Internal Jugular Vein Stenosis Causing Troublesome Pulsatile Tinnitus

[Wheella]

Dear Dr Nagler,

I have been experiencing high pitched humming with certain neck positions over the last 5 weeks. This arose immediately after a chiropractic neck adjustment. A neuro radiologist carried out a DSA on me and diagnosed me as having internal jugular vein stenosis. He tells me that bypass veins have formed around my ears to compensate for the stenosis, which is why I am hearing the troublesome pulsatile tinnitus.

My neuro radiologist further tells me that (1) stenting the internal jugular vein isn't advisable as the stent may crush after a few years, and (2) ballooning the vein may lead to restenosis and the need for repeat ballooning.

I however recall that you had successfully treated a patient of yours through dilation / ballooning?

May I please seek you views on how best to treat my condition, which is causing me tremendous distress. Thank you very much Dr Nagler.

 

[Dr. Nagler]

Hello @Wheella -

Thank you for your interesting question. I apologize for taking so long to respond.

There are three issues to be addressed:

(1) How bothersome is the tinnitus? You say that it is causing you tremendous distress, but knowing that the cause does not represent a threat to your health can, in time, go a long way towards relieving that distress. So, since it has only been five weeks, there is no harm in taking a "wait and see" approach to things. In fact, your tinnitus just might resolve on its own!

(2) The next issue has to do with the fact that just because you have internal jugular vein stenosis and development of dilated venous channels, that does not mean that any of it is related to the chiropractic neck adjustment, nor for that matter does it mean that it is causing your tinnitus. For all you know you have had it (the stenosis and dilated vascular channels) for years! So there are some tests that can be done to determine the relationship (if any) between what the DSA shows and your tinnitus. In my patient's case, the tests determined that the tinnitus (more properly termed a "somatsound") was indeed due to the stenosis. [My patient's stenosis was the result of her being hit directly high in the neck by a sharp line drive while playing fast-pitch softball; she was the pitcher some 40 feet away from home plate at the time she was struck.] Moreover, my patient had extraordinary distress from her somatosound, which was so loud that her husband could readily hear it while lying in bed next to her! I am attaching a .wav file. You can hear exactly what she was hearing in the recording from her left ear that starts at around the 18 second mark. We cured my patient by balloon dilation. She had traveled some 1000 miles to my clinic, and she told me she considers the cost of her airline ticket to be the single best investment of her life!

(3) And the third issue has to do with the fact that dilation with or without stenting carries with it some risk that must be taking into account in view of (1) above.

Each of these three issues must be weighed against the other, and this is a conversation much more suited to a doctor's office than to an Internet forum such as this. Moreover, there are a number of technical factors to be taken into consideration with the procedure itself. If your doctor wishes to contact me off the board, I would be happy to discus them with him or her in detail.

Hope this helps.

All the bast with it.

Stephen M. Nagler, M.D.