me to see how we should proceed going forward.

This whole ordeal has been very scary and overwhelming. It seems like I just can never catch a break between my mental health struggles and my medical issues, especially with my normal tinnitus and pulsatile tinnitus. I hope things continue to improve, and I will have no permanent damage.

I’m writing this so those with pulsatile tinnitus are aware that these procedures do not come without risk, although they are very rare. Jugular stenting is also more intense than stenting for venous sinus stenosis.