原因不明搏動性耳鳴患者之椎基底動脈研究

The Study of Vertebral-Basilar Artery in Patients with Idiopathic Pulsatile Tinnitus

搏動性耳鳴臨床上並不多見，若其頻率與心跳同步時，有可能是腫瘤性或血管性的病灶，然而，大多數患者原因不明，有可能是椎基底動脈的結構異常所致。回溯2008年至2010年間，作者共遇到9名患者（男／女：4/5），平均年齡51.7 歲，兩側病症者1名，右側5名，左側3名，在以磁振造影排除器質性的病灶後診斷均為原因不明，特回溯這些患者在飛行時間效應血管造影下之椎基底動脈系統之狀況，並以另外18 名診斷為偏頭痛性眩暈患者為對照。搏動性耳鳴患者有較對照組為高的機會合併基底動脈扭曲（77.8％，7 of 9）或椎動脈發育不全（66.7％，6 of 9）。在單側性搏動性耳鳴合併基底動脈扭曲患者（n=6）中，病症傾向異於基底動脈偏向側（費歇恰當檢定，p=0.4，α=0.5）。此外，在單側性搏動性耳鳴患者（n=8）中，病症傾向同於優勢顱內椎動脈側（費歇恰當檢定，p=0.179，α=0.5）。所有患者均採取藥物保守治療，包括血壓控制（n=3）、降低血阻（n=7）、症狀治療（n=5）、血脂控制（n=2）或血糖控制（n=1）等複合療法，在治療1週～2 個月後病症緩解消失，爾後追蹤1～2.5 年，病症並未復發。因此，椎基底動脈的結構變異有可能會促成搏動性耳鳴，本文限於個案數，未來尚需更多的研究與探討。

Pulsatile tinnitus (PT) is clinically unusual and is attributable to a neoplasm or a vascular lesion if its frequency is the same as the heartbeat. However, most PT is of unknown etiology, and may be ascribed to a vertebral-basilar arterial variation. Between 2009 and 2010, nine patients (man/woman: 4/5) with an average age of 51.7 years were retrospectively enrolled. Of them, one patient suffered bilateral PT; five patients, right PT; and three patients, left PT. They were identified idiopathic after magnetic resonance imaging has excluded an organic lesion. We reviewed their time-of-flight angiogram of vertebral-basilar arteries, and recruited another 18 subjects diagnosed with migrainous vertigo as a control group. As a result, the nine PT sufferers had a higher percentage to have a tortuous basilar artery (77.8%, 7 of 9) or a hypoplastic vertebral artery (66.7%, 6 of 9) than the control group. Among the sufferers suffering unilateral PT and having a tortuous basilar artery (n=6), the PT side is prone to be opposite to the basilar arterial deviation (Fisher’s exact test, p=0.4, a=0.5); in addition, among the sufferers suffering unilateral PT (n=8), the PT side is prone to specific to the predominant intracranial vertebral artery (Fisher’s exact test, p=0.179, a=0.5). All our nine patients were treated with a conservative compound strategy, including blood pressure control (n=3), vascular resistance reduction (n=7), empirically symptomatic control (n=5), blood lipid control (n=2) or blood sugar control (n=1). PT subsided after one week to two months. The following 1 to 2.5 years were uneventful. Therefore, vertebral-basilar arterial variation may contribute to PT. Because the case number was limited in the article, we hope a further study with a larger case number in the future.