拍動性耳鳴を主訴とした頸動脈海綿静脈洞瘻の1症例

A Case of Carotid-Cavernous Fistula（CCF）Complaining of Pulsating Tinnitus

I．はじめに

　日常の診療における耳鳴はそのほとんどが自覚的耳鳴であり，その治療に難渋する場合が多い^1）。しかし，音源が聴取できる他覚的耳鳴では適切な治療法により改善し得るのもある^1）。

　今回われわれは，拍動性耳鳴を主訴とする症例に対して脳血管造影を行い，音源を同定し血管内手術によって耳鳴が消失した1例を経験したので報告する。

　A patient presented with carotid-cavernous fistula（CCF）who complained of pulsating tinnitus,vertigo,and conjunctival injection.

　The vascular murmur was audible through an otoscope,synchronous with the heartbeats. Contrast-enhanced computed tomography（CT）of the head revealed enhancement of the right superior ocular vein. Cerebral angiography suggested CCF.

　Intravascular surgery was performed and a platinum coil was placed in the cavernous sinus. After treatment,conjunctival injection improved and pulsating tinnitus and vertigo disappeared.

　In the differential diagnosis of unilateral pulsating tinnitus,CCF should be considered. Examinations with contrast-enhanced CT and MRA of the head are less invasive and useful. However,cerebral angiography is essential for definitive diagnosis and identification of these vascular lesions.