Effects of traditional Chinese medicine on symptoms of patients with spleen and stomach deficiency-related tinnitus

BACKGROUND Tinnitus affects 10%-30%of the population.Recent evidence suggests that tinnitus is associated with spleen deficiency.However,compared with kidney deficiency-related tinnitus,less research has been conducted on the impact of spleen defi-ciency-related tinnitus.AIM To investigate the clinical efficacy of using Guipi Wan and dietary and lifestyle modification based on traditional Chinese medicine for treatment of patients with spleen and stomach deficiency-related tinnitus.METHODS We enrolled 110 patients with spleen and stomach deficiency-related tinnitus who were distributed into treatment(58 cases)and control(52 cases)groups.Tinnitus severity,sleep quality and emotional state were assessed by questionnaires[Tinnitus Evaluation Questionnaire(TEQ);Pittsburgh Sleep Quality Index(PSQI);Depression-Anxiety-Stress Scale-21(DASS-21)]that were used for analysis in the two groups during the initial and intervention and after.In the treatment group,patients were treated with oral administration of Guipi Wan and consulted for healthy dietary and lifestyle modification.In the control group,patients were only assessed and not treated.RESULTS At the end of the 6-months,TEQ scores decreased significantly in the treatment group(P=0.021)but not in the Control group.Significant effects in the treatment group were noted for PSQI total score(P=0.043)and several PSQI component scores in the treatment group(P<0.05).After treatment,the DASS-21 scores were significantly reduced in the treatment group(P<0.05).CONCLUSION Guipi Wan combined with dietary and lifestyle modification based on regulating the spleen and stomach can be considered core to the treatment of tinnitus related to spleen and stomach deficiency.

Cognitive Behavioral Therapy for Tinnitus in Adults: A Review of Efficacy in Quality-of-Life Enhancement

Background: Tinnitus, characterized by the perception of sounds without an external source, significantly affects quality of life. Cognitive Behavioral Therapy (CBT) has emerged as a promising approach for managing tinnitus-related distress and enhancing psychological well-being. Objectives: This review aims to analyze the effectiveness of CBT in tinnitus management, focusing on alleviating distress, enhancing coping mechanisms, and improving overall well-being. Methods: PubMed and World of Science databases were systematically searched using keywords related to tinnitus, CBT, and quality of life. English, peer-reviewed studies focusing on adult populations were included. Studies involving pediatric populations or not meeting inclusion criteria were excluded. Data extraction was performed using PRISMA guidelines, with a narrative synthesis approach for analysis. Methodological quality and risk of bias were assessed using appropriate tools. The search engine initially identified 155 studies that met the inclusion criteria for the systematic review. However, upon further evaluation, 140 of these studies were excluded due to their non-randomized design. Of the remaining 15 studies, 11 were found to be partially accessible but ultimately excluded from the review as they did not meet the full accessibility criteria. Therefore, only four studies remained in the review, deemed suitable for inclusion based on their randomized design and full accessibility. Results: Studies by Beukes et al. [1]-[3] and Simoes et al. [4] evaluated CBT’s effectiveness. With internet-based CBT, Beukes et al. demonstrated reductions in tinnitus distress, negative cognitions, and comorbidities. Simoes et al. proposed combination treatments for tinnitus management. The review outcome suggests that CBT is an effective treatment for tinnitus, as it can help reduce tinnitus distress and improve quality of life. However, limitations in sample sizes and follow-up durations highlight the need for further research to establish CBT’s long-term efficacy and optimal parameters. Integrating internet-based CBT into comprehensive care strategies can enhance the well-being of individuals affected by tinnitus.

Analysis of Etiology,Diagnosis,and Treatment Strategy and Efficacy of Pulsatile Tinnitus Caused by Abnormal Vascular Anatomy

Objective To investigate the etiology,clinical characteristics,diagnosis,and treatment strategies and efficacy of pulsatile tinnitus(PT)caused by vascular anatomy abnormality.Methods The clinical data of 45 patients with PT in our hospital from 2012 to 2019 were collected and retrospectively analyzed.Results All 45 patients had vascular anatomical abnormalities.The patients were divided into 10 categories according to the different locations of vascular abnormalities:sigmoid sinus diverticulum(SSD),sigmoid sinus wall dehiscence(SSWD),SSWD with high jugular bulb,pure dilated mastoid emissary vein,aberrant internal carotid artery(ICA)in the middle ear,transverse-sigmoid sinus(TSS)transition stenosis,TSS transition stenosis with SSD,persistent occipital sinus stenosis,petrous segment stenosis of ICA,and dural arteriovenous fistula.All patients complained of PT synchronous with heartbeat rhythm.Endovascular interventional therapy and extravascular open surgery were used according to the location of the vascular lesions.Tinnitus disappeared in 41 patients,was significantly relieved in 3 patients,and was unchanged in 1 patient postoperatively.Except for one patient with transient headache postoperatively,no obvious complications occurred.Conclusion PT caused by vascular anatomy abnormalities can be identified by detailed medical history and physical and imaging examination.PT can be relieved or even completely alleviated after appropriate surgical treatments.

Evaluation of chronic idiopathic tinnitus and its psychosocial triggers

BACKGROUND The tinnitus susceptibility patterns in relation to different psychological and life stressors are unknown in different cultures.AIM To determine the comorbid psychosocial factors and behaviors associated with tinnitus and the predictors for the increase in its severity.METHODS Participants were 230 adults(males=70;females=160;mean age=38.6±3.3).They underwent audiograms,speech discrimination and masking testing,and neuropsychiatric evaluation.Measures used for assessment included tinnitus handicap inventory,depression anxiety stress scale 21(DASS-21),perceived stress scale(PSS),and insomnia severity index(ISI).RESULTS Patients had mean duration of tinnitus of 11.5±2.5 mo.They had intact hearing perception at 250-8000 Hz and 95(41.3%)had aggravation of tinnitus loudness by masking noise.Decompensated tinnitus was reported in 77%(n=177).The majority had clinically significant insomnia(81.3%),somatic symptoms(75%)other than tinnitus and perceived moderate(46.1%)and high(44.3%)stress to tinnitus.The severe/extremely severe symptoms of depression,anxiety and stress were reported in 17.4%,35.7%and 44.3%,respectively.Patients with decompensated type had significantly higher scores for ISI(P=0.001)and DASS-21(depression=0.02,anxiety=0.01,stress=0.001)compared to those with compensated tinnitus.Psychiatric interviewing showed that 35.7%had non-specific anxiety disorder,17.4%had major depression,and 19.6%fulfilled the criteria of somatization disorder.Multivariate analysis showed that the only independent predictors for tinnitus severity were the duration of tinnitus[odd ratios(OR)=0.832,95%CI:0.640-1.158;P=0.001]and PSS(OR=0.835,95%CI:0.540-1.125;P=0.001)scores.CONCLUSION To the best of our knowledge,this is the first study in our culture to evaluate the causal relationship between psychological factors and tinnitus onset,severity and persistence.Tinnitus could be the earliest and dominant somatic symptom induced by life stressors and psychological vulnerabilities.Therefore,multidisciplinary consultation(psychologists,psychiatrists,and neurologists)is important to acknowledge among the audiologists and otolaryngologists who primarily consult patients.

Surgical treatment of pulsatile tinnitus related to the sigmoid sinus

Objective: Tinnitus-a common clinical symptom-can be categorized into pulsatile tinnitus(PT) and non-PT. Among these, PT is usually associated with sigmoid sinus symptoms, such as sigmoid sinus wall defect or diverticulum, for which various surgical treatments are available. We have discussed the clinical efficacy of surgery for sigmoid sinus-associated PT via the transmastoid approach in this study.Methods: We conducted a retrospective review of 4 patients who underwent surgery for sigmoid sinusassociated PT via the transmastoid approach at Nanjing Drum Tower Hospital from January to December2020. Of these, 2 patients had sigmoid sinus wall defect and 2 had sigmoid sinus diverticulum. Postoperative tinnitus grading and surgical efficacy were determined.Results: After surgery, PT dissolved in 3 patients, while tinnitus significantly decreased in 1 patient.During the follow-up period of 12-18 months, none of the 4 patients showed complications related to increased intracranial pressure or venous sinus thrombosis, and tinnitus symptoms disappeared in 3patients without recurrence, although 1 patient occasionally developed tinnitus. Postoperative thin-slice CTA of the temporal bone indicated that the sigmoid sinus bone wall defect or diverticulum was completely repaired with a thick soft tissue coverage.Conclusion: Surgical repair of sigmoid sinus-associated PT via the transmastoid approach deserves clinical promotion as it exhibited better efficiency while being relatively less invasive.

Hearing loss and tinnitus associated with COVID-19 vaccines:An analysis from the national pharmacovigilance database in Malaysia

Objective:To compare the reporting pattern of hearing loss and tinnitus across different vaccines brands used in Malaysia(BNT162b2,CoronaVac,ChAdOx1,Ad5.CoV2-S and BBIBP-CorV).Methods:This retrospective study included all reports of hearing loss and tinnitus occurring after COVID-19 vaccination that were received in the national pharmacovigilance database,QUEST,from February 24,2021 through July 31,2022.Reports given causality consistent or indeterminate were included.Results:There were 21 cases of hearing loss,with overall reporting rate of 0.29 cases per million doses.The rate was similar across BNT162b2,CoronaVac and ChAdOx1.For tinnitus,35 cases were reported,with the overall reporting rate of 0.49 cases per million doses,and the highest rate was reported for ChAdOx1.For both events,most cases aged 30 to 49 years.No gender disparity was observed.Both events were mainly reported to have occurred after the primary doses,with a median time-to-onset of two days.There were no statistically significant differences in the reporting patterns for both events across BNT162b2,CoronaVac and ChAdOx1 by age group,gender,race,and dose number.Conclusions:Despite the low reporting rates and insufficient evidence to confirm its relationship,hearing loss and tinnitus following vaccinations should not be ignored due to its disabling potential and impact on one’s quality of life.Continual reporting is encouraged for better signal characterization in the future.

Tinnitus characteristics and associated variables on Tinnitus Handicap Inventory among a Hungarian population

Background:Tinnitus is a sound precepted without an external sound stimulus.Its background can be categorised into primary and secondary cases.The secondary cases include pathologies of the external,middle and inner ear.Tinnitus can be objective or subjective;the latter can only identified by the sufferer.Previous research results have shown that tinnitus significantly affects the quality of life and daily functioning.Objectives:To analyse the impact of tinnitus on the daily functioning and the possible influence of demographical data and tinnitus duration on it.Methods:630 patients(265 males and 365 females,25e85 years of age)suffering from primary tinnitus were enrolled.In the Hungarian language,these patients completed the Tinnitus Handicap Inventory(THI)questionnaire and underwent a complete otorhinolaryngological examination.IBM SPSS V24 software was used for data processing;correlation tests,the Mann-Whitney U and Kruskal-Wallis nonparametric tests were used.Results:According to the THI questionnaires outcomes,most patients(62.5%)were presented with a mild handicap.Based on statistical analysis,no significant correlation was observed between the total THI points and the age of the patients,along with the duration and localisation of the symptoms.However,the total THI scores of male and female patients significantly differed,indicating higher THI values in the female group(p=0.00052*).Conclusions:The tinnitus severity was not affected by the duration,localisation of the symptoms and age but by gender,indicating higher values in the case of females.

Role of cerebral digital subtraction angiography in the evaluation of pulse synchronous tinnitus

Objectives: The aim of this study was to evaluate the value of digital subtraction angiography (DSA) in thediagnostic evaluation of a highly selected patient population presenting with pulse-synchronous tinnitus(PST).Methods: We retrospectively reviewed the charts of all patients referred for evaluation of possiblevascular etiology of pulsatile tinnitus. Patients were evaluated with regards to presenting signs,comorbidities, non-invasive imaging results, angiographic findings and outcomes.Results: Fifteen patients underwent cerebral DSA. Dural arteriovenous fistula (dAVF) was identified in sixpatients, and five patients had other significant vascular pathology identified on DSA. Seven patientswith ‘negative’ non-invasive imaging were found to have significant pathology on DSA.Conclusions: Catheter angiography may have a significant yield in appropriately selected patients presenting with pulse synchronous tinnitus.

Neural metabolic activity in idiopathic tinnitus patients after repetitive transcranial magnetic stimulation

BACKGROUND The central mechanism of idiopathic tinnitus is related to hyperactivity of cortical and subcortical auditory and non-auditory areas.Repetitive transcranial magnetic stimulation(rTMS)is a well-tolerated,non-invasive potential treatment option for tinnitus.AIM To investigate the changes of neural metabolic activity after rTMS in chronic idiopathic tinnitus(IT)patients.ME THODS Eleven patients underwent rTMS(1 Hz,90%motor threshold,1000 stimuli/day for consecutive 10 d)on the left temporoparietal region cortex.Tinnitus handicap inventory(THI)and visual analogue score(VAS)were assessed at baseline and posttreatment.All patients underwent 18 F-fluorodeoxyglucose(FDG)positron emission tomography to evaluate the neural metabolic activity.Data were preprocessed using statistical parametric mapping and Gretna software to extract the regions of interest(ROls).The correlation between brain areas involved and THI scores was analyzed.RESULTS Baseline and posttreatment parameters showed no significant difference regarding THI score(t=1.019,P=0.342>0.05)and VAS(t=0.00,P=1.0>0.05).Regions with the highest FDG uptake were the right inferior temporal gyrus(ITG),right parahippocampa gyrus(PHG),right hippocampus,rectus gyrus,left middle frontal gyrus,and right inferior frontal gyrus in IT patients.After rTMS treatment,IT patients showed increased activities in the right PHG,right superior temporal gyrus,right superior frontal gyrus,anterior insula,left inferior parietal lobule,and left precentral gyrus,and decreased activities in the left postcentral gyrus and left ITG.The ROIs in the right parahippocampa gyrus and right superior frontal gyrus were positively correlated with THI scores(r=0.737,P=0.037<0.05;r=0.735,P=0.038<0.05).CONCLUSION Our study showed that 1-Hz rTMS directed to the left temporo-parietal junction resulted no statistically significant symptom alleviation.After treatment,brain areas of the limbic and prefrontal system showed high neutral metabolic activity The auditory and non-auditory systems together will be the target for rTMS treatment.

Subjective tinnitus: lesion-induced pathological central homeostasis remodeling

Subjective tinnitus is the most common type of tinnitus, which is the manifestation of pathologicalactivities in the brain. It happens in a substantial portion of the general population and brings significantburden to the society. Severe subjective tinnitus can lead to depression and insomnia and severely affectspatients’ quality of life. However, due to poor understanding of its etiology and pathogenesis, treatmentof subjective tinnitus remains challenging. In recent decades, a growing number of studies have shownthat subjective tinnitus is related to lesion-induced neural plasticity of auditory and non-auditory centralsystems. This article reviews cellular mechanisms of neural plasticity in subjective tinnitus to providefurther understanding of its pathogenesis.

Influence of Acupuncture on Autonomic Balance in Adult Tinnitus Patients:An Exploratory Study

Acupuncture is an alternative therapy for tinnitus in clinical practice.The mechanism by which acupuncture can alleviate tinnitus is still unknown.Autonomic nervous system was reported to be responsible for tinnitus.The aim of this study was to explore the effect of acupuncture on autonomic balance in adult tinnitus patients.Thirty patients were randomly assigned into either the deep acupuncture(DA)group or the shallow acupuncture(SA)group.Each patient received 6 acupuncture sessions(a-f phase)over three weeks.Measures of heart rate variability and Tinnitus Handicap Inventory(THI)were obtained at baseline and after the sixth acupuncture session in all patients.The results showed that the low frequency/high frequency(LF/HF)pattern was increased at b-f phase until the sixth acupuncture session when compared with that at the first acupuncture session in DA group.However,it continuously increased at b-f phase in SA group even at the sixth acupuncture session,which was not significantly different from that at the first acupuncture session.The decrease in THI in DA group was greater than that in SA group after 3-week treatment(P=0.043).Our preliminary study suggests three-week deep acupuncture can improve tinnitus symptoms in adult tinnitus patients,which may be related to the regulation of autonomic nervous system balance.

Deep Brain Stimulation──A new treatment for tinnitus

Intractable tinnitus can lead to serious consequences. Study evidence indicates that the central nervous system is involved in generation and maintenance of chronic tinnitus and that tinnitus and other neurologic symptoms such as chronic pain may share similar mechanisms. Brain ablation and stimulation are used to treat chronic pain with success. Recent studies showed that ablation and stimulation in non-auditory areas resulted in tinnitus improvement. Deep brain stimulation (DBS) may be an alternative treatment for intractable tinnitus and deserves further study.

Regional homogeneity on resting state fMRI in patients with tinnitus

Objective:To study central functional network connections and their alterations in tinnitus patients using fMRI.Methods:Regional homogeneity(ReHo) values on fMRI were obtained from 18 tinnitus patients and 20 age and gender-matched control subjects.ReHo values were compared between tinnitus patients and control subjects to evaluate functional network connection differences.Results:Tinnitus patients showed increased ReHo values in gyrus frontalis inferior and decreased ReHo values in the anterior lobe of cerebellum in comparison with the controls.Analysis of functional network connection from the gyrus frontalis interior shows stronger connections to the middle brain(FWE,P < 0.001) and right ventral striatum(FEW,P < 0.05,small volume correction).Conclusions:The fMRI results indicate that both auditory and non-auditory centers play important roles in tinnitus.Functional connections among the auditory cortex,thalamus,medial temporal gyrus,parahippocampal gyrus and insula may be an underlying cause for the development of tinnitus.

SUBJECTIVE TINNITUS AS FIRST PRESENTATION IN A PATIENT WITH METASTATIC LUNG CANCER IN TEMPORAL BONE-A CASE REPORT

Metastasis of lung cancer to the temporal bone is a very rare disease and subjective tinnitus as the present-ing symptom in these patients is even rarer. Here we report a case in which a 42-year-old male presented with subjective tinnitus of three months, with no pulmonary disease symptoms. Pure tone audiometry indi-cated moderate conductive deafness in left ear with an air-bone gap of 21.3 dB. HRCT temporal bone scan-ning indicated high-density shadows in the left epitympanic cavity, sinus tympani and mastoid cavity. Chron-ic otitis media with cholesteatoma was suspected and surgical treatment recommended. However, preopera-tive chest x-ray revealed high-density millet lesions scattered widely in both lungs. HRCT lung scanning confirmed the lungs lesions and indicated lung cancer. In order to determine correlations between the tempo-ral bone and pulmonary lesions, a CT-guided trans-mastoid aspiration biopsy and immunohistochemical study were conducted, which confirmed that the temporal bone lesion was metastatic from the lungs. The pa-tient was given a series of chemotherapy immediately and his tinnitus significantly improved after three months of treatment, with full recovery of his hearing and complete resolution of shadows in the mastoid cavity. Unfortunately, he subsequently developed multiple bone metastases in the 9th month and cerebral metastasis in the 18th month. Multiple organ failure resulted in death in 2.5 years.

Bone remodeling in sigmoid sinus diverticulum after stenting for transverse sinus stenosis in pulsatile tinnitus: A case report

BACKGROUND Pulsatile tinnitus(PT)is a potentially disabling symptom that has received increasing attention.Multiple causes of PT have been confirmed by targeted treatment.However,dynamic changes of related structures in PT patients with multiple causes after stenting for ipsilateral transverse sinus stenosis(TSS)have not been previously reported.We report such a case and present postoperative computed tomography venography(CTV)follow-up findings to demonstrate the decreased sigmoid sinus diverticulum and bone remodeling.CASE SUMMARY A 45-year-old man suffered from left-sided PT for 15 years that was occasionally accompanied by headache and dizziness.Pre-operative CTV revealed left-sided sigmoid sinus wall anomalies(SSWAs),TSS,outflow dominance,large posterior condylar emissary vein,and an empty sella turcica.A cerebrospinal fluid pressure of 270 mmH2O was further detected.The sound disappeared immediately after stenting for ipsilateral TSS,with no recurrence during 2 years of follow-up.After the procedure,the patient underwent four consecutive CTV examinations.The diverticulum decreased 6 mo after the procedure with new bone remodeling.The density of the remodeled bone was further increased 1 year later,and a hardened edge was formed 2 years later.CONCLUSION PT associated with SSWAs,TSS,and idiopathic intracranial hypertension can be cured by stenting for TSS alone.And bone remodeling around SSWAs is a more significant finding.

Gain adjustment at tinnitus pitch to manage both tinnitus and speech perception in noise

To investigate how much gain variation is required from prescription to effect tinnitus percept,and if this revised prescription affects speech recognition.Twenty participants who experienced catastrophic tinnitus even after fitted with hearing aid were included.Participants were grouped based on their tinnitus pitch and the prescriptive formula used to fit hearing aid.They were evaluated for handicap from tinnitus using Tinnitus Handicap Inventory(THI).Hearing aid was programmed using either NAL-NL2 or DSL(I/o)v5 prescriptive formula and gain at tinnitus pitch was adjusted till the tinnitus get suppressed.SNR 50 was determined soon after fitted with hearing aid and 30 days of hearing aid use.Further,THI and international outcome inventory for hearing aid(IOI-HA)were determined after 30 days of hearing aid use.A significant higher gain adjustment was needed at tinnitus pitch to reduce tinnitus precept using NAL-NL2 than DSL(I/o)v5 prescriptive formula.Further,SNR 50 was not affected by either tinnitus pitch or revised prescription formulas.However,SNR 50 improved after 30 days of hearing aid use.A 76% of the participants’experienced habituation to perception after 30 days of hearing aid use,10% had slight,10% had mild,and 4% had a moderate degree of tinnitus on THI.On IOA-HA,96%(N=19)of participants have reported satisfactory,and 4%(N=1)reported moderate benefit from hearing aid.Irrespective of prescriptive formula adjusting gain at tinnitus pitch is an efficient method to reduce tinnitus symptoms and improve speech perception.

An Integrated Physical Regulation Theory and Classification of Acute Tinnitus

Tinnitus,acute or chronic,is one of the most common and refractory disorders.Acute tinnitus is a symptom that is a warning sign when compared with chronic tinnitus.Although hearing loss initiates acute tinnitus,the relationship between hearing loss and tinnitus is far from straightforward.Other factors beyond the auditory system may play important roles in the occurrence of acute tinnitus.To address this issue,we propose an integrated regulation theory of the possible physical causes of acute tinnitus,and summarize a classification system for acute tinnitus based on this regulation theory to help guide clinical treatment.

Acoustic trauma-induced auditory cortex enhancement and tinnitus

There is growing evidence suggests that noise-induced cochlear damage may lead to hyperexcitability in the central auditory system(CAS)which may give rise to tinnitus.However,the correlation between the onset of the neurophysiological changes in the CAS and the onset of tinnitus has not been well studied.To investigate this relationship,chronic electrodes were implanted into the auditory cortex(AC) and sound evoked activities were measured from awake rats before and after noise exposure.The auditory brainstem response(ABR) was used to assess the degree of noise-induced hearing loss.Tinnitus was evaluated by measuring gap-induced prepulse inhibition(gap-PPI).Rats were exposed monaurally to a high-intensity narrowband noise centered at 12 kHz at a level of 120 dB SPL for 1 h.After the noise exposure,all the rats developed either permanent(>2 weeks) or temporary(<3 days) hearing loss in the exposed ear(s).The AC amplitudes increased significantly 4 h after the noise exposure.Most of the exposed rats also showed decreased gap-PPI.The post-exposure AC enhancement showed a positive correlation with the amount of hearing loss.The onset of tinnitus-like behavior was happened after the onset of AC enhancement.

Tinnitus and hyperacusis in children: clinic reports and basic research

Objective Tinnitus and hyperacusis are subjective symptoms which can be reponeu tJy p^t, lJ ： age. Although tinnitus and hyperacusis can have a negative effect on child development, these symptoms are commonly overlooked by their parents and clinicians. In this paper, we review clinical reports on tinnitus and hyperacusis in children and basic scientific studies on these disorders in order to provide updates of these disorders in the pediatric population. Recent studies have found that tinnitus and hyperacusis are not uncommon in children, especially in those with conductive and sensorineural hearing loss. The parents and clinicians should pay attention when children show abnormal behaviors and especially when they develop hearing loss. Since there is no objective measurement for tinnitus and hyperacusis, the diagnosis in children can be challenging. Tinnitus and hyperacusis are also common in Williams syndrome and autism but the mechanisms are still not clear. High doses of salicylate and noise exposure can in- duce tinnitus. Animal studies have determined lack of inhibition in the auditory cortex and the inferior colliculus may be critical for tinnitus and hyperacusis generation. The non-classic auditory system may also be involved in the aware- ness and tolerance of tinnitus and hyperacusis.

Diploic vein as a newly treatable cause of pulsatile tinnitus: A case report

BACKGROUND Pulsatile tinnitus(PT)is an annoying sound that can be eliminated with targeted treatment of the cause.However,the causes of PT have not been fully elucidated.CASE SUMMARY A 38-year-old woman with right-sided objective PT underwent preoperative computed tomography arteriography and venography(CTA/V).A 3.8 mm vine diploic vein(DV),which passed through the mastoid air cells posteriorly in a dehiscent canal and was continuous with the transverse-sigmoid sinus,was thought to be the causative finding.Four-dimensional flow magnetic resonance(4D flow MR)imaging showed that the blood in the DV flowed toward the transverse-sigmoid sinus.The closer the blood was to the transverse-sigmoid sinus,the higher the velocity.No vortex or turbulence was found in the DV or adjacent transverse sinus.The sound was eliminated immediately after ligation of the DV with no recurrence during a three-month follow-up.No flow signal of the DV was noted on postoperative 4D flow MR.CONCLUSION A DV may be a treatable cause of PT.CTA/V and 4D flow MR could be utilized to determine the morphological and hemodynamic characteristics of the DV.